001320 (SFD)PERMIT APPLICATION
City of
La Duinia
- Department of
Building and Safety
This permit becomes void if work not commenced within 180 days from date of issuance, OR, ibwork 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 P am licensed .under provisions. of Chapter, 9
the permit is for one hundred ($100) o, less. I certify that in the performance of the work for, which this permit is
(commencing with Section 7000) o1 Division 3 of.the Business and Professions Code, and my license is in full force
issued. I shall not employ any person.inany manner so as to become subject tothe Workers'Compensation Laws of
aAd effect.
California.
/.License Class Lic, Number
Date Applicant -
Date Contractor
NOTICE TO APPLICANT: If; alter making,this.Certificate of Exemption; you should become subject to the Workers'.
' OWNER -BUILDER DECLARATION: I hereby:aflirm that 1 am exempt from the Contractor's License' Law for the
Compensation,provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall . .
be deemed revoked.
following reason -(Sec. 7031.5. Business and Professions Code: Any city.or county which requires a permit to
TRACT NAME ,
construct, altei, improvedemolish, or repair any structure, prior to its issuance, also requires the applicant for - •
DIVISION OF.INDUSTRIAL SAFETY PERMIT CERTIFICATION: .
sychpermit to file a signed statement that he islicensed pursuant to the provisions of the Contractor's License Law-
0 1 h6ieby certify that no excavation five (5) or more feet in depth into Which a Person 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 permit, and that no building structure, scaffolding, falsework, or
therefrom and the basis for -the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit-
demolition or dismantling thereof, will be mole than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art.2, Sec 341, Title 8;
subjects the applicant to a.civil penally of not more than five hundred dollars (SWO.):
D.A.D.) xo..
•O I, as owner of the property, or my employees with.wages as their sole compensation, will do the work,and the .
O.As owner -builder, I will not employ anyone to do work which would require a permit from the Oivision'of
structure is not intended oroffered for sale (Sec: 7044. Business and Professions Code: The Contractor's License.
IndustrialSafety, 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..
m
through his own employees, provided that such improvements are notilitended or offered for sale: If; however, the,
O Division of Industrial Safety Permit No.
building or improvemnt is soldwi!hih one year of completion. the owner -.builder -will have the burden of provingthat
Date Applicant
- he did not build or improve for the purpose of sale.). I;
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
O 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. Q.
' 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
- ZONE ORD II
Contractor's License Law.)..
Lender's Address
J O 1 am' exempt -under Sec. B.,B P.C. (Attached,Certificate). ,
I certify that I have read this application and state that the above information is correct. I agree to comply with all '
tt
t Date " °`!� S Owner 4'= Gam-' ^
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: Ihereby affirm that I have a certificate of consent to self -insure, ora
.. '
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800YLab. 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
O Certified copy is hereby furnished.
the information given is correct. I agree to comply with all statedaws and county ordinances relating to buidling
'O 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 t e pro erty for whit I have,applied for this permit forlhe purpose of making inspections. -- , ..
Date Applicant
O•-
4 c
' Sigture of Applicantor Agent Date
Print Applicant/Agent Name
APPLICANT NAME (L.'F, MpFloyd Cash
ADDRESS 78-341 Darby lbad
CITY/COMMUNITY/STATE/ZI, � [fp22�o1,�s�
,108 SITE ADORESS/SPACE 52-175 Aver • A.iCL7 F. -mirex
Avenida
CITY/COMMUNITY/STATE/ZIY ^ �ta` CA '92253
8073
PAG
PRCGlALl
L
C
TWN .. -
RNG
SE ..
. S
TRACT ..
LOTMOO
Cmst. Fee 355.00
-,
Elect. Fee 67.04
S8
SMI Fee 5.H
TRACT NAME ,
OWNER NAME (L. F. MI) App,calt
CONTRACTOR -FIRM NAME .. . -
applicant '
ADDRESS ^��
VV
�G .
CITY/COMMUNITY/STATE/ZICdNP,
PHONE a
LICNC e
2,580.27
ARC/ENG FIRM NAME -
ADDRESS '
CITY/COMMUNITY/STATE/ZIP
.PHONE M
LICNC
USE OF PERMIT
single -family duelling
BL
ZON
-.FSB
SSB
SSB'.
'•RSB
-
OFC
.
- ZONE ORD II
- LOT SZ^:.p:
.END
SIDE, .
APPL/P,RMT !9.� d?fl (�A� 185
S.F.
Permit to construct 1412 sq. ft.
of house
plus 176 sq. ft. of porch and 440
sq. ft.
of garage as per approved plans,
Mech."Fee 25.00
Plan Cbeck Fee 297.08
Cmst. Fee 355.00
-,
Elect. Fee 67.04
SMI Fee 5.H
Plwtt. Fee. 81.00
Infrastructure 2,000.00
;M
2,830.27
250.00 DEPOSIT PAID
2,580.27
TOTAL.'
2,830.27
_.
A 0 6 4 4 4 11. 25
VALUATION 73j976.00'
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
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.
❑
NPON
ADDITIONAL IN MATION
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 A P OVALS
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 q
25 Final
Tank Pit L. Line
.ELECTRIC
APPROVALS
REAR OF PROPERTY LINE
PSL P)
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final g
4
i.�+��*' R f ..5 fr-
Desert Sands. ti. ed School District
y'BERMUOA DUNES r
-? c ,--
RANCHO'MIRAGE C' 82-879 HIGHVV i-1 O INDIO, CALIFORNIA 82201-5678:A (619) 347-8631
' "INDIANMELLS' ,y
PALM=DESERT. a
Ap.r 11 2,; 1985 ,
-P LA-OUINTA
INDIO
City of La: `Qui
nta
Department" of•Community-Development
78-105 Calle Estado
La Qui'nta, CA'9.2.253
Re: Block 78,
Un i.t 10, Lot 9;, . La_ Qu i nta
Gentlemen:
The- developer
of t.h.e.above. referenced lot
has mi,ti:gated,
its. impacts on our overcrowded schools,,by"payment
of the amount
of'$628 per. unit to. be'.app°lied to the. cost of
district, educational
.facil f t es made necessary by such new
development.
-;Sincerely,`
John D-. Brooks .
,Ass,i scant Super n.tende.nt
$usiness.Services
JDB/crm