SFD (001138)53360 Avenida Martinez
001138
PERMIT APPLICATION
City of La Duinta
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: 1 hereby affirm that I am licensed under provisions of Chapter 9 the permit is,for one hundred ($100) o. less..) 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. [shall not employ any person in any manner so as to become subject tothe Workers'Compensation Laws of
and effect. F"( .7 ! L S California.
License Class Lid. Number I Date Applicant
Date f Contractor_ ° j• - 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 tAe 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 reljuires the applicant for'. DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
such permit to filea.signedstatementthatheislicensedpursuanttotheprovisionsoftheContractor'sLicenseLaw 01 hereby certify that no excavation five (5) or more feet in depth into which a f5erson 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 peimit, and that no building structure, scaffolding; falsework, or '
therefrom and the basisfor the alleged exemption. Any violation of,Sect(on 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, Sec 341, Title 8. *+
subjects the applicant to a civil penalty of not more than live hund(ed.dollars (5500.): " C.A.C.) -
O I. as owner of the properly, or my employees with wages as their sole compensation, will do the work; and the . ❑ 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. 70.44, 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, and who does such work himself or
through his own employees. provided that such improvements are not intended or offered for sale. It, however, the O Division of Industrial Safety Pprrmit No.
building orimprovemntissold within one year ofcompletion. 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 agencyfor-the performance
0 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 Lender's Name
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.). _ Lender's Address
❑ 1 am exempt under Sec. B. 8 P.C. (Attached Certificate).. I.certify that.l have read this application and state that the above information is correct. I agree to comply with all,
DateOwner 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. I 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 prop erty.forwhich I Have applied for this permit.for the purpose of making inspections.
Date Applicant
Signature of Applicant or Agent Date
/Print Applicant/Agent Name
i
APPLICANT NAME (L. F. MI) -
Rick Johnson
ADDRESS
P.O. Box 2288
CITY/COMMUNITY/STATE/ZIP -
Indio, CA 92201
JOB SITE AOORESS/SPACE '
53-360 Avenida Martinez
CITY/COMMUNITY/STATE/ZIP -.
La Quinta, CA 92253
BLOK
714
PAG
092
PRC
006
1 '
TWN
RNG
SE
s
TRACT
I LOT
19
Elect. Fee
MOD .
1
I SO •
_
TRACT NAME None'
OWNER NAME (L. F, MI) Rick Johnson
CONTRACTOR -FIRM NAME Rick Johnson. Const -
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP _
above
.PHONE.
347-7171
NC
LIC39#7169
pA
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE N
TFEE •
LICNC I
,
USE OF PERMIT
BL
ZON
FSB
SSB
SSB
'RSB
OFC.
ZONE ORD M
-
LOT SZ
END
SIDE ,
APPL/PRMT ICA—E17-84 S. F. D.
XMIN Permit to construct 1592 sq.
ft. of S.F.D. and
91 sq. ft. of
pOorch and 430 sq.
ft. of garage
as per approved'plans.
Mech.'Fee
22.00
Plan Check Fee
244.40.
Const. Fee
376.00
Elect. Fee
43.13
SMI Fee
5.64
Plumbing Fee
50.50
Prop. Devl. Fee
450.00
pA
.
TFEE •
1,191.67
BLDG.DEPT.
VALUATION 80,628. i0l
NO.
OPERATION
DATE INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms/02
.'j
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
o2
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. '❑
NON
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath r
12A Drywall raj b
13 Finish Grade
INSULATION Thick al
Value
7A Walls (Batts)
126 Ceiling (Batts)_ •• '•
12C Ceiling (Blown) ..
14 Final
- ; L•UMBING APPROVALS
15 Ground Plumb r
r
16 Water Piping ¢
17 Rough Plumb / �3
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
PSL
STREET NAME
LINE
PiI
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring 2
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
f1E0 S
o
_
-0
y BERMUDA DUNES r
RANCHO MIRAGE
INDIAN WELLS H
PALM DESERT'
LA OUINTA
p INDIO
Desert Sands Unified School District
82-879 HIGHWAY 111 O INDIO. CALIFORNIA 92201.5678 • (619) 347-8631
December 19, 1984
City of La Quinta
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
Re:Lot 9
Lot ,;Z, Block -212, Santa Carmelita Valle, La Quinta, Unit No. 20
Gentlemen: 5 3 -.3 6'0 Ck- , Yv-\
The developer of the above referenced home
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.
JDB/crm
a
Sincerely,
John D. Brooks .
Assistant Superintendent
Business Services