0465 (SFD)PERMIT APPLICATION
Date^ ? Applicant /
• City of La Dg a •
Department of Building and Safety
Litt Quintall, CA
7lLr.a,a Jl.Gil
SSISPACE
1 /321 JOB SITE RE�.gNti= n a
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: I,hereby affirm that I 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) of Division 361 the Business and Professions Code; and my license is in full force
issued, I shall not employ any person in any manner so as to become subject to the Workers'CompensationLaws of
and effect.
California.
- License Class Lic. Number
Date Applicant
Date ` Contractor
..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 the 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 requires the applicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
such permit to file a sigped statement that he is licensed pursuant to the provisions of the Contractor's License Law
0 thereby ce . rtify that no iixcaJafion five (5) or more feet in depth into which a person is required to descend,willbe
(Chapter 9(commencing with section 7000) of Division 3 of the Business and Professions Code) or that heis exempt '
made in connection with work' authorized by this permit, and that no building'structlire'scaffolding, falsework, or
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit n
demolition or dismantling thereof, will be more than thirty-six (36) feet high: (Chap 3.2, Grp 2, AA 2, Sec 341, Title 8,
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.): n: t'nt,
C.A.C)
O I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
0 As owner-builder.1 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. 7044, 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. If, however, the
❑ Division of Industrial Safety Permit No.
building orimprovemntissold within one year ofcompletion, the owner -builder will have the burden of proving thaL
Date Applicant
he did not build or improve for the purpose of sale,).
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lend ino agency for the performance
❑ 1, 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 contractors) licensed pursuant to•the
Contractor's License Law.).
Lender's Address
0 1 am exempt under Sec. . B. 8 P.C. (Attached Certificate).
I certify that I have read this application and slate that the above information is correct. I agree to comply with all
Date w Owner
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
SIDE
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; ora
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. •3800. Lab. C.).
Signature of Applicant or Agent bate
Policy No. Company.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION0 ENTRY: I certify l have read this application and state that
O Certified copy is hereby furnished. c. - •. -
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
/
'0 Certified copy istiled with the City Building Inspection Dep.a�yrtment'or)city'2 - Department.
construction, and authorize a representative of;the City of La Ouinta Department of Building and Safety to enter
f flj�jt�*—�
upon the property for which I have applied for this permit for the purpose of making inspections.
APPLICANT NAME ( L, F. MI)
Ancien .. titilm
AODr.R V. B=780
Litt Quintall, CA
7lLr.a,a Jl.Gil
SSISPACE
1 /321 JOB SITE RE�.gNti= n a
cLa E
QuIntao, CA 92253
BOK
PAG
PRC
C
Plan Check Fee
TWN
RNG•
SE
S
TRACT
14,,T4,9.,61
LOT
197
7.39
Plu mbLng Fee
MOD
P-3
Sa
450.00
TRE
/�
Santc?� Cme .
OWNER NAME (L, F. Mq ^
COQ N�T'R�CTOR•FIRM NAME
_ _ b
AS
..
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE*
564-1315
U
LICNC 8
333762
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE 0
;
564-131.5 33762
3
X$1.311.34
M
USE OF with Attached Garage
BL
ZON
FSB
I SSB
SSO
RSB
OFC
ZONE ORD • :
LOT SZ
END
SIDE
Signature of Applicant or Agent
Print Applicant/Agent Name
Date
APPL/PRMT n w g DATE
s�
20,326 Sq. Ft. of S/F/D
Pla mitLy
yto��crostLv
'Atli Attached Garage
Mechanical Fee $
31.00
Plan Check Fee
291.20
Construct ilon Fee
448.00
Electrical Fee
'31.25
SM Fee
7.39
Plu mbLng Fee
52.50
Property Development Fee
450.00
l
ft°
U
1W
e
;TEFF
X$1.311.34
BLDG.DEPT
VALUATION $105,699.40
•
rI
NO.
OPERATION DATE
INSPECTOR
NO. OP ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33 Ventilation. System
2
Ftgs & Frms
s
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
(p
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 ,ADDITIONAL INFORMATION
��2���V'' A ,¢,�.. •
I
/
-51(3 o
•.
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath/
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATIONThickHIV"aluel
7A Walls (Batts)
12B Ceiling (Batts) 111
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 APPROVALS
REAR OF PROPERTY
P/L
STREET NAME
LINE
P/I
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
298 Bonding
30 Fixtures
31 Service
32 Final