0338 (SATT)PERMIT. APPLICATION �l ✓C�?�'
City of La Ouinta
' Department of Building and Safety
t
- - This permit becomes void ifwork not commenced within 180 days from date of
issuance; OR; if work has been:suspended or abandoned for a period of 180 days.:
CITY/COMMUNITY/STATE/ZIP
92253 .. .
CERTIFICATE OF F'(EMPTION FROM WORKERS' COMPENSATION INSURANCE: -This section need not be completed if -
LICENSED CONTRACTORS DECLARATION: I hereby affirm that .l am'licensed under provisions of Chapter 9
the,permit is -for -one hundred ($100) o, less. I 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; I shall not employ any person inany manner so a=to become subject to the Workers.Compensation Laws of
and effect.
California.
r
License Class ` Lic. Number
Date Applicant
Date: -- ' ' Contractor: -
NOTICE TO APPLICANT: It, after making this Certificati •.f Exemption, you should become subject to the Workers'
-• •u'
• OWNER -BUILDER DECLARATION:- Ihere" affirm'ihat Lam exempi.tromAlie Contractor's License taw 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 CERTIFICATIF-N:
sugh permit -to file a signed statement that, he..is,licensec! pursuantto the provisions;of the Contraictors License Law
.011 heieby"certify1hat no excavation five (5) or more feetin depth into which a person is required to clescend,will bi-
j(Ch.apter 9 (commencing with section 7000).01 Division Sof the Business and Professions Code) orthat heisexempp } :
made in connection with work authorized by this'permiLand that no building structure, 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 thirt,/-six (36) feet high. (Chap 3.2. Grp 2, Art•2, Sec 341; Title 8:
subjects the applicant to a civil penaltyaitnot more than five hundred dollars ($500.): ;
C.A.C.j
_ O I, as owner of the property..or myemployees with _wages as their sole compensation, will do the work, and.the
..pAs 'owner•builder:' I will;nol employ anyone to do work which' -would requiie a permit from the Division. of
-.structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License . _
'Industrial Safety; as not above, unless such person I as 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
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S1„,031A77
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 or imprqvemni is sold within one year of completion. the oWner-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 There is a co.ostruction 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, ;iv. 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 suchprojects with a contractor(s) licensed pursuant to.the.
,
Coniractor's License Law.). „
Lender's Address
• O 1 am exempt under. Sec.' B..B P.C: (Attached Certificate)..
I certify that I have read,this application and state that he above information is correct.I agree to comply with all
Date" ' Dwner -
city and county ordinances and state laws relating to bLilding construction, and hereby authorize representatives
_`
of this county to enter upon the above-mentioned proprty.for inspection purposes..
WORKERS' COMPENSATION DECLARATION:. I hereby, affirm that I have a certificate of consent to self -insure: ora '
certificate'o1,Workers' Compensation Insurance , or a.certified copy thereof (Sec. 3800: Lab. C.).• - T ,
Signature of Applicant or A'g""enc Date
Policy No. Company. _
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION'OF ENTRY: I certify I have read this application and state that
❑ Certified copy is hereby furnished. ,. ..;; - ... _ •
the information given is correct. I agreedo comply withall state laws and county ordinances relating to buidling .
❑'Certified cLopy is filed with the City Building Inspection.Oepartmen 'or City' ' Department.
construction, and authorize a'representative of the CID, of La Ouinta Department.ot Building and Safety to enter
6-Z 7 �• y j ' �`
upon the. property for whichl have applied,fortfiis permit for the purpose of making inspections. • . .. .
Dati� Applicant - --_
Signature of Applicant or Agent Date
Print. Applicant/Agent Name
APPLICANT rrAME (L, F. MI) ..
La Quanta Joint voiture •
ADDRESS - - • '-
P. O. Bali 780
CITY/COMMUNITY/STATE/ZIP _
La Quintal CA' 92253
50-076 RES_ S SPACE
Ile Rosarita
CITY/COMMUNITY/STATE/ZIP
92253 .. .
BOK
PAG .
PAC ,
C
422' Sq. Ft.
TWIN.
PING
SE ::
S
TRACT.
144954
LOTOD.
145
Construction Fee
373.00..
MM
SB
,
TRACT NAMES�� ..
Santa Pbw
OWNER NAME (L. F. MI( -
CONTRACTOR -FIRM NAME •• -
Xrxlen Oozporatim
ADDRESS
P.. O. Rn 780
CITY/COMMUNITY/STATE/ZIP • --• . .
La•Quinta„ CA 92253
PHONE IrI'
619->564-1315
4`
LICNC +
333762
'ARC/ENG FIRM NAME + .. ..
ADDRESS ,
CITY/COMMUNITY/STATE/ZIP - - -
PHONE 6 w -
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S1„,031A77
LICNC +
'
USE OF PERMIT
BL20N
FSB
Sse,'
- SSB
RSB
OFC ;
.ZONE ORD4 ;�, .-
y
LOT SZ
-
END +
SIDE ,N
APPL/PRMTfl.-9
'DATE
SR LID -19-83 •sE'D ,
Penut to OonstLu L. 1"tich1 P -3—B
"j„ '�'k
Dwel.l.ina
1 f390 Sq. Ft. '
Porch..122
Sq. Ft.
Garage
422' Sq. Ft.
+� 1 1 • r' �,.z + {'k_VALUATION
Mechanical Fee
$ 31:00
Plan Check Fee
242.45
Construction Fee
373.00..
Electrical Fee
31.25
Sidi Fee
5.57 =
Plumbing Fee
48,50...
Property Develcpment Fee 300.00
+.
TOTAL'
FEE
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S1„,031A77
i w Y,
^„',�,
' � 3
"j„ '�'k
i's. -t
� ; ..F _I x, •,i
;. i
� �:•h:'�. _a'1 �� .�.
i � 1 �r-� r .,V'�, .,.�
•
+� 1 1 • r' �,.z + {'k_VALUATION
.
$ 79s103:20
BLDG. DEPT.
NO.
OPERATION DATE INSPECTOR
NO. OPERATION DATE INSPECTOR
BUILDING APPROVALS.
MECHANICAL APPROVALS
1
Set Back
33 Ventilation System
2
Ftgs & frms
/ ///,p
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
Ap kT
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 ADDITIONAL INFORMATION
NO.
//
'i AA ^I
C� 1:251V efl' to
SEWAGE SYSTEM SIZE & LOCATION
/• 6
11 Exterior Lath
12 Internal Lath
12A Drywall 'S
13 Finish Grade
INSULATION Thick Value
7A Walls (Batts)
12B Ceiling (Batts) Ut
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb �i
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer /o'%
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS .
REAR OF PROPERTY LINE
p/L
STREET NAME
P/I
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service ,
32 Final