001137 (SFD)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 oP 180 days.
LICENSED CONTRACTORS DECLARATION: khereby affirm that 14m licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
and effect.
License Class Lic. Number
Date — 7 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 per mit 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 penalty of not more than live hundred dollars ($500.):
0 1, 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 i mprovemnt 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.).
0 1, 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. & P.C. (Attached Certificate).
Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to -self -insure, ora
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 Johnson `
ADDRESS P.O. BOX 2288
CITY/COMMUNITY/STATE/ZIP Indio, CA 92201
6
JOB SITE AODRESiS/SPACE
53-3:5 Avenida Ramirez
CITY/COMMUI
La. Quinta, CA 92253
so 4
�NITTY/STATE/ZIP
PA O 1
PRC1 7
C
TWN
RNG
SE
S
TRACT
LOT
6
376.06
MOD
SB
'
TRACT NAME None
OWNER NAME (L. F. MI) Rick Johnson
Illi
CONTRACTOR -FIRM NAME
Rick Johnson const.
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
above
PHONE• 347 ,7171
LS
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE a
1 191.67
LICNC II
USE OF PERMIT '
Single family dwelling
BL
ZON
FSB
I SSB
SSB
RSB
OFC .
ZONE ORD-.
LOT SZ
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSCTION'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 -n become subject to the Workers' Compensation Laws of
California.
Date Applicant
NOTICE TO APPLICANT:.If, after making this Certificate o Exemption, you should become subjectto the Workers'
Compensation provisions of the Labor Code, you must to. thwith comply with such provisions or this permit shall
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATIO 4:
0 I hereby certify that no excavation five (5) or more feet is depth into which a peison 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),4eet high. (Chap 3.2, Grp 2, Art 2. Sec341. Title 8,
C.A.C.)
-O-iAs'owner-builder, I will not employ anyone to do wcrk which would require a permit from the Division of
Industrial Safety, asnotedabove, 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
of the work for which this permit is issued (Sec. 3097, Gv.•C.). .
Lender's Name
Lender's Address
certify that I have read this application and state that IN above information is correct. I agree to comply with all
city and county ordinances and state laws relating to buil ling construction, and hereby authorize representatives
of this county to enter upon the abov"entioned 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 ail state laws and county ordinances relating 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.
l t Signature of Applicant or Agent
-t r Date
�—
Print Applicant/Agent Name
APPL/PRMT n e d l 1' J
1 VE17 ` S 4 S.• D.
Permit to construct 1592 sq.'ft.
of S.F.D. and 91
sg. ft. of
porch and 430 sq.
ft. Ifif garage
as per approved plans.
Mech. Fee
22.00
21an Check'Fee
244.40
Const. Fee
376.06
Elect. Fee'
43.13
SMI Fee
5.64
Plumbing Fee
50.50
Prop. Devel. Fee
450.00
TOTAL'
FEE
1 191.67
BLDG. DEPT. VALUATION 80,628.8 0
�'�
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
S
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.
❑
OPEN ADDITIONAL INFORMATION
NO.
SEWAGE SYSTEM SIZE & LOCATION ,
11 Exterior Lath
12 .Internal Lath
12A Drywall
,
13 Finish•Grade
INSULATION Thick
Value .
7A Walls (Batts)
126 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 APPR VALS
REAR OF PROPERTY LINE
PSL P/I
STREET NAME
26 Power Pole .f 57
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final