SFD (0147)77733 Avenida Madrugada
0147
PERMIT APPLICATION / 7 3 3
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, it 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 it
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 the permit is for one hundred (5100) 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 any manner so as to become subject to the Workers'Compensation Laws of
and effect. California.
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 penally of not more than five hundred dollars (8500:):
❑ I, as owner of the properly, 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. IL however, the
building or improvemnt issold within one year of completion, theowner-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 contractsforsuch projects with a contractor(s) licensed pursuant to the_
Contractor's License Law.).
❑ 1 am exempt under Sec.
Date
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
N,
Certified copy is hereby ereby furnished ,1 f ._ /X
r [ fi`A
D Certified copy Isflled t thellCdy Building Inspection Dep a S entbr CI{y. -+ -+ Degartment.,.T......
Date J i Applicant 1-1 ~
t.-
APPLICANT NAME (L. F. MI)
La Ouinta Joint venture
ADDESS
P.O. BOX 780
La°°C2u ntAa,IP Ca 92253
JO ITE>ADDRESS/SPACE
-133 Avenida Madrugada
CITY/COMMUNITY/S ATE/Z
Isa QuIlntIP a t Ca 92233
BOK
PAG
I PRC
I C
433 Sq. Ft.
TWN
RNG
SE
s
T 4T496'• _
LOT
2
1
M JOD
w
SB
Plan Check Fee
TRACTE
an£Ma Rosa Cove
OWNER NAME (L. F. MI)
CONTNAME
Anagen FIC orporation
?.U. Box 780
% °°qui"n a, Cal 92253
P679-564-13.5
`,333762
-
ARC/ENG FIRM NAME -
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE N
LICNC p
Ei°ngli•amiiy Dwelling
BL
ZON
FSB
SSB
SSB
RSB
OFC
ZONE ORD •
LOT SZ
END
SIDE
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:
❑ 1 hereby certify that no ex6vation 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, Title8,
C.A.C.)
❑ 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.
❑ Division of Industrial Safety Permit No.
Date 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
Lender's
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'tan raut6oriieka"represeentative of the City of La Ouinta Department of Building and Safety.to enter
upon the prl pepy ior 'ichS6h' Je appli d_fg this,permit for the purpose of making inspections X
V U " f5
Sgnalure'b (,AppI i6nt,or• Agent Date
T1 rse
Print Applicant/Agent Name V
APPL/PRMT N! 0147
WA—Ei 6' 8 .
Permit to construct
model P -3-B
Dwelling
1616 Sq. Ft.
Guest Room
277 Sq. Ft.
Garage
433 Sq. Ft.
Patio cover
140 Sq. Ft.
Piech.- Fee
$ 31.00
Electric Fee
31.25
Plumbing ree
52.50
Plan Check Fee
209.00
Building Fee
424.62
Property rev., ree
450.00
.. D ..
• . 01. La %a Liss—
A. n Ir Mm",,A,
Im, 1
•
TOTAL
FEE
$1,P198.37
.
Arrow Printing 250/1-83 White: Finance Canary: Assessor Pink: Applicant, Tag: Bldg. Dept. VALUATION pa / 617 . 00
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
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
I1 `SS Nc
r'Ng/g✓ OiY c5[7L f1L
!!
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 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
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
P/L P/1
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Groundipg Wire•'•. ' ' 1
29B Bonding -',•
30 Fixtures
31 Service
32 Final
I