0320 (SATT)a 5/
PERMIT APPLICATION
-63
City of
La Ouinta
- t Department of Building
and Safety
r•;
C
r. • o - . :This permit becomes void if work not commenced within.,180 days from date of
issuance, OR, if.work has been suspended or abandoned for e,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,lor one hundred.($100) o. less..l certify-tha in -the performance of the work for which -this permit is.
(commencing with Section'7000) of,Division 3 of the Business and Professions Code, and my license is in full force
issued• l shall notemploy.any, person in any manner soasto become subject to the Workers'Compensation Laws of; .
and effect.
California. ,
License Class Lic..Number
Date Applicant
rxDate Contractor
NOTICE TO APPLICANT: If. atter making this Certificate .-t, Exemption. you should become subject to the,Workers' •
OWNER, DECLARATION: I hereby affirm that I am'exempt Irom'the'Contractor's License Law for the .,
' Compensation provisions of the Labor -Code. you must .rthwith 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 CERTIFICATICN:
- suchpermiitofileasignedstatementthatheislicensedpursuanttotheprovisionsoftheContractor'sLicenseLaw .,
01 hereby Certify that no excavation five (5) or more feet n depth into which a person is required to descend, will 66.
(Chapter 9(commencing with section 7100) of Division 3 of the Business and Professions Code) or that heisexempt ...
made in connection with work authorized by this permit and that no building structure, scaffold ing,4alsework, or .
_.
therefrom and the basis forlhe alleged exemption., Any, violation of -Section 7031.5 by any applicant fora permit , .,
demolition or dismantling thereof, will be -more than thirty-siz,(38) feet high. ICh'ap3.2, Grp Z. Art 2, Sec 341; Title 8, .
' subjects the,applicant to a civil penalty of not more than five hundred'dollars ($500.):
C.A.C.)'
0 1, as owner of the property, or my employees with wages as theicsole compensation, will,do the work: and the
0 As owner -builder, 1 will notemploy anyone to do work which' would require a permit from the Division of
• structureJs 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 16 an owner of property who builds• or improves thereon, and who does such work himself or._
v-.. + �--- .,-...,, • • .. .
Division of Industrial_Safety Permit.No.
through his own employees, provided that such improvements are not intended or offered for sale. It, however, the
SSB
building orimprovemntissold within one year ofcompletion,the owner -builder will have the burden of proving that
Date Applicant
he did not build or improve for, the purpose of solei):
CONSTRUCTION LENDING AGENCY: I her affirm that Mere is a construction lending agencyforihe performance' '
• ❑ 1, as owner of the property, am exculsively contracting with licensed contractors to construct the.project (Set::. ..
• of the'work.lor which.lhis permit is issued (Sec. 3097, :iv. C.).
7044. Business and Professions Code: The Contractors 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 •."=
'• •END
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 state that tie above information is correct.) agree to comply with all
Date . `Owner +! -
city and county ordinances and state laws relating to budding construction, and hereby authorize representatives' '
. - - •.of
this county to enter upon the above mentioned prop:rty 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.)r -, •n
Signature of Applicant orAgent " Date
Policy No. Company r
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I'certify l have read this application and state that
0 Certified copy is hereby furnished: .: • - /•�. -
�, /
❑Certified c is filed' d13A it -Buildinginspection Department or C ty Department. ' •_,
p� o
the information given is correct. I agree•to comply with all state laws and county ordinances relating to buidling
:. construction, and authorize a representative. the Cit- of La Ouinta Department -of Building and Safety to enter. ;
V.� . •
�'
upon the property for which I have applied for this pe ralit for the purpose of making inspections.
Date j Applicant
Signature of Applicant or Agent Date
Print Applicant/Agent Name
AP.PIICA TN, NAME (, l.: _F. `ibint ven - - c
tmm
AY.ES0, •BcDc 780
CITY/COMM_ U ta0 ZI, 92253 .
iA
JOB SITE DOREIMCEle a�oWrita•
CTIsV/CGMMUNT y�9ITYta.,. ,ZIPT 92253
`•!'..
BOK "'
PAG
PRC
C
...
TWIN
RNG
SE,
S
f44T96=1 '
178
Plan Check' Fee
271.70
C-3
sB
Electrical. Fee
T�gWA AMEFcosa Ccyive .
OWNER NAME (L. F. MI) '
ironCONTRACTOcbM NAME ipbiatam ..
P°. RESS
U. Bc= 780 '
Com- ITY/COMM_ _ UNIT,Y/ST;TEA 92�53 * '
6 ° 564-�13i5
450.00
L`JNC
33+762
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP • '-
PHONE 1
I.LICNC •
'
USE OF Dw�ellimig _
rBl.
ZONFSB
'SSB
SSB
RSB'
OFC' -
ZONE ORD 1
LOT SZ .
'• •END
SIDE •
T■ ■ DATE
. APPUPRMfl .12
10=-10-83 -
Permit to cmwtruct Mc�•l G -3-A
Dwelling 1,893 Sq.
Ft.
Garage 433 Sq.
Ft. .
-Patio Cover 140 Sq.
Ft.-
Mach. FeeCV
23.00
Plan Check' Fee
271.70
oomtruct•ian Fee
418.00
Electrical. Fee
36.90
SMI Fee
6.62
Plimbi.ng Fee "r
69.00
Property Development Fee
450.00
■` E c
OCT'! 31983
.�'..0 alIP1�� • TOTAL
FEE
511275.22
BLDG. DEPT. '
VALUATION 1$94;617.80 .
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
4
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. ❑
OP'NO. ADDITIONAL INFORMATION,
3/2
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath 3
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick Value/�K
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
25 Final
Tank it L. Line
ELECTRIC APPROVALS
-
REAR OF PROPERTY LINE
p/L P/I
'
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
- 31 •Ser"vice
32 Final