0481 (BLCK)APPLICANT NAME (L. F, MI). -• :e` ' • • - ......' -
Ed F=itke
ADDRESS ' ' •' _'
52-4.3 Avean a Villa '
PERMIT .APPLICATION ``• r a
City of La Ouinta
- Departmentlof
Building and Safety,
' - This permit becomes void•if work not commenced -within 180 days from date
of issuance: OR, if work has been suspended or abandoned for a period of 180 days. -
r
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
'"LICENSED CONTRACTORS DECLARATION: •1 hereby affirm that I am licensed under provisions 'of Chapter..9
s -•the permiCis for-one°hundred ($100).o, fessA cert-fy that in•the performance of the work for which this permit is
• (commencing with Section 7000) of Division 3 of the Business and Professions Code,:and my license'is in full force.
issued, I shall -not employ any persowin any manner so as to become subject to the Workers' Compensation Laws of
and effect. ,
'California.
License Class ♦ Lic. Number
Date a Applicant
Date Contractor
NOTICE TO APPLICANT: It, after making this Certs-icate of Exemption, you should become subject to the Workers'
• +' r:. - • e'•
OWNER -BUILDER DECLARATIONS I hereby alfirm tllatl am exempt fromthe Contractor's License Law for the
Compensation provisions of the Labor Code, you rust forthwith comply with such provisions or this permit shall r _
.� •
following reason (Sec. 7031.5. Business and Professions Code: Any -city or county. which- requires a permit to
be deemed revoked., -
' construct, alter; improve, demolish; or repair anystructure, priorto'its issuance, also requires the applicant for -
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:* s
such permit to file a sigged statement.that0 e is licensed pursuant to the provisions of the,Contractor's License Law.,b
I herebrj cerlifi that no e)Ccavation five (5) br mcre feet in depth into whicKa person is rbquifed to descend, will be
(Ch (commencing with section 7000) of Division 3 of the Business and Professions Code) or that he is exempt'
: •, =/ made in connection with work authorized by this iermit, and that no building'structure, scaffolding; lalsework, or
therefrom, and the basis forthe.alleged exemption.. Any violation of Section;7031'5 by any applicant,for a permit
•' demolition or dismantling thereof; will be more th..n thirty-six (36) feet high: (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8, •y
subjects the applicant to a civil penalty of not more than five hundred.dollars,(S500.):
C.A:C.) -
..0 I: as -owner of the property. or my employees with wages as their sole compensation, will do the work, and the.
O•As owher-builder, I- will ool'employ anyone b do work which would require -a permit Irorn'the Division of - .
structure is not intended. or offered for sale (Sec. 7044, -Business and Professions Code: The Contractor's License
Industrial Safety; as noted above, unless such'persoo has a' permit to do such work from that division. i
Law does not apply to an owner of property who builds: or improves thereon; and who does such work himself or-
rthrough
throughhis own employees, provided that such improvements are not intended or offered for sale. If, however the•
O Division, of Industrial Safety Permit No. „
building orimprovemntis'soldwithin one year ofcompletion, the owner -builder will have the burden of proving that
DateApplicant '
„ he did not build or improvefor the purpose of,sale.).
CONSTRUCTION *°°'
LENDING AGENCY: I hereby affirn that there -is a construction lending agency for the performance
- .O I, as owner of the property..am ezculsively contracting with licensed contractors lo.eonstruct the project(Sec:. •
• of the work for which this permit is issued (Sec 3097; Civ. C.):
I •7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
+f t
Lender's Name
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
w LOT SZ
Contractor's License Law.)..
Lender's Address
O 1 am exempt under Sec: " • ' "!,' ' B. &!P/.C. (Attached Certificate).
��li
I certify.that I have read this application and stat that the above information. is coaecC I agree to comply with all 's ;
and state laws relatirg to building construction; and hereby authorize
Date % ' ' Owner " � �°♦" .4 /� + ' �" �0. -
city and county ordinances representatives'
'
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of'this*county'to enter upon the above=mentioned property for inspection purposes. I
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell -insure; ora
• " .. ,
`"certificate of'Workers'.Co'mpensation Insurance., or -a certified copy thereof:(Sec..3800. Lab. C.).":..'
Signature of Applicant or Agent Date'
_Policy,No. Company
CERTIFICATE OF COMPLIANCE ANDAUTHORIZATON OF ENTRY':'I'cert'ity lhave read this application and*state that; '
` O Certified copy is hereby furnished. „
-the information given is'correct I agree to comp y with all state laws and county ordinances relating to buidling
' O•Certified copy is filed with the City Building Inspection Department or.City' 'Department.
construction, and authorize a'representative of :he City of La Ouinta Department of Building and Safety to enter .
,. ..
upon the property for which I have applied for Mis permit for -the purpose of making inspections. ,e
Date Applicant
Signature of Applicant or Agent Date
Print Applicant/Agent Name
¢
APPLICANT NAME (L. F, MI). -• :e` ' • • - ......' -
Ed F=itke
ADDRESS ' ' •' _'
52-4.3 Avean a Villa '
CITY/COMMUNITY/STATE/ZIP -
La Quinta, CA 92253:
JOB SITE ADDRESS/SPACE
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AS Above
CITY/COMMUNITY/STATE/ZIP - -
BOK
PAG
PRC
C,
-
TWN
RNG -
SE-. -
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TRACT - - -
LOT •
MOD
'SB
TRACT NAME -
OWNER NAME (L. F. Mn
CONTRACTOR -FIRM NAME - ,• ,�. . ,
ADDRESS -
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CITY/COMMUNITY/STATE/ZIP
PHONE N - �'
3231-7742
LICNC 1'
ARC/ENG FIRM NAME - - -
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE II
.LICNC N -
USE OF PERMIT - f
Block M.1-
Bl
ZON'
:., FSB
- + SSB
SSB
RSB
...
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ZONE ORO 0�..
w LOT SZ
.' END
SIDE"
:APPL/PRMT . DAT_•- ' ♦ FJl ^T :CJI�L-29-83' • Bl��... ..
Permit to construct 82 Lin. Pt. of . Block.
Carden Wall
4
T.
_®M.
ToTAL
FEE $"3'9 0-00
s. f t VALUATION ''$2050.00 to .
BLDG. DEPT.' '
NO.
OPERATION DATE INSPECTOR
NO.
OPERATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
/ (�%
34
Plenums &Ducts
2A
Slab Grade
35
Furnace Compart.
3
Steel
36 •
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
39
Appl. Clearance
7
Framing
40
Fire Damper
8
Vents
41
Smoke'Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P.L.
❑
43
Final
10A
fireplace T.O.
❑ 'UP
TN ADDITIONAL INFORMATION
NO.
r f
•
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
PSL P/1
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final