001044 (SFD)PERMIT APPLICATION
City of
La Oug
Department of Building and Safety
a
•
This permit becomes void if work not commenced within 180 days from°late of issuance. OR, if work has been suspended or abandoned for a period of 180 days.
•
BOK
617
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if .
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'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 person in any manner so as to become subject to the Workers'CompensationLaws of
and effect.
California.
License Class Lic,.Number
Date Applicant
f
Date Contractor •
NOTICE TO APPLICANT: If, after making this Certificate of, Exemption; you should become subject to the Workers'
r •`� .%
OWNER -BUILDER DECLARATION: I hereby affirm that 1 am exempt Irom fhe C ntractors icense Law torte
- .Compensation provisions of the labor Code, you must forthwith comply.with such provisions or this permit shall
following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a per It.to
be'deemed revoked.
construct, alter, improve, demolish, or repair any structure• prior to its issuance, also requires the applicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
.such permit tofile a signed statement that he is licensed pursuant to the provisions oltheContractor'sLicenseLaw
Oil hereby 6ertify that no excavation five (5) or more feet in depth i nto' which a person is required to descend, will be .�
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) orthat he is exempt
made in connection with work authorised by this permit, and that no building structure, scaffolding, falsework, or
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
demolition or dismantling thereof, will be more than thirty-six (36).feet high. (Chap 3.2, Grp 2. Art 2, Sec341, Title S.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
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 owner -builder, I. will not employ anyone to do work which would require a permit from the Division of
structure is not intended or offered for,sale (Sec. 7044, Business and Professions Code: The Contractors License
Industrial Safety, as noted above, unless such person has a permit to do such work from that division.
Law does not apply to an owner of property who builds, or improves thereon, avid who does such work -himself or,- ••
USE OF PERMIT
S.F.D.
through his own employees, provided that such improvements are not intended or offered for sale. If, however, the .
0 Division of Industrial Safety Permit No..
building or improvernnt is sold within one year,qf completion, the owner-builder.will have the burden of proving that
Date Applicant
he did not build or improve for the purpose of sale.).
CONSTRUCTION LENDING AGENCY: I hereby Affirm that there is a construction lending agency for the performance
0 I, as owner of the property -am exculsively contracting with licensed contractors to construct the project.(Sec. •
of the work lor.which 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 Name
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
ZONE ORD •.
Contractor's License Law.).
Lender's Address
0 I am exempt under Sec. B. 8 P.C. (Attached Certificate).
I certify that I have read this application and state,that the above information is correct. I agree to,comply with all
Date Owner 14
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.
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.
O.Certified copy is tiled with the City Building Inspection Department or City Department.
Date Applicant
APPLICANT N ME (BF, MI) ohnw
�L• • �J 11i3�A1
ADDRESS 400 N. TustinAve^. Suite 231
CITY/COMMUNITY/STATE/ZIPSanta _ , CA 92705
05
JOB SITE ADDRESS/SPACE ff_ E /% S JMOP
1/V'/ 74 Or �. N1a
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
BOK
617
PAG
059.0`
PRC- 'C
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TRACT64b-1
-Laguna
LOTU
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SB
TRACT NAME
De l Pa
OWNER NAME (L, F, IAD„ t ,
CONTRACTOR -FIR _,ME t
app���n
ADDRESS
abow
CITY/COMMUNITY/_STATE/ZIP -
wi1•J•G
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PHONE.
LICNC N
-
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE N
LICNC I
-
USE OF PERMIT
S.F.D.
BL
ZONFS8
SSB
SSB•
RSB
OFC
ZONE ORD •.
-
LOT SZ
END
SIDE -
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have.read,thisapplication and state that
the information given is correct. I agree to comply with all state laws and,county ordinances relating to buidling
constructlon and authorize a're{ resentative of the Cit of La Ouinta Department of Building and Safety to enter
upon tl�e pr_oD�rt� y to ich I�awe aYp`plicd�or is ,iamb urpose of making inspections.
Signature of Applicant or Agent Date
Print Applicant/Agent Name /
'APPUPRMT nni,m,if-39^84 S.F.D.
Permit to add an additional 26 sct. f . t
Refer knack to oricainal permit #0514.
does ot conform
Previous bedrao�a�mp� ri
as bedroas 1+,•,•_ UBC Rogress 0 &fires:
om
remdrawnts. At not ime can this
mm be used as a bedroom.
i
RECEIVEDI
NOV 2 91984
CITY 01 LA' UINTA
TOTAL
FEE
—0—
VALUATION —Q�
BLDG. DEPT.
NO.
OPERATION ATE
INSPECTOR
NO.
OPERATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
`a, Set Back
33
Ventilation System
2
-"#' Ftgs & Firms
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 .
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
r
,
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
P I L P)
STREET NAME
26 Power Pole
27 Conduit .
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final