0467 (SFD)PERMIT APPLICATION'
City of La Ouinta
Department of Building and Safety
This permit becomes void if work not commenced within 180 days from date of issu
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions'of Chapter 9
(commencing with Section 7000) of Division 301 the Business and ProfessionsCode; and my license is in full force
and effect.
LicenseClassLic. Number
Date Contractor
OWNER-BUILDIR 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 permit 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 703.1.5 by any applicant for a permit
subjects'the applicant 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-build9 f will have the burden of proving that
he did not build or improve for the purpose, of sale.). Ed
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, ora"
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.).
Policy No. Company
0 Certified copy is hereby, furnished.
1
D Certified copy is filed with tfie'City,uilding Inspection, or City Department. ,
Date / 0 -1 Applicant
1 L
APP_ LICANT NAME (L, F. r
ncLen atim
ADDRESS '.
P. O. Boli 780
C_ a COM_ M ntao.ao. E�/ZC
�DD�R•E�.GS��iS�..GiItUS:✓`L'L
09'2253
JOB SITE J-34 � � .. tam
CITY/COMMUNITY/STATE/ZIP
La Qainta, CA 92253
BOK
PAG
PRC
C
31.00
TWN
RNG
SE
S.
TRACT
14496-11
LOTMOD
199
SMI Fee
7.39
P-3
SB
Property Develormnt Fee
TRACT NAME (�.��
Santa Rosa. (�
OWNER NAME (L. F. MI) -
C__ONTRACTOR-FIRM NAMEam ..
As�R7Ir•.AVJKYri.�
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE •
564-1315
I -
I LICNC II
333762
'
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE N
City ®P A. (F1'a.�� TOTAL
FEE
LICNC ,
-
USE OF PERMIT
S/F/D with Attacbed Garaicie
BL
1
1 ZONF%B
SSB SSB
RSB
OFC
ZONE ORD , -
LOT SZ
END
SIDE."
ante, OR, if work has been suspended or abandoned for a period.of 180 days. :+
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section neednot be completed if
the permit is for one hundred ($100)'x, less. I cenifythat in the performanceof the work for which this permit is '
issued, I shall not employ any person i n any manner so as to become subject to the Workers' Compensation Laws of
California.
Date Applicant
NOTICE TO APPLICANT: If, 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 1 hereby"certify that no excavation five (5) or more feet in depth into which a person is required to descend. w ill be .>A
made in connection with work authorized by this permit; and that no building structure, scaffolding, falsework, or
demolition tt dismantling thereof, will be more than thirty-six (36) feet high. (Chap 12, Grp 2. Art'2, Sec 341, Title 8'
C.A.C.)
0 As owner -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.
Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the perforinance
of the work for which this permit is issued (Sec. 3097, Civ: C.).
Lender's Name
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
,o 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 l have read this application and state that
the information given is correct. I agree to comply with all state laws and county ordinancesrelating 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'l have applied for this permit for the purpose of making inspections.
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPL/PRMT DATE
12--28-•83
S/F/D
Pewit to c;onstn=t 2,326 Sq. Ft.
of S/FJD
with Attached Garage
Mechanical Fee $
31.00
Plan Check Fee
291.20
Construction Fee
448.00
Electrical Fee
31„25
SMI Fee
7.39
Plumbing Fee
52.50
Property Develormnt Fee
450.00
City ®P A. (F1'a.�� TOTAL
FEE
$1F311.34 y.
VALUATION $105 ,699.40,
J
r
Ah
NO.
OPERATION DATE
INSPECTOR
NO. OP TION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33 Ventilation System
2
Ftgs & Frms
34 Plenums & Ducts D
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
/d o%
��
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.
❑
NoADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE &LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick Vaalulu e
7A Walls (Batts)
12B 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 42,4
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
P/L• P/I
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
296 Bonding'
30 Fixtures
31 Service
32 Final
STREET NAME