0082 (COMB) IIIIIIIIVIIIIIIVIIIIIII 45 PERMIT APPLICATION 99,
1 City of La Ouinta
IE 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.
CERTIFICATE OF 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 Chapter 9 the permit is for one hundred($100)o,less.I certify that 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 anymannerso as to become subject to the Workers'CompensationLaws of
and effect. California.
License Class Lic.Number Date Applicant
Date Contractor NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Workers'
OWNER-BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the 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,demolish,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 that he is licensed pursuant to the provisions of the Contractor's License Law ❑1 hereby certify that no excavation five(5)or more feet in depth into which a person 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 in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or
therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap 3.2.Grp 2.Art 2,Sec341,Title8.
ksub'ects the applicant to a civil penalty of not more than five hundred dollars(5500.): C.A.C.)
i 1.as owner of the property,or my employees with wages as their sole compensation,will do the work,and the O As owner-builder,I will not employ anyone to do work which would require a permit from the Division of
structure is not intended or offered for sale(Sec.7044,Business and Professions Code:The Contractor's License Industrial Safety,as noted above.unless such person has a permit to do such work from that division.
Law does not apply to an owner of property who builds,or improves thereon,avid who does such work himself or
through his own employees,provided that such improvements are not intended or offered for sale.If,however,the ❑Division of Industrial Safety Permit No.
building or improvernnt is sold within oneyear of completion,the owner-builder will havethe burden of proving that Date Applicant
he did not build or improve for the purpose of sale.). CONSTRUCTION LENDING AGENCY:I hereby affirm that there is a construction lending agency for the performance
❑I,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.3097,Civ.C.).
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 Lender's Name
Contractor's License Law.). Lender's Address
❑1 am exempt under Sec. B.&P.C.(Attached Certificate). I certify that I have read this application and state that 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 enter upon the above-mentioned property for inspection purposes.
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.). Signature of Applicant or Agent Date
Policy No. Company CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify I have read this application and state that
❑Certified copy is hereby furnished. the information given is correct.l agree to comply with all state laws and county ordinances relating to buidling
•Certified copy is filed with the City Building Inspection Department or City Department. 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.
Date Applicant " / r " F-, . _ —, - c, f
` o Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPLICANT NAMk L�M�I) APPL/PRMT DATSi, t 3-fix
'21-83 Ccxb.MSSA
ADORE1/?- QpU WA'Q_.A !
v
cYCOMr TMwU /S7ATZP 92253 Prmit to construct 3,610 Sq.Pt. of House,
JOZ&FOSA 472
Sq.Ft.. of bbic.harlical Rom and 758 Sq.Ft.
CITY/COMMUNITY/STATE/ZIP
of Garage Per Appra4ed Plans
OK 617 PAAG� P9C! f�1.fCI TWN RNG SE S
TRACT t� j„�, LOUTOD
Firo :rty Ii1QlOgt21 Fee $ 600.00
MSB
TRACT NAME 1 - �r jjyca PFi.�it Fee 37.00
r
CV� hrVILE(L; Mssen - E � Permit
� 110.80
O , AC O'-FNjr PlmbiM Permit Fee 126.50
ADDRESS
/00. 00.. P12m a ook Foe 321.50
CITY/COMMUNITY/ST TE/ZIP l? �. Building
u y dJ t. Fee 643.00•n•00
PHONE N.��� � , LICNC S.M.I•P. 12.85
ARC/ENG FIRM NAME SpaE7uipwnt Pertuit 45.00
ADDRESS
CITY/COMMUNITY/STATE/ZIP
auk
PHONE N LICNC M
2 11983
"Xj1U Family Melling City of La Quinta
BL ZON FSB SSB SS8 RSB OFC �.
ZONE ORD M LOT SZ END SIDE �, t
TOTAL
FEE $1,896.65
VALUATION I $183,700.00
Arrow Printing 250/1-83 White: Finance Canary: Assessor Pink: Applicant Tag: 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
"T Framing 4r. 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. ❑ NO ADDITIONAL INFORMATION
11. Exterior.Lath
12 Internal Lath
12A Drywall.
13 Finish.Grade
INSULATION Thick R
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
SEWAGE SYSTEM SIZE& LOCATION
Tank Pit L. Line
ELECTRIC APPROVALS- -REAR OF.PROPERTY LINE
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire P/L P/L
29B Bonding
30 Fixtures
31 Service -
32 Final
STREET NAME