SFD (0149)77713 Avenida Madrugada
0149
PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
I- /3
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
Date 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 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 hundred dollars (5500.):
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 i mprovemnt 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
El Certified copy is hereby furnished.
r-
❑ Certified copyyis''fi1ed with A City Building Inspection Departmentto C'hy Dyepartment.
Date . ' r Applicant i I f V
{inc6r Ce .
PPLICANT • ME L F- A1q
A o6 QaThta Joint venture
g°.RU. Box 780
CIT y WU Ld;IPCa 92253
JOB rS_T" D.fEs,.,PACE
Vvnida Madrugada
uTJ°D' j?Li 4110 ii, 92253
BOK
PAG
I PRC
I C
I
TWN
RNG
SE
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JAA4496_r ,
LOTw
31.25
Plumbing ree
-MOD `
3B
209.00
TRACTC. i,osa Cove
OWNER NAME L. F. MI)
cD ryYCTS°R-FIv,poration
t.v. BOX 780
;_'w°°"I".►:;,'PCa 92253
PVTV-564-1315
1 inipa-u ft...'v/
L,', -,c 762
TOTAL
FEE
ARC/ENG FIRM NAME
ADDRESS
CITY/COM MLIN ITY/STATE/Z I P
PHONE N
LICNC N
v10f1PE,M4 family Lvelling
BL
ZON
FSB
I SSB
SSB
RSB
OFC
ZONE ORD N
I
LOT SZ
END
SIDE
R
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed it
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 asto become subject to the Workers'Compensation Laws of
California.
Date Applicant
NOTICE TO APPLICANT: If, 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, Sec 341, 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.
Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that 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 AddrE
I certify that I have read this application and state that the above information is correct. I 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,) agree to comply with all state laws and county ordinances relating to buidling
construction, andAauthorize'a`representative of the City of La Ouinta Department of Building and Safety to enter
upon the pro rtty foT whic i h vi applied for,th.Lspermit for the purpose of making/ts,-ppeections.
Sjg atufe,of p licant or Agent Date
'jf.ce.t %.rA
Print Applicant/Agent Name
APPL/PRMT 12 {
., r, rj)
9 6 N 6 N O 3
k 1 V S7 .}
Permit to construct Model P -3—A
Dwelling
11616 Sq. rt,
Guest Room
277 Sq. Yt.
Garage
433 sq. rt.
Patio Cover
140 Sq. Ft.
.tech. Fee
$ 31.00
Electric vee
31.25
Plumbing ree
52.50
Flan Cheek Fee
209.00
Building Fee
424.62
Property Dev. Fee 450.00
ECEIVED
UN 201983
L
1 inipa-u ft...'v/
TOTAL
FEE
,,71,198.37
VALUATION y 94, 617. 80
Arrow Printing 250/1-83 White: Finance Canary: Assessor Pink: Applicant Tag: Bldg. Dept.
NO. OPERATION I DATE
BUILDING APPROVALS
1
Set Back
16
2
Ftgs & Frms
Rough Plumb
2A
Slab Grade
19
3
Steel
Sewer
4
Grout Blocks
22
5
Bond Beams
Water Service
6
Roof Deck
25
7
Framing
8
Vents
.9
Garage Fire Wall
10
Fireplace P.L.
❑
10A
fireplace T.O.
❑
1
Exterior Lath
12
Internal Lath
12A
Drywall
13
Finish Grade
INSULATION
Thick R
Valu
7A
Walls (Batts)
12B
Ceiling (Batts)
12C
Ceiling (Blown)
14 Final
PLUMBING APPROVALS
INSPECTOR NO. OPERATION I DATE INSPECTOR
MECHANICAL APPROVALS
33 Ventilation System
34 Plenums & Ducts
35 Furnace Compart.
36 Inlets & Outlets
37 Combustion Air
38 Compressor
39 Appl. Clearance.
40 Fire Damper
41 Smoke Detection Device
42 Commercial Hood
43 Final
NO. ADDITIONAL INFORMATION
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
ELECTRIC APPROVALS
26
Power Pole
27
Conduit
28
Service Entrance
29
Wiring
29A
Grounding Wire
29B
Bonding
30
FixturesZ.
31
Service
32 1
Final
SEWAGE SYSTEM SIZE & LOCATION
Tank Pit L. Line
STREET NAME
REAR OF PROPERTY LINE
P/L