0846 (RR)1 .
PERMIT APPLICATION
City oYLa Duinta
Department of Building and Safety
Z This permit, becomes void ifwork not commenced within 1x10 days from date of issuance, OR, If work has been suspended or abandoned fora period of 180 days.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am• licensed under provisions: of Chapter 9
.(commencing, with Section 70o0)At Division 3 of the Business and Professions Code; and my license is'Indull force
and effect.
License:Class Lic. Number
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt'from the Contractor's License Law for the
following reason (Sec. 7031.5. Business and Professions Cods:.Any.city or county wh'ich•requires•a permit to
construct„ after, improve; demolish, or repair anystructure, prior to•iis issuance, also requires the applicant for
such permit to file a signed statement that he is licensed pursuant to the provisions otthe Contractor's License Law
(Chapter 9 (commencingwith section 7000) of Division 3 of the Business;and.Prefessfons Code) or that he.is exempt
p, therefrom_and,the basis for the alleged exemption -Any violation of Section Mtfi byany applicant for a permit ..;I,
subjects the applicant to a civil penalty of not more than five hundred -dollars (5500:):
• O Las owner of the property, or my employees 'with wages,as their sole.compensation; will do the work, and the
structure is not intended or offered for sale (Sec. 7044r Business and Professions Code: The Contractor's License
Law does not apply to an owner of property who builds, or Improves thereon, and who does such work himself or
through his own employees, provided that such improvements are not Intended or offered for safe. If; however, the
building or improvemnt is sold within one year of completion, the owner -builder will have the burden of proving that
he did not build or improve -tor the"purpose of sale.).
❑ I„as owner ofdhe property, am excufsively contracting with licensed contractors to construct the project (Sec. -
7001, Business and Professions Code: The Contractor 's License Law does not apply to.an owner of property who
builds'.or improves thereon, and who contracts for such projects with a contractor(s).licensed pursuant to the
Contractor's License Law.).
❑ 1 am exempt under Sec. B. d P.C..(Attached Certificate)._ -
Date' d Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a -
certificate of Workers' Compensation Insurance , or certified copythereof'(Sec. 3800. Lab. C.).�
Policy No. Company
O Certilied.copy is hereby furnished.
•O Certified copy is filed,with the City Building Inspection Department or City Department.
Date Applicant
APPLICANT` &- (L. F. yl)
ADDRESS �.
Q -19 �Etil 1iu L .
GTY/C ITY/STAT"P
JOS SITE ADORESSISPACE
CITY/COWL)MITY/STATE/ZIRt�,
A
PRC
C
TWN
RHO .
ISE. -I
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TRACT
I LOT
TRACT NAME
OWNER .NAME '(L. F, I)��`�
CONTRACTOR -FIRM NAME
'.ADDRESS`i0
CITY/COMMUNITYLlTATE/ZIP
PHONE a
LICNC»
ARC/ENG FIRM NAME. -
ADDRESS .
CITYICOMMUNITY/STATE/ZIP
PHONE a
LICNC It
- TOTAL .'
FEE.
USE OF PERMIT'
SL.
ZON
FSS
SSS
Sas
RS13
OFC .
ZONE ORD a
LOT SZ
END DE .
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION, INSURANCE: This section need not be completed if - -
the permit'isJor one hundred ($100) or less. I certify that in the,performance of the work for which this permit is
Issued,1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of
California.
Date Applicant
_ NOTICE TO APPLICANT: II, after.making this Ceriificati of Exemption, you should become, subject to the;Workers'
;Conipenseticm provisions of ;the Labor -Code. , you must forthwith comply with such provisions or this permit shall
'be deemed revoked.
DIVISION Or:1NDUSTRIAL SAFETY PERMITCERTIFICATION:
lT l hereby Certify that no excavation five (5) or more feet in depth lnto,which a person is required to descend, Will be
made in connection with work authorized by this permit; and that no building structure; scaffolding; falsework, or.
demolition or dismantling thereof; will be more than thirty-six (36)feet hiptr.^(Chap 32, Grp Z Art 2, Sec341, Title 8,
'C.A.C.) -
l7 As owner -builder, I will,not employ anyone to do work which, would require a permit,from'thei Division of
.Industrial Safety, as noted above, unless such person has a permit to;do such'work from that division.
o Division of IndustrialSafety Permit "No.
Date Applicant
CONSTRUCTION LENDING AGENCY; I hereby affirm that therels'e construction lending agency for the performance'
of:the work for which this permit is issued (Sec. 3097, Civ: C.).
Lender's Address
I certify that l have read;this application and state that the above information is correct. I agree to comply with.all.
city, and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above;mentioned property for inspection purposes.
Signature of Applicantor Agent Date
CERTIFICATE OF CO1IPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read thisapplication and statethat.
_
he infocmatiort. ' En is cogtecCtagr_&Jo comply with all stale laws and county ordinances relating to buidling.
btnlstZtffo nd'aut orize25Ffied
e of the City of LaDuinta DepartmenUof Building and Safety to enter
upo art f whicforthis.permit for the purpose of meJking' inspections. l r q
J
/
Silfinj4061 Applicant gen Date
Ile Print Applh: ! Agent Nam
APPL/PRMT
- DATE •.
� •
(D�
�
a _
V E D
dul
I La
b
- TOTAL .'
FEE.
t'
�M YU LU
BLDG. DEPT.
VALUATION11, �'7-%_J .
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.
❑
NON ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE &LOCATION'
11 Exterior Lath
t2 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick Value
7A Walls (Batts)
128 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
P/L 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
„I State of
CALIFORNIA
County of LOS ANGELES
OFFICIAL SEAL
JACKIE J CAYDAM
m NOTARY PUBLIC - CALIFORNIA
LOS ANGELES COUNTY
My comm. expires DEC 27, 1985
GENERAL ACKNOWLEDGMENT FORM 7110052
On this the. 25thday of MAY 1984 before me,
Jackie:J. Caydam
the undersigned Notary Public, personally appeared
Jule T. Faulkner
EF'personally known tome
❑ proved tome on the basis of satisfactory evidence.
to be the person(t) whose name(s) is subscribed to the
within instrument, and acknowledged that he executed,it.
WITNESS my hand and official seal.
NATIONAL NOTARY
Ventura Blvd. - Woodland Hills, CA 91364
May 225, 1984
RECER VED
JUN 141984
My of La Q.uh-ita
PLANNING%BUILDING DEPARTMENT
City of La Quinta
La Quinta, CA 92253
Gentlemen:
S/ -v t9.
Jule T. Faulkner
600 Marie Avenue
Los Angeles., CA 90042
This is to authorize Mr. Rudy Perez, Manager of Tampico Apartments
on Eisenhower Drive.in La Quinta, Ca., to sign on my behalf for
permits to allow for the re -roofing of Tapi.co Apartments. Also
to sign on my behalf for construction of an adobe brick trash bin -
for use by the tenants of the apartments.
In as much as I reside in Los Angeles, I trust this letter will
be sufficient to allow Mr. Perez to proceed with these two projects.
Thank you for your consideration.
Yours very truly,
/.aWulkner