001015 (SFD)PERMIT APPLICATION
all%• City of La Dg a
F�
:'� � Department of Building and Safety '
This permit becomes void if work not commenced within 180 days from.date of issuance, OR, it work has been suspended -or abandoned `or a period of 180 days.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am liceeqed-under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
and effect
License Class /�i` L~ic/Numbeir�
Date J-?" Contiactar-✓ �� "`w JX.
x'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 Code: Any city or county which requires a permit to
construct• alter, improve, demolish, or repair any structure, prioeto its issuance, also requires the applicant for
such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
(Chapter 9(com meriting with section 7000) of Division 3 of the Business and Professions Code).or that he is exempt
therefrom and the basis for 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 otfired,for sale. If, however, the
building or i mprovemnt is so Id 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• 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.).
0 1 am exempt under Sec., A. 8 P.C. (Attached Certificate).
Date '. Owner ,r
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.. :A Company
0 Certified copy is, hereby furnished. +
0 Certified copy.: is filed with the' City Building Inspection Department or City
Date Applicant
Department.
APPLICANT NAME (L. F. MSI_)_^ Corp.
ADDRESS '
P.O. B= 780
CITY/COMMUNITY/STATE/ZIP -
La Quina, CA 92253
JOB SITE ADDRESS/SPACE '
49-258 Avenida Vista Bonita
CITY/COMMUNITY/STATE/ZIP '
La Quinta, CA 92253
BOK
PAG
PRC !
C
I
TWN
RNG
SE'
S
TRACT
14496-2
I LOT
23
Elec. Fee
18.45
MOD
G-3
SI3
'
TRACT NAME �^�.,�,.w
Santa How W V F
OWNER NAME (L. F. MI).
An&m
CONTRACTOR -FIRM NAME
Amen
ADDRESS �
atom
CITY/COMMUNITY/STATE/ZIP
above
PHONE. 1
564-1315
7
LICNC .
333762
ARC/ENG FIRM NAME
PA= Berlms
ADDRESS
1531
CITY/COMMUNITY/STATE/ZIP '
Santa Barbaga. CA 93101,
PHONE 11
LICNC A
USE OF PERMIT
eimle fwdly t llincr
SL
ZON
FSa
SSB SSB RSB
OFC +
ZONE ORD . - 1
LOT SZ
- IL
END'
SIDE +
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPLNSATION 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, after making this Certific:.te of Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you mist forthwith comply with such provisions or this permit shall
be deemed revoked. '
+ DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFIC4TION: . .
❑ 1 hereby certify that no excavation five (5) or more eel in depth into 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 flirty -six (36) feet high. (Chap 32; Grp 2, Art 2, Sec 341, Title 8,
C.A.C.)
0 As owner -builder, I will not employ anyone to 0o work which would require a permit 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 ULM there is a construction lending agency for the performance
of the work for which this permit is- issued (Sec. 3187, Civ. C.).
Lender's Name
Lender's Address
I certify that I have read this application and state tlatthe 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 F-operty for inspection purposes:
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATIONDOF ENTRY: I certify I have read this application and state that
the information given is correct.al.agree to comply with all state laws and county ordinances relating to buidling
construction and auA n5 a representative of the City. of La Ouinta Department of Building and Safety to enter
upon the property or�tiwh[cJh_;,6ve.applied for this permicfor' the purpose of m aking.nspections.
Signature of Appplicant or Agent Date
Print Applicant/Agent Name
APPUPRMT "M n i 5
, DATE
10-22`84 S.r .D•
Permit to oaLstnuct
2.326 gar. ft. of
sinlarlie family dwalUmalt
to y
caracre. 171LL3'S •IS. lao-, -
0 0429 EXPZT=.
of rv-,m; al-rn
mwb. F<__P_
n
13 -nn
Plan Check Fee
29.12
Const. Fee
224.00
Elec. Fee
18.45
Plumbing Fee
36.50
.
V
Oct F
NC pgtT
TOTAL .'
FEE?�
�A
BLDG.DEPT. VALUATION -0-
A A91k
NO.
OPERATION MTE
INSPECTOR
NO.
OP MATION 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
3a
39
Appl. Clearance
'7
Framing
40
Fire Damper
8
Vents
41
Smoke Detection Device
91
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 a ��
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer o?11.2TY7 ,
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 �p '
c