001045 (SFD)P
PERMIT APPLICATION
• City of Ca Ouinta -
• Department -of B Illding 3nd'Satety •
This permit becomes void if work not commenced within 180 days'from'date of issuance, OR, it work has been suspended or abandoned fora period of 180 -days.
LICENSED -CONTRACTORS DECLARATION:.1 hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) o1 Division Sof the Business and Professions Code, and my license is in full force .
and effect.
License Class Lic..Number f •e '
Date Contractor f�' <
rT��
OWNER-BUILDER'DECLARATIONi: I hereby affirm that�r exempt from the Contractor's License Law,for the
following reason (Sec. -7031.5. Business and Professions Code: Any city or county which requires a permit to
construct, alter, improve. demolish, or repair any structure; prior to its issuance, also requires the -applicant for
• such permit to file a signed- statement that he is licensed pursuant to the provisions ofthe Contractor's License Law
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) or that he is exempt
therefrom and the basisklor, the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit.
subjects the applicant to a,civil penalty of not more than five hundred dollars ($500):
0 I. as 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. 7044, 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 sale. If, however, the•
building or i mprovemnl is sold within one year of completion, the owner -builder will have the burden of proving that
he did not build or improve for the purpose of sale.).
0 I, as owner of the property, am exculsively contracting with licensed contractors to construct the;project (Sec:
7044. iBusiness 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.).
0 1 am exempt under Sec. B. 8 P.C. (Attached Certificate).
Date 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 a certified copy thereof'(Sec. 3800. Lab. C.).
Policy No. Company
0 Certified copy is hereby furnished.
0 Certilied copy is filed With the City Building Inspection Department or City Department.
Date Applicant
APPLICANT NAME (L• F. MI)TT ``,M,,,�..^^
m. n n tJQA Anson '
ADDRESS
400 N. Tustin Ave. Suite 231
CITY/COMMUNITY/STATE/ZIP
Santa Ana. CA, 32705
JOB SITE AODRESt[.SfSPA`yCE
4 � / � -J , %� F2/�•f..{ �, ti -1711[ t]/ .
CITY/COMMUNITY/STATE/ZIP -
Ia Onimta . CA 92253
BOK
;-I- -Un5q
PAG IPRC .0
O
TWN
PING
9E
i
S
TR1ACT
3640-3
LOT
I
8= 60 iRi TI�CrJT
MODE,
SB
TOTAL
FEE FEE
TRACT NAME J.a� Paz De i!i Pa '
OWNER NAME Ml
(TL�_ �
CONTRACTOR -FIRM NAME
applicant
ADDRESS '
aiime
CITY/COMMUNITY/S,. TATE/ZIP
m
J
PHONE .
LICNC
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE •
LICNC •
-
USE OF PERMIT
S.F.D.
BL
ZON
FSB
SSB
SSB
RSB
OFC -
ZONE ORD N
LOT SZ
END ;
SIDE
CERTIFICATEOF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
the permit is for one hundred ($100) o, less. I certify that in the performance of.the work for which this permit -is
issued. I 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: If, atter making this Certificate of Exemption; you should become subject to -the Workers:
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permi0shall -
be deemed revoked.
.DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
0 1 herebyeertify that no ekcavationfive (5) of more feet in depth into which a person is required to descend, w ill 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 high. (Chap 3.2, Grp 2, Art 2, Sec341; Titlefl, -
C.A.C.)
0'As owner -builder, I will not employ anyone to do work which would require apermit from the Division of
Industrial Safety, as noted above, unless such person has a permit to do such work from that division.
0 Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm.that there is a construction lending agency for the performance
of the work for which this -permit is issued (Sec. 3097, Civ. C.). `
Lender's Name
Lender's Address
I certify that I 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 Applicant or Agent . • Date
CERTIFICATE OF COMPLIANCE AND r UTHORIZATION OF ENTRY: I certify I have read this application and state that
the information given is correct. I a ree•to`comply w;th all state laws and county ordinances relating to buidling
consUuctiond and authorize aFrep esentative otzt�e City oI� Ouinta Department of Building and Safety to enter,.
upon She pros pArty for whicli�l h e applied for this/"permit 7 the purpose of making inspections.
v
Signature of Aicant or Agent Date
Print Applicant/Agent Name
APPUPRMT fl , , y'� IV9••84 S.F.D•
Po mit to add an additional 26 sq. ft.
Refer back to original vennit #0520.
Previous bedrom does not conform a8
as ner UPC Pbress & Pis
xi_xte►zwnts. At time can Ods
yno
R=EIVED
8= 60 iRi TI�CrJT
TOTAL
FEE FEE
0—;
t
BLDG. DEPT.
VALUATION -0
Ah
Ah
NO.
OPERATION ATE INSPECTOR
NO.
OPRATION 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.
❑
NO
;
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)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb.
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewag 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/I
-
STREET NAME
26- Power Pole
27 Conduit
28 Service Entrance: ,
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final