0427 (SATT)PERMIT APPLICATION
City of La Ouinta 10
Department of Building and Safety
CITY/COMMUNITY/STATE/ZIP
La QWnta,, -CA 92253
JOB AWRES&SPACk
9--2- Athida Vista':[§imita
v This permit becomes void if -work not commenced within 180 days from date of
issuance, OR, if work has been suspended or abandoned fa a period of 180 days..'-
PAG
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This'section need not be completed if
' '.LICENSED CONTRACTORS DECLARATION:' hereby -affirm that Tam licensed under provisions of Chapter -9
the permit is for one hundred ($100) o,'Iess.-I certify hat 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' Compensation Laws of
and effect.
California.
'License Class Lic. Number
'Applicant.
Date Contractor
.-.:NOTICE TO APPLICANT: .11, after makirig this Certifica-iof-Exemption; you should become§ubjecito the Workers'
0
OWNER -BUILDER DECLARATION: I hereby a firm,that I'arrf exiamptAr rn�the Contractor's 06n's; aw4or-the'
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
a
-be
-
following reason (Sec:.7031:5. Business and Professions Code: Any city or county which requires a permit to
deemed revoked.
construct, altu,,improve. demolish, or repair any structure, prior to its issuance, also requires the applicant for
I I DIVISION OF -INDUSTRIAL SAFETY PERMIT CERTIFICAIrION:
such permit to file a signed statement that he is licensed pu!suant to the provisions ofthe Contra ' ctor'sLicense Law
- 0' 1 h6ibVcertify that no ix'ciavation five (5) or more feet in depth iht6Which a lierion is'required'to'descend. will be
(Chapter 9 (Commencing with section 7000) of Division 3 of the Business and Professions Code) or that he is exempt
'made iriconnection with.woik aulhorizeb by thfipiIrrvit, and that no bUilding structu . re. scaffolding, falsework. or X
.:,.,,therefrom and the. basis for the alleged exemption. Any, violation of Section-7031.5by any applicant for a permit
demolitioh brdismantling'iheriol,'Will be'more than thrty-six,(36) feel high. (Chap 3.2, Grp Z Art 2,Sec341,TitI68.,
subjects the applicant to.a civil penalty of not more than five hundred dollars (5500.). k.�
C.A.C.)
tojilas owner, o1 ' the property, or my employees with wages as their sole compensation, will do the work, and the.
0 As `owner -builder, I will' not employ anyone to do work which wduld req6ire'i 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 abow unless such person has a permit to db such work from that division. -
Law does not apply to an owner of property who builds, or improves0ereon, and who does such work himself or
. . '. . . . ... 1� .. . . . . . - . . -1.
• through his own employees.'provided that such improvements are not intended or offered for.sale. If, however., the
0 Division of Industrial,Salety. Permit No
building or improvemnt is sold within one year of,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 h4lreby affirm Ih;t there is a construction lending agency for the performance
`(Sec.
.'0 1,*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 applyrto an owner�of property'who
of the work for which this permit is issued 30W. Civ. C.).
Lender's Name
builds or improves thereon, and who'contracts for such projects with a contractor(s) licensed pursuant to the
Lender's
Contractor's License Law.).
Address
I am exempt under Sec., .,B. & P.C. .(Attached.Certificate).
I certify that I have read this application and state IhElt the above information is correct. I agree.to'comply withal l
Date 6', n. e r
6
city and county ordinances and state laws relating to wilding construction, and hereby authorize representatives I
END-
of this county to enter upon the above�rnentioned' popaty for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I heiebylaffirm that I have.a certificate of consent to selfinsure, or a
,certificate of Workers' Compensation Insurance , or 36ertified copy thereof (Sec., 3800: Lab: Q.
Signature of kIpplicant or Agent Date
Policy No. Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION I;F.ENTRY: I certify I have read this application and state that
0 Certified copy is hereby 1umished..
the information given is correct. I agree to comply w th,all-state laws and county ordinances relating to buidling
�0'1'Q,e,I.Iied,coP7yis filed Inspection
L• -•. Cfit/y 2ilding Insp tion/Depa
rt I C't Department.
men ior I y,
construction, and authorize a 'representative of the 0 ity of La Ouinta Department of Building and Safety ' to enter,.
upon the for which I have applied for this ermit for the of making inspections. ,
, Date a Applicant
0
properly I purpose - '84
Signature of Applicant or Agent Date
Print Applicant/Agent Name
n_
APPLICANT NAME (L. F:'MI)
MM Obtpbtatiow
.ADDRESS
P. 0. &-m 780
CITY/COMMUNITY/STATE/ZIP
La QWnta,, -CA 92253
JOB AWRES&SPACk
9--2- Athida Vista':[§imita
CITYICOMMUNITY/STATE/ZIP
La Q=ta, (A 92253
BOK
PAG
PRC
C
'Plan Check Fee.
T"
R NG
SE
S
TRACT.
14496-2
LOT
21
.7,39
Plumbing Fee
MOD
G-3
se
450100,
TRACT NAME
Santa Rosa- Cow
OWNER NAME (L. F. Mn'
CONTRACTOR-FIR!hr E
As
ADDRESS
.CITY/COMMUNITY/STATE/ZIP
PHONE 0
,564-1315
LICNC
3337621
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP ......
PHONE P
LICNC 0
USE OF PERMIT
USE with. Attached Garage
BL -
ZON
FSB
SSB
SSB
FISS
OFC •.
ZONE ORD 0,
-,LOlr SZ
•
iK
END-
"SIDE
APPUPRMT DATE
'n42 12-28-83
Permit to cInst it� 2,326 Sq. Ft,; of i/W6,
with Attached Garage
'00
'Plan Check Fee.
-291.20,
()ms1t:n;cticn Fee
448,00-,
Electrical Fee
36:90"
SMI Fee
.7,39
Plumbing Fee
73,00
ftmertv Deye�t Fee
450100,
97 -A83:
TOTAL
FEE
vo-
#
4%
14
�J
'r
BLDG. DEPTf
1
VALUATION` $10%867.6
;0 i 01
a
r1
NO.
OPERATIONI low DATE
INSPECTOR
NO.
OP ATION DATE INSPECi:�R
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
/
`
v •
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
t2A Drywall
13 _ Finish Grade
INSULATION Thick al
Value
7A Walls (Batts)
126 Ceiling (Batts)
126 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/I
STREET NAME
26 Power Pole
27 Conduit,,.
28 Service 'Entrance
29 Wiring
29A Grounding Wire
29B Bonding ,.
30 Fixtureg,-;;
31 Service
32 Final