0434 (SFD)APPLICANT NAME (L F MI)
M11WI Ga��
ADDRESS
P* U. B= 780
4, PERMIT APPLICATION
41
City'of Ca'Quinta 7
Department of Building,and Safety
12 CQ=ta, E/CZl
A 9225'j`-`
This permit becomes void if work o commenced within 180
• not -days from date of issuance:
OR, it -work has been suspencled,or abandoned or a period of 180'clays.,.'.
i
CERTIFICATE OF EXEMPTION FROM.WORKERS'COMPiENSATION INSURANCE: This section need not be completed if
LICENSED CONTRACTORS DECLARATION:,,'I, hereby affirm that I •arri licensed -under provisions, of, Chapter 9.
the permit is -for..one hundred ($100) o, lessA certify. that in the performance of the worli which this permit is7
(commencing with Section 7000) of Division 3of the'Business and Professions.Code, and my license is in full force.,
issued, I shall not employany person in any m@nmer%asto become subject to the Workers' Compensation Laws of
and effect'
California. y.
License Class Lic.-Number :11
Date Applicant
Date Contractor
NOTICE TO APPLICANT: If, alter making this Certificite'of Exemption, you should become subject to I e pris,
OWNER -BUILDER DECLARATION: .1 hereby affirm that I am exempt om the Contractor's License Law for thd r
ji�
Compensation provisions of the Labor.Code you must forthwith comply with such.provisionsthis s permit shall
be deemed
following reason (Sec. 7031.5. Business and Professions Code:.Any,cily or county. which requires a permit to
revoked.
construct, alter, improve: demolish, or repair any structure, prior to its.issuance, also requires the applicant.for.
SAFETY OF INDUSTRIAL SAFE Y PERMIT CERTli.'1CA_Tldli
such permit IoJile a signepstatementthat he is licensed pursuant to the provisions of the Coni License Law
0 1 hiribj certify that no exc"ation five (5) or more :eet in.depth into whi&a person is required to'descend, will be
.(Chapter 9 (commencing with section 7000) of Division'3 of the Business and Professions Code) o r that he is exempt
�.
made tri connection with work authorized by this pernil,.and that no building structure,-scaffolding;falsework,6r
therefrom and the basis for -the exemption. Any.yiolation of Sec)ion.70dl.S by any.applicant formIi -'demolition or dismantling thereof, will be mole Ifiari (36) feet high. (Chap 3,2; Grp 2:Art 2: Sec 341.,Title 8` 1
subjects the applicant toaxiv i4 penalty of not more than five hundred dollars ($500),,..
C.A.C.) 1'.
. : . I
-,wq
0 1. as owner of the property. or my employees with wages ais1heir sole compensation, will do the work, and the.,
0 As owner builder, F will hotemploy'anyone to'. o work which -Would reqOire a permit from the Division of
structure is not intended or offered for sale.(Sec. 7044. Business and Professions Code: The Contractoirs License
Industrial Safety, as noted ab6ve, unless such permn has*a permit to do.such work'from that division.
P Law does not apply to in'owner of property who builds, or improves thereon, and who does such work himself or
Division Industrial Siifei�, Peri
'through his own employees. provided that such improvements are not intended or;btfered for•sale. If;however. the.
Q of
building.or improveri sold within one year of completion. the owner.-builderwill have the burden of proving that
Date -Applicant
he did not build or improve for the purpose ot sale.).
CONSTRUCTION LENDING AGENCY: I hereby affirm 11at'there.is a construction lending agency for the performance
0 1, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec
of the work for which this permit.is issued (Sec. 3971Civ, 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"contraclor(s) licensed pursuant. to the
Y . ZONE ORD oi
Conir5ctor's License Law.).
Lender's Address–
0 1 am exempt under Sec. B. & P.C. (Attached. Certificate).
I certify that 1have read this application.and state tLat,the above information is correct. I agree to comply -with all
Date Owner
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to entiYupon the above mentioned property for inspection purposes..
WORKERS' COMPENSATION DECLARATION:- I Kereby affirm that I have,a certificate of consent toi.self-insure, or a'
'certificate of Workers' Compensation Insurance . or a.certified copy thereof (Sec: 3800: Lab. C.).:
•Signature
of Applicant or Agent Date
Policy No rnmnanv —7
CERTIFICATE OF'COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
.0 Certified copy is hereby furnished. - u. -t
e., Ivn
luitillied;
the: information given is correct. I agree to comply with all state laws and county. ordinances relating to buidling
and a of:the City of La Quinla Department of Building Safety to enter
jj fled With the City Buildihg.inspection Oepartment,i v
--I copj.—Iij
V U,
construction, authorize representative.
taind
upon the properti'for'which I have applied for this permit for the purpose of making inspec ons:
L .
Date, Applicant
4
Signature of Applicant or Agent Date.
Print Applicant/Agent Name r
APPLICANT NAME (L F MI)
M11WI Ga��
ADDRESS
P* U. B= 780
CITY/COMMUNITY/STATE/ZIP t
i.a vx=tia 1, CA 92253
JOB SITE.ADDRESS/SPACE
Vista'Boatia
12 CQ=ta, E/CZl
A 9225'j`-`
SOK
PAG
-PRC
C
.Plan' -Cher -k Fee.
TWN
R NO
SE
S
JACT449
LOT
127
5085
Plwibing Fbe'
Mei
sB
450,00
TRACT NAM
sant a E IbEa ome
OWNER NAME (L. F. MI)
CONTRACTOR -FIRM NAME.
bi� AS AbdVP-
ADDRESS
PITY/COMMUNITY/STATE/ZIP
PHONE
.564-1315
1,333762
LICNC 0
1
ARC/ENG FIRM NAME•
ADDRESS
CITYiCOMMUNITY/STATE/ZIP
PHONE 0
USY.Ofl,ERMIT
L
SL
ZON
SSB
SSB
OFC
Y . ZONE ORD oi
LOT SZ,
END
SIDE:
APPUPRMT .1!OATE
/28/83 S
Pemit to =mtruct 1,903 Sq. Ft'
of S/F/D
x4ith Attached Garage
F6e,
31,10_0 -
.Plan' -Cher -k Fee.
250.25
i0motructim Fee
385,00
Electrical ,F06.
31925
Mr Fee
5085
Plwibing Fbe'
WqelkmieSit 'Fee
450,00
-Property
ET C El
ULU 9*- 1§83 7W III
cil'hg P
4 9
TF
FEE
$1,201,85
BLDG. DEPT.
VALUATION$ 834869.
801.
NO.
OPERATION ---] 7-At-E-1,,�1 -INSPECTOR
;NO:
OP, IWTION —T—DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System r
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. ❑
OPO.'N ADDITIONAL INFORMATION
N
/
0o,7
�31F
SEWAGE SYSTEM SIZE &. LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
R"
INSULATION Thick Value
7A Walls (Batts) z 1�;tj
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb 0,0 AW
18 Vents
19 Sewage Disposal
20 Sewer --174
21 Water IZ(eater
22 Water Sdf)ner
23 Water Servi e
24 Gas Test.
25 Final r
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
P L P/I
26 Power Pole
27 Conduit
28 Service Entrance .
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME