0340 (SFD)PERMIT APPLICATION r 5-bV C3
-t City of
La Ouinta
Department of Building
and Safely. 4, .4
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 Jeriod of 180 days. -
PRC
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed it..
LICENSED CONTRACTORS DECLARATION: I.hereby affirm that *l am-licensed'under provisions -of Chapter -9
thepermit is for -one hundred ($100) o; less. I certify that n 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, I shall not -employ any person in any manner so as t:) become subject to the Workers'.Compensation Laws of
and effect.
California.
.License Class Lic. Number
Date Applicant
Date Contractor
NOTICE TO APPLICANT'If, after making this Certificatelo- Exemption, you should become subject to the Workers'.. -
OWNER -BUILDER DECLAIIATIOk. Thereby 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
be deemed revoked
following reason (Sec. 7031.5. Business and Professions Code: Any -city or county which requires a permit to
OWNER NAME (L. F. MI)
construct, alter, improve, demolish: or repair any structure, prior to its issuance, also requires the applicant for
DIVISION OE INDUSTRIAL SAFETY PERMIT CERTIFICATIOA:
such permit to I - ile asigned statement that he is licensed pursuant to the proyis ions of,the Contractor's License Law•
0'1 hereby certify that no excav . atiorffive (5) or more feet i i depth into which aperson is required to descend. Will bd,
-(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) or that he is exempt
made in connection with work authorized by this pbrmil, -nd that no building structure, scaftolding,.falsework.or
- therefrom and the basis for the alleged e i xemplion. Any violation of Section 7 031.5 by any applicant for a permit,
demolition ordismiiintling thereof, will be more lhanthirt�,-six (36) feet high. (Chap 3.2, 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.) A
0 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
0 -As owner -builder, I will not employ anyone'to'do work which would'require a permit from the Division of 't
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License
Industiial Safety, as noted above, unless such person Kos 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
-'. . . I . 4. 1
through his own employees, provided that such improvements are not intended or offered for sale..If; however, the
I? Division of Industrial Safety Permit No.
building_or improvemnt is sold within one year of completion. the oYmer-builder will have the burden of proving that -
-Date Applicant.
he did ,not. build or improve for the purpose of sale.).-.
CONSTRUCTION LENDING AGENCY: I hereby affirm that dere is a construction lending -agency for -the performance
0 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, G iv. Q.
7044. Business and Professions Code: The Contractor's License.Law does not apply to an owner of property who.
Lin.der's Nam.
builds or improves thereon, and who contracts.for such projects with a contractor(s) licensed pursuant to.the
Contractor's License Law.). t,
Lender's Address
4
0 1 am exempt under Sec.B. & P.C. (Attached. Certificate).
I certify that,I have read this application and state that Ile above information is correct. I agree to comply with all
Date Owner-
city and county ordinances and state laws relating to bu Iding construction, and herebyauthorize representatives
of this county to enter upon the above-mentioned property for inspection purposes.
WORKERS' COMPENSATION DECLARATION: thereby affirm that I have a certificate of consent to self -insure, or a -
certificate of Workers' Compensation Insurance . or,a,certified,copy thereof,(Sec. 3800. Lab. C.). t .. .1
Signature of Applicant 6r Agent' Date
Policy No.Company
-CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF,:NTRY*: -1 certify I have read this application and state that 't - -
• 0 Certified copy is hereby furnished.
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
0 Certified Building I - nspection'Department;df. City Department.
construction, and authorize a 'represqqlative of the Cit- of La Ouinta Department of Building and Safety to enter
/..) . -� T .., .1
upon,the property for which I have applied for this permit for the purpose of making inspections..
_
Date' Applicant"&=4
Signature of Applicant or Agent Date
APPLICANT NAME (L. F. MI)
La Qu4ita Joint Vmftze
ADDRESS
P" 0, Box 780
CITY/COMMUNITY/STATE/ZIP
La Quintao, CA 92253
JOB S ODREWSP C
56:4.3fa CaUe Rosaifta
CITY/COMMUNITY/STATE/ZIP
La Quinta# CA 92253
SOK
PAG
PRC
C
.Garage
TWN
RNG
SE
S
.TRACT
14496=11
LOT
1141
1.- ''IP
MOO.
-1
so
-31,25
TRACT NAME -
S-
. anta Pima Com
OWNER NAME (L. F. MI)
CONTRACTOR -FIRM NAME
&x1m Corporation
ADDRESS
P. 0. B= 780
CITY/COMMUNITY/STATE/ZIP
La Quintas, M 92253
PHONE a
-619-564-1315
Nc -
33376 2
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE 0
LICNC P.
Is .1 #201;.85
USE OF PERMIT,
Single Fatly Dwelling
OL
ZON
FSB
SSB -
sse
FISS
OFC
SIDE
ZONE ORD LOT SZ ND
E
14—
Print Applicant/Agent Name
APPL!PRMT
n3
DATE
4010-�19_0 sni
Penlit to C=tn=t MOLL -1 P -1-A
Dwelling
1#481: Sq. Ft..
Porch
3.12 Sq* Ft,
.Garage
.422 S4,
VAchmical Fee'
31.00
Plan Meek Fee
0onstructim Fee
385900
Electrical Fee
-31,25
SMI Fee
5,85
48.50
Property Development Fee 450,00
TOTAL
FEE
Is .1 #201;.85
BLDG. DEPT.
V* T_ VA
L-LiATION
1$ 83v889
.7-
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
! 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.
❑
OP'N
NO.
ADDITIONAL INFORMATION
P
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal LathFf%
12A Drywall
13 Finish Grade
INSULATION Thick
VaR lue
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 ZV -�{
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
PSL P/I
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final