SFD (0161)77511 Los Arboles Dr
0161
PERMIT APPLICATION
City of La Og a 2 O r
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
(commencing 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
)ate Contractor
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor'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 a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) or that he isexempt
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 hundred dollars ($500.):
0 I, 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
building or improvemnt is sold within one year of completion, the owner -builder will have the burden of proving that
he did not build or improve for the purpose of sale.).
0 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.).
0 1 am exempt under Sec.
Owner
B. 8 P.C. (Attached Certificate).
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.).
Policy No. Company
p'Certified,copy is hereby fur fished. - •4
❑
Certified copy is'fileed with)the Gity Building Inspection De tmenI i Clt'.' ' Department.
Date 1 r t' -"} Appli. 6,
x
LA LICANu L.Tta1-`)oint Xx Venture
/,A.D16. Box 780
iCITY/COMMUNITY/STATE/ZIP
t.a luinta, Ca 92253
'°r 1 5PIDRxsg'Loa
ct.; ioMt u+L`tsiVg2! C:A 72253
Ca
BOK
PAG
PRC
C
Patio Cover
TWN
RING
SE
S
TRACT 1
.A ^'
j
L113
31.2:,
lumbinq i ee
IM-O
S8
.' uilding vee
TRACT NAME
L>antaR isosa L-lVe
OWNER NAME (L. F. MI)
CA RA841jFIR _02 poration
ADDRESS Bok 780
CITV MMUAT
AJL,1.. 92253
P,
LI3JJV84
t
r .
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE M
LICNC M
USr: IF,PE, Ye ;: Emily I!wel.lin(;
BL
ZONFSB
SSB
SS8
RSB
OFC
ZONE ORD M4
LOT S2
END
SIDE
t
Cit
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
the permit is for one hundred (5100) 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.
Applicant
NOTICE TO APPLICANT: IL 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:
0 1 hereby 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, Sec341, Title 8,
C.A.C.)
0 As owner -builder, I will not employ anyone to do work which would require a permit from the Division of
Industrial Safety, as noted above, unless such person has a permit to do such work from that division.
0 Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: 1 hereby affirm that there is a construction lending agencytor 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 state that the above information is correct.) agree to comply with all
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.
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; dndlauthorize a{r J pptative of the City of La ouinta Department of Building and Safety to enter
upon the propeUtj'for W`oseh l liav applted'for tis permit for the purpose of making inspections
f/ p
Signature; of ApplicafI or Agent Date
} ,< f ;,.
Print Applicant/Agent Name
APPL/PRMT ISA
116t l6rA...!6-83
Permit to construct '-'odel
Dwelling
1,616 Sq. rt.
_nest ;zoom
277 ;q. vt.
<_arage
433 Sq. I -It.
Patio Cover
140
ech, gee
fi 31.Cu
lectr ic tee
31.2:,
lumbinq i ee
52.50
Plan Check - rye 209.00
.' uilding vee
42.1.62
roperty bev,
:--'ee 450.00
C 1VED"
of LZ,Qujrft
t
r .
TOTAL
FEE
1 , 198.37
VALUATION 941617.8 t'
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
7
Framing
Ae/s/gr40
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'N ADDITIONAL INFORMATION
NO.
o u /61.•t2 s
7:J
//` `
i ' - -
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath o
t2 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B 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 1-219-M 7--
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 +.N
32 Final