0343 (SFD)PERMIT APPLICATION �) `P
City of La Ouinta
Department of Building and Safety
, This permit becomes void it work not commenced within 180 days from date of issuance, OR, it 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 3 o the Business and Professions Code, and my license is in full force
and effect.
License Class Lic. Number
Date 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 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 3of the Business and Professions Code) or,that he is exempt
therefrom and the basis for the alleged.exemption. Any violation of Section 7031 S;by any applicant for a permit,
subjects the applicant to a civil penalty of not more than five hundred dollars:(S5g0.):
❑ L. 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, andwho does such work himself or
through his own employees, provided that such improvements are not intended or offered for sale. It, however, the
building or i mprovemot is sold within one year of completion, the owner -builder will have the burden of proving that
• he did not build or improve for thepurpose of sale.).
❑ 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.). ..
❑ 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
❑ Certified copy is hereby furnished.
.0 Certified copyyis filed wit the City Building Inspection De artment,or City ' > Department.
Date !� CEJ �. .�✓� Applicant --
T NAME (L, F. ijit N
v entxze
(Y0.µ1+11+T1•Bim
�A, yPPLICA�N,_
P. 780
CITY/COMMUNITY/STATE/ZIPYy�y�yy_,irrt^C922533
1.%iBit/
SITE AD -V Vtii�RC E%Y 1 Plc''ita
CITY/COMMUNITY/STATE/ZIPLL __gP 922 53
i�GPACC
BOK
PAG
(2nd Floor)
C
Porch
TWN
RNG
SE
S
���laa4496-11�
vechanical Fee
$ 31.00'
Plan Check Fee
P-3
SB
418,00
rye`°150
SSantaTRACT ME� Cove
OWNER NAME (L. F. MI) -
CON„T�IMTOR-FIR_- M NAM�m
(yva�'1"�iY�
ADDRESS '
P. 0. Bay 780
LCITY/COMMUNITY/STATE/ZIP
__ f�.
*t+�n•� \d] 92253
PHONE •
619-564-1315
Property Development Fee 450.00
LICNC 0
333762
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE M
LICNC •
Is 1„311.34
USE OF PERMIT • .
+6 I - y � JT
4i
BL
ZON
FSB
S1S"TBt-fr
SSB
RSB
OFC
ZONE ORD 0
LOT SZ
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE:. This section need not be completed if
the'permit is for one hundred ($100) o, less. I certify that ii the performance of the work for which this permit is:
issued, I shall'not employ any person in any manner so as tc 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 forhwith comply with such provisions or this permit shall
be deemed revoked.
DIVISION OF. INDUSTRIAL SAFETY PERMIT CERTIFICATION:.
'0 I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be
made in connection witfi woik authorized by this permit, and that no building structure, scaffolding, falsework, or
demolition or dismantling thereof twill be more thawthirtysix (36) feet high. (Chap 3.2. Grp 2, Art 2, Sec 341, Title 8,
C.A.C.)
O As owner -builder, (will not employ anyone to do.work which would require a•permiffrom the Division'of
Industrial Safety. as noted above, unless such person has a•permit to do such work from that division.
O Division of Industrial Safety. Permit No.
Date Applicant • '
CONSTRUCTION LENDING AGENCY: I hereby affirm that thre 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
I certify that I have read this application and state that tN above information is correct. I agree to comply with all
city and county ordinances and state laws relating to buiding construction; and hereby authorize representatives.
• of this county to enter upon the above=mentioned "property for inspectiorf purposes. -
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF 1 NTRY: I certify I 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 Ouinta Department of Building and Safety to enter
upon the property for which I have applied for this pernit for the purpose of making inspections.
Signature of Applicant or Agent Date
Print Applicant/Agent Name
. APPL/PRMT
- DATE
_0^19-83 SFD
Pe nit to Cmis rust Model P-3- A
Dwe-11(1st Floor)
1,616 Scl. Ft.
(2nd Floor)
277 Sq. rt.
Porch
112 Scl, Ft.
Garage
433 Sq. Ft.
vechanical Fee
$ 31.00'
Plan Check Fee
291.20
Constructicin Fee
418,00
Electrical Fee
31,25
SNI Fee
7.39
Plumbing Fee
52.50
Property Development Fee 450.00
TOTAL
Is 1„311.34
BLDG. DEPT.
VALUATION $105,699.40
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
I
35
Furnace Compart.
3
Steel
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
8
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.
❑
UPNADDITIONAL INFORMATION
% G,
i7/a C�� S,C �•,d �\d� 00
� � 4
^c'
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
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 /r
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
e
PSL PA
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final