SFD (001061)54450 Avenida Madero
001061
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
(commencing with Section 7000) of Division Sof the Business and Professions Code, and my license is in full force
and effect.
r
License Class Lic. Number
Date t f Contractor{ 4 tv - - r -
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 o1 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 (S500.):
O 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.).
O I, as owner of the property, am exculsively contracting with{icensed 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 contractors) licensed pursuant to the
Contractor's License Law.).
O 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 self -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 Certified copy is filed with the City Building Inspection Department or City Department
Date
Applicant
APPLICANT NAME (L. F. MI)
Rick Johns9n
ADDRESS
P.O. Box 2288
CITY/COMMUNITY/STATE/ZIP
Indio, CA 92201
JOB SITE ADDRESS/SPACE
54-450 Avenida Madero
CITY/COMMUNITY/STATE/ZIP
La Ouinta CA 92253
BOK
'PAG
PRC
C
TWN
RNG
SE
S
774
232
009
Plan Check Fee
244.40
Const. Fee
TRACT
LOT
Elect. Fee
43.13
MOD
SB
5.64
I
15 1
Pron. Devel. Fee 450.00
TRACT NAME
Nome
OWNER NAME (L. F. MI)
Rick Johnson; Const.
CONTRACTOR -FIRM NAME
Owner
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
above.
PHONE*
347-7121
LICNC •
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE •
LICNC
USE OF PERMIT
S.F.D.
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 if
the permit is for one hundred ($100) 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: 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:
O 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 B,
C.A.C.)
O 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.
O 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 Name
Lender's Address
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. I agree to comply with all state laws and county ordinancesrelating 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
Ix
jPrin( Applicant/Agent Name
iAPPL/PRMT
OfIl +.1
DATE
11`20-84
$.F.D.
Perot to construct 1592
sq. ft.
of S.F.D., 91 sq. ft. of
porch
and 430 sq. ft.
of garage as per
approved plans.
Meth. Fee
22.00
Plan Check Fee
244.40
Const. Fee
376.00
Elect. Fee
43.13
SMI Fee
5.64
Plumbing Fee
50.50
Pron. Devel. Fee 450.00
PAID
NOVZ9
TOTAL
FEE
VALUATION a u ,,d9 .00
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
-5-
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.
❑
NOADDITIONAL INFORMATION
f
/ f
cid// e v c,2111
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lathy
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 7Final-
PLUMBING APPROVALS
15 Ground Plumb D
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal c2
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
PSL P/l
STREET NAME
26 Power Pole 2 7
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
\FIEp
r . % o
a BERMUDA DUNES r
RANCHO MIRAGE
INDIAN WELLS H
PALM DESERT a
%% LA QUINTA
' INDIO y
Desert Sands Unihed School District
82-819 HIGHWAY 111 O INDIO, CALIFORNIA_ 92201-5678 • (619) 347-8631
November. 26, 1984
City of La Quinta
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
Re: Lot 15, Block 261, Santa,.C.armelita at Vale La Quinta, Unit No. 24
Gentlemen:
The developer of the above referenced lot
has mitigated its impacts on our overcrowded schools by payment
of the amount of $628 per unit to be applied to the cost of
district educational facilities made necessary by such new
development.
Sincerely,
y
John D. Brooks
Assistant Superintendent
Business Services
JDB/crm