SFD (001321)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. '
LICENSED CONTRACTORS DECLARATION: I hereby affirm'that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3of the Business and Professions Code• and my license is in full force
and effect.
License Class Lic. Number' /
Date Contractor
r •r. 1
OWNER *BUILDER DECLARATION: I hereby affirm that I am eiiempt from the Contractor's License Law for the
following reason (Sec. 7031.5, Business and Professions Coder 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 pursuantto the provisions of the Contractor's License Law'
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code)orthat he isexempt
therefrom end the basis•for the alleged exemption. Any violation of Section7031.5.by any applicant for a permit
subjects the If
to a civil penalty of not more than five hundred dollars ($500):
0 I. as owner o1 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 MLIhave 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.
B. 8 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 Woikers' Compensation Insurance or a certified copy thereof (Sec: 3800. Lab. C.).
Policy No. Company
0 Certified copy is hereby furnished. ..
0 Certified copy is filed with the City Building Inspection Department or City. Department:
Date Applicant
APPLICANT NAME (L. F. MI) Rick Johnsm Cbri t. -
"ADDRESS '
P.O. Box 2288
CITY/COMMUNITY/STATE/ZIP
Im io, CA 92201
JOB SITE ADDRESS/SPACE 54-215 Avenida Mendoza
CITY/COMMUNITY/STATE/ZIP IJa 6Cu••:nta,` CA 92253
BOK
774
PAG
22
PRC
020
C
Elect. Fee 68.75
7 W-
RNG
SE
S-
TRACT
LOT
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-
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MOD
SB
TRACT NAME '
OWNER NAME (L. F. MI)
CONTRACTOR -FIRM NAME -
applicant
ADDRESS .
above
CITY/COMMUNITY/STATE/ZIP -
abow
PHONE . r
347-7171
LICNC 8
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP . .
PHONE N
LICNC 0
USE OF PERMIT
sirmtl a family awellinq
81.
ZON
FSB
SSB I
SSB
RSB
OFC.11
ZONE ORD 0 .,
LOT SZ
.END
• SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE: This section need not be completed if
the permit.is lor•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: 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 I hereby certify that no excavation live (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, Gep 2, Art 2, Sec 341; Title 8,
,r. C.A.C.)
•0 As ownei-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: I hereby affirm that there is a construction lending agency for the performance
of4he work for which this permit is issued (Sec. 3097, Civ. C.).
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) 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; and: authorize a representative of the City of La Duinta Department of Building and Safety to enter
upon the property for which I have applied for this permit for the*purpose of making inspections. -
rYiw �� Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPWRMT , i fl1 J7 4—fV85 S.F.D.
Pem it to • ocrostruct 1592 sq. ft. of hawse
with 277 sq. ft. of porch and• 430 sq. ft.
of garage as P?•r'ap Pte•
Meeh. Fee 40.00
Plan Cbeck Fee 326.58'
Const. Fee 388.00
Elect. Fee 68.75
SMI Fee 5,95
Plumbing Fee 89,00
Infrastructure Fee 40-00.00
TOTAL
FEE
2 918.28
..A0676 4 15
BLDG. DEBT.
2.9.
VALUATION 84,248.00
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.
❑
NO.
NO.
ADDITIONAL INFORMATION
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 jam'!( 7` `
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
PSL P/I
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
IED
o
:
—0
y BERMUDA DUNES r
RANCHO MIRAGE
t' INDIAN WELLS H
PALM DESERT a
-P LA OUINTA
''gyp INDIO
April 18,1985
Desert Sands Unified School District
82-879 HIGHWAY 11 1 O INDIO, CALIFORNIA 92201-5678 • (619) 347-8631
City of La Quinta
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
Re: 54215 Mendoza,--LaQuinta t 54225.Mendoza, La Qunita
Gentlemen:
The developer of the above referenced 54215 & 54225 Mendoza, La
Quinta
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 faci'li'ties made necessary by such new
development.
Sincerely,
�VJ
John D. Brooks
Assistant Superintendent
Business Services
JDB/crm