0439 (SFD)PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
This permit becomes void if work not commenced within'180-days from date of issuance, OR, if work has been suspended or abandoned for a period of 180'days.
LICENSED CONTRACTORS •DECLARATION: I hereby affirm that I am licensed under provisions' of Chapter 9
(corhmencing'with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
and effect.
License Class. Lic. Number
Dater Contractor -
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from Aelcontractorl'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, prior to its issuance, also requires the applicant for
such permit to file asigne4 statement that heis licensed pursuant to the provisions of the Contractor's License1aw - ..
(Chapter 9 (commencing 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 hundredidollars'($500.):
0.1. 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 offered for'sale. If, however, the
bu ild ing or i mprovemnt is sold within one year of completion, the owner -builder will have the burden of proving that
he, did not build or.lmprove for the purpose of sale.).
❑ 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.).
• ❑ 1 am exempt under Sec. . B. & P.C. (Attached Certificate).
Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell -insure, or a
"certificate of Workers' Compensation Insurance', or a certified copy thereof (Sec. 3800. Lab: C.)..
Policy No. Company
O Certified copy is hereby furnished.
O^Ce_rtified co is fil¢d)with the Gt Bu,
Inspection
klepAmen o City Department.
Date __ I copy r M09cant a J lJ -.. '
AAy��PP��,�LI,yCy�AAN�TT NAME (L. F. MI( y.,
Aroen ��C L.im
ADDRESS
P. O. BIS 780
C- ITY/COMMUNITY/STATE/ZIP 953 .
Ta Ouir a, `!'A
149c S!yG��•�rJOB
SITE �+R+.N�Vf PAC
^T—C7GMMLa �_UNRi/BT!' ,TECA 92253 -. .
CITY/COMMUNITY/STATE/ZIP
BOK
PAG
PRC
C
31..00.
TWN
PING
SE
S
TRACT
14496-1
LOT
159
WE Fee
5957
MOD
P-2
SB
- r
Property Development Fee
TRACT NAME
Santa Rma Cove
OWNER NAME L. F. MI(
COam TQA-FIRM_, NAME
As Above
ADDRESS .
CITY/COMMUNITY/STATE/ZIP
564.1315
�'.
L333762
ARC/ENG FIRM NAME-
ADDRESS'
CITY/COMMUNITY/STATE/ZIP '
PHONE 11
LICNC 1
USE
/r- /D with Attgahed (><am e
BL
ZON
FSB
' .SSB
SSB
RSB
OFC:
ZONE ORD .#
LOT. SZ
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS:COMPENSATION INSURANCE: This section need not be completed It • -
the permit is for one hundred (S10D) 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: It, after making this Certificate of 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
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: n
0 Ihefeby certify that no excavation five (5) or more feet 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 thirty-six (36) feet high. (Chap 3.2, Grp 2. Art'2; Sec 341; Title 8.
'C.A.C)
f7�As-owner-builder, I:will not employ anyone to& work which would require a permit from the Division of
Industrial Safety, as noted above, unless•sucA person has a permit to do such'work from -that division.,
D Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: .1 hereby affirm thal.there is a construction lending agency for the performance
of the work for. Which this permit is issued (Sec. 3097, Civ. C.): "
Lender's Name
Lender's Address
I certify that I have:read this application and slate that the above information is correct. I agree to comply with all
city and county ordinances and.state laws relating to build ing-construction, and hereby.authorize representatives
of this county to enter upon the above=mentioned property for inspection purposes.
Signature of Applicant or'Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling -
construction, and authorize a, representative of the City of La Ouinta Department of. Building and Safety to enter
upon the property for which I have applied for this permit for the purpose -of making inspections.
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPL/PRMTDATE
f 4-3 9, 12-28-83
'
Permit to =Mtruct 1,813 Sq. F,.
of S/F/D
with Attached G3xaqe
Miachanical Fee $
31..00.
Pian C beck Fee
242.45
Construction Fee
373.00
E1.ectca1\,Feer
31.25
WE Fee
5957
Plumbing Fee
48.50
- r
Property Development Fee
300.00
.R lav . `C E 11
�'.
ULU 691983
'� gB91f.IG1
TOTAL
FEE •
$ 1,.031.,77 '
BLDG. DEPT. -VALUATION $ 79,103.20A';
•
NO.
OPERATION 'DWE INSPECTOR
NO.
OPE ION DATE INSPECTOR
BUILDING APPROVALS„
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
35
Furnace Compart. lA ,
3
Steel
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
Q %
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.
❑
OP'NO.
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick al
Value
7A Walls (Batts)
12B Ceiling (Batts)
12CT Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb s�s
16 Water Piping
17 Rough Plumb
18 Vents -'
19 Sewage Disposal
20 Sewer s
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