000906 (RER)PERMIT APPLICATION
-City of La Quinta
Department of Building and Safely
e
JOB SITE ADDRESS/SPACE
49-685 Avenida Vista Bonita
-This becomes if days from -date
issuance, OR. if has been for
permit void work not commenced within 190
of work suspended or abandoned a period of 180 days.
PRC
CERTACATEOF 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 Chapterl,9 7, ,
the permit is.for. one hundred .($100) a, less. I certif,,, that in the performance of the work for which this permit is
(commencing with. SectionJ000) 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 -.o as to become subject to the Workers'Compensation Laws of
and effect.
California.
License Class Lic: Number
Dale Applicant
MOD
//
0e- • Contractor`i/
'bWNER-BUILDER OEC'LA'RATION:� I hereby affirm that I amexempt /iro In the Contractor's'L-_1 -_1 'Law for.the
cense
NOTICE TO APPLICANT: If, after making this Certificate*Qt Exemption,, you should become subject to the Workers: -
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 permit to :
be deemed revoked.
.. - . .
construct. . alter, improve: dimolish, or repair any structure, prior to its issuance, also requires the applicant.for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
such'permit to file a signed statement,t.hat he is lice.nsed pursuant to the provisions of the Contraclor's License Law..
01 hereby certify that no excavatibn five (5) or moreJeet in depth into -which aperson is re-quired to descend, will be
(Chapter. 9 icommencing with section 7000) of Division 3 of the Business and Professions Code) or that he is exempt
made in connection with work authorized by this pe,mit, and that rio.building stiruclure..scaffolding, falsework, or
....therefrom and the basis for the alleged exemption. Any violation of Section 7031,5 by any applicant fora permit
demolition or, dismantling thereof, will be more than :hirtyzsix:(36)feet high: (Chap 3.2; Grp 2, Art 2, Sec 341, Title 8;
subjects the applicant to a civil penalty of not more than live hundred dollars ($500.):
-C.A.C:)
11 1, as owner of the property, or my employees with wages as their sale compensation, will;d6the work. and _the-.,
0 As owner -builder;, I will not employ anyone to III work, which -would require a: permit from the. Division of
."Structure is not intended or offered for sale (Sec..7044, Business and ProfessionsCode: The Contractor's license
Industrial Safety. as'noted above, unless'such per5ori has a permit to do.such work from that division'
Law does not apply to an owner of property who builds, or improves thereon, and who does such work himself or - -
ADDRESS
through his own employees, provided that such improvements are not intended or offered for sale. If, however, the
0 Division okinddsirial Safety Permit. No.
..building or impmemnlAs sold within one year of completion. the owner -builder will have the burden of provingthat
Date. Applicant
he. did not. build or improve for the purpose of sale!
. % , ).." " * � - , 1. , I . , . ,CONSTRUCTION
LENDING AGENCY: I hereby affirm Oat there is a construction lending agency for the performance
._:0 1, aslowner of theproperty, am exculsively contracting. with licensed contractors to construct the project (Sec:..,
of the work.for which this permit is issued (Sec. 307, 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 contractors) licensed pursuant to the .
SSB_
Contractor's License Law.).
Lender's Address
0 1 am exempt under Sec. B.,& P.C. (Attached Certificate).
I certify that I have read this application and state ti at the above information is correct. I agree to comply with all
Date Owner
city and.county ordinances and state laws,relating t3.building construction, and hereby authorize,representatives
of this county to enter upon the above-mentioned lroperty for inspection purposes.
ra-
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, ora'
.. •. -
.'certificate
'certificate of Workers' Compensation,insurance , or a certified copy thereof (Sec. 3800. Lab. C.).,:
Signatureof Applicant or Agent Date
PolicyNo. Company
OF COMPLIANCE AND AUTHORIZATION OF ENTRY: .1 certify. I have read this application and state that
CERTIFICATE-
• Cert:iiieJco:py,i's hereby -furnished;
the information given is correct. I agree,to,comp[Tv—i-th all state laws and county ordinances relating to buidling
• Ce Oiled copy is filed with,the City Building Inspection pection Department'or'City Department.
Date t .. I .e Applicant . — '. 1. ... ; . .
construction,and authorize a:representativ�elof the City of La Quinta Department of,Building and Safely to enter.
upon,th—ellro'perly,for w'hic'KI have'applieh for this permit for the purpose of maW6'inspections.
Signature of Applicant or Ajint Date
Print Applicant/Agent Name
APPLICANT NAME. (L. F, MI)
Craig Conklin
ADDRESS
73-6612 Maty ill
CITY/COMMUNITY/STATE/ZIP
Palm Desert, CA 92260
JOB SITE ADDRESS/SPACE
49-685 Avenida Vista Bonita
CITY/COMMUNITY/STATE/ZIP. .
:La rOuinta, CA _92253
BOK
PAG'
PRC
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TWN
FIND
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1445TRACT6"2
8 I LOT5
-'
MOD
'J,SB
TRACT NAME
OWNER NAME- (L. F. MI)
CONTRACTOR -FIRM NAME
Cr,
aig Cmiklin OD.'
'ADDRESS
73-612 Hwy' 111
CITY/COMMUNITY/STATE/ZIP
Pa.1m Desert, CA 92260
PHONE 0
LICNC 0
346-8805
ARC/ENG FIRM NAME
ADDRESS
CITYICOMMUNITY/STATE/Zl . P
PHONE 0
[LICNC 0
USE OF PERMIT
enclose atrium
81.
ZON
F
FSB'
SSB_
SSB'
R.-
OFC.
ZONE ORD .#
7
LOT SZ r
_S IDE.
APPUPRMT%' ,
'onnns DATE EMIG.
Permit to enclose existing
atrium as per approved plan
and all anDlicable codng and
ordinances
• Plan Clwck POMA-
Permit Fey 44,50',
S.M.Y. Fee -:50
i.
U 1i YJ -U Wo"
City of La"QUORAt'a
-TOTAL-
FEE --s-73.92--
VALUATION V3,500:00,
BLDG. DEPT.
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION 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
f=ireplace T.O.
❑
NPON ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
126 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
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
PSL PiI
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance j
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final