0422 (SFD)Print Applicant/Agent Name
APPLICANT NAME:(L. F. MI) . . •. . . - 4,_' * '. . . . . . I.. .
kilen corToratim
ADDRESS . . • I . ". . . I .. •• .,
P. 0. Bcx 780
PERMIT APPLICATION
JOB SITE ADO
77,;-147 ViaRESSISPACE Huerta
City of La Quinta
Department of Building and Safety
BOK"
PAG
This permit becomes void if work not commenced l within 180 days from date of
issuance, OR, if .work has been suspended or abandoned for a :)eriod:of 180 days;
/70
J2i6.95
T WN
PING
1 ERTIF16ATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be.1completed it
LICENSED' CONTRACTORS DECLARATION:.. I hereby affirm that I am licensed :under provisions of Chapter, 9
"the permit is.for one hundred ($100) o, less: I certify that in the performance of the work forwhich.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 person in anymannerso asm become;subject tothe Workers'Compensation Laws of
and effect.
California.
License Class Lic. Number
Date Applicant
Date Contractor
NOTICE -TO APPLICANT: If,, after making this, Certificate o Exemption... you should become subjec'to the Workers'
OWNER . -BUILDER•DECLARATI . ON: I h . ereby-affirm I . hat'l am exe`m'pI* iro' r�rjk�e Contractor's LLicense Law for -the
Compensation
nsation provisions of the Labor Code, you must forthwith comply with such provisions orchis permit shall•
following reason (Sic. 7031.5. Business and Professions Code: Any city or county which requires.a permit to
be'deemid revoked.
construct, alter, improve. demolish, or repair any structure, prior to its issuance, also requires the applicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATIO 4:,
such permit to file a signed.statement that he is licensed pu rsuan! to the provi.s ions of the Contractor's License.Law
0.1 herebycertify that no excavation fiv�e (5) ormorefeeti adepthinto which a person is required todescend,will be
(Chapter 9 (commencing with section -7000) of Division 3 of the Business and Professions.Code) or that he is exempt
I* made in connection with work authorized by thispermit, i nd that no building structure, scaffolding, falsework; or..
therefrom and. the. basis for the alleged exemption. Any violation, olation of -Section 7031,5 by any applicant fora permit .
'applicant
demolition or dismantling thereol;will be more than thirty, --six (36) feet, high. (Chao 31. Grp Z Art 2, Sec 34 1.,Title 8,
subjects the to a civil penalty of not more:thanjfive hundred dollars (i50O.):.
C.A.C.)
0.1. as owner of the property, or.my.employees with wages as their sole compensation, will do themork andthe
:0 As owns/ -builder, I �will not employ,;iinyone to do w..rk which would require a permit from 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 person h.as a permit to do such work,from that division.
Law does not apply to an owner'of property who builds, or improves thereon, add who does such work himself or:
. ' . , ... . . — . I ... . . 1 1. 1 - - . ..
through his own employees, provided that such improvements are not intended or offered for sale. It; however, thtink.
0 Division of Industrfjtl.Safe1y.PerTit.No.
building or imRrovemni is sold within oneyear of completion, the owner -builder will havethe burde.n.otproving that
_Date Applicant
he did not build or improve for the purpose of sale.)..
— �� I - - ' - - .. . I I - . ;1 .. . . . . 0. � I . "... ,
'CONSTRUCTION LENDING AGENCY, I hereby at firm that Were is a construction lending agencyfor the performance.-
0 1, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec:.
of the, work forwhich-this permit is issued (Sec. 3097, Civ. C.):
• 7044. Business and Professions Code: The Contractor's License Law.does not apply to an owner of -property who,
Lender's W'
builds or improves thereon, and who contracts.for such projects with a contractor(s) licensed.pursuant,to the
Contractor's License Law.).
Lender's Address
'0 1 am exempt under Sec. B: & P.C. (Altached,Certificate).
I certify (hat,l have read this application and state that If- above information is correct. I agree to comply with all
-',Date Owner—
city and county ordinances and state laws relating to.bui ding construction, and hereby authorize thorize representatives.
of this county to.enter upon the above-mentionedprope-ty for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure; or
'certificate of'Workers' Compensation Insurance , or,a certified.copy thereof (Sec. 3800. Lab. Cj:
Signature of Applicant or Ajeht- Date
,Policy No.— Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that'. -
�r
the.information given is correctJ agree to comply with JI,state laws and county ordinances relating to buidling
'representative
Ce o
Building Inspection, Dyartment �-ffy
I—/ I rlc—. t 121�
construction. and authorize a of. the Cityof La Ouinta Department of Building and Safety to enter
upon the'property for. which I have applied foi this permit for the,purp6se of making inspections.
Date Applicant
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPLICANT NAME:(L. F. MI) . . •. . . - 4,_' * '. . . . . . I.. .
kilen corToratim
ADDRESS . . • I . ". . . I .. •• .,
P. 0. Bcx 780
CITY/COMMUNITY/STATE/ZIP -
La Quinta,. CA 92253
JOB SITE ADO
77,;-147 ViaRESSISPACE Huerta
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
BOK"
PAG
PAC
C
/70
J2i6.95
T WN
PING
SE..,
S
TRACT
14496-2
LOT
16
Plwbinq Fee
3 1, .5 0 '7j.00
MOO
G-1
SB
TRACT NAME
Sw*a Fosse Cbw
OWNER NAME (L. F. MI)
CONTRACTOR -FIRM NAME
Sam AS AJXM
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE N —
5641315
LICNC a
333762
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE I!,
LICNC 0
gS1Eg1P6MIT
idth.Attached Garage
SL
'ZON
FSB-
sse
ssaAsa
'OFC
DATE
APPUPRMT n427,' 12-28-83. S/F/D .
Permit to =mtruct 2#758 Sq. Ft. of S/F/D
with Attached Garage
END
Mech��� 1p�p,
z 26:00
Plan. Cheak Fee
/70
J2i6.95
Canstructinn . Fee
;92,5 1 5io 603.00'
Fee
41,16
SMI Fee
- 8.93
Plwbinq Fee
3 1, .5 0 '7j.00
il�� Develpanent Fee 450.00
ri f;:ZN
R E C -E 8-V E 0
I I lul
0A U
UL 9
U .1983
40nu
4- 1
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ZONE PRO 0
LOT SZ
END
-SIDE':
Ah
Ah
NO.
OPERATION ATE
INSPECTOR
NO.
OP ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
'2A
Slab Grade
6
�,
35
Furnace Compart.
3
Steel
�j
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.
❑
OPINO.
ADDITIONAL INFORMATION
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)
12CT Ceiling (Blown)
14 1 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 Pi
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 .Final