0337 (SFD)t ' _ PERMIT APPLICATION^
City of La Ouinta
, - Department
of Building and Safety
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:S This -permit becomes void if work not commenced within 180 days from date
of issuance. OR, it work has been•suspended or abandoned bf. a period of 180 days..
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CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE:.This section need not be completed if •` a:-
-LICENSED CONTRACTORS DECLARATION:I "hereby affirm that. I am licensed under provisions..of Chapter9
the permiCis for.one hundred ($100).o, less: I certify :hat in the performance of the work for which this permit is
^ (commencing with Section 7000) o1 Division 3 of the Business and Professions Code, and my license is in full force
issued. I shall not employ any person in any manner s.. as to become subject to the Workers'Compensation Laws of •�
and effect.
California. '
License Class Lic. Number
Date Applicant
-•->-Date • Contractor
NOTICE TO APPLICANT: If, after this.Certificleof Exemption,,you shauld,become subject to the Workers'-
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' OWNER -BUILDER DECLARATION:' I hereby affirm that I am exempt from the Contractor's License Law for the
Compensation provisions of the Labor Code, you mu :t forthwith complywith Such provisions or this permit shall
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following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to
be deemed revoked.
construct, alter, improve: demolish, or repair any structure, prior to its issuance, also requires the applicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICFTION:
such permil-to file 9signed statement that he is licensed pursuant to the provisions of.the Contractor's License Law
171 hereby certify that no excavation five (5)ormore f-etindepth into which'aperson isrequired todescend, will be "
,(Chapter 9(commencing with section 7000) of Division 3 of the Business and Professions Code)orthat he is exempt
made in connection with work authorized by this permit; and that no building structure.scaffolding,talsework, or •'
Z, therefromand the basis.for.the alleged exemption. Any. violation of Section 7031.5 by any applicant for a permit ...
- demolition or dismantling thereof, will be more than$ irty-six'(36)•feet -high. (Chap 3.2, Grp 2• Art 2; Sec341, Title 8,
•. subjects the applicant to a civil penalty of not more than five hundred dollars (WO.):•E
C.A.C.) ' ' ' .. •
❑ I, as owner of:the property. or•my employees with wages as their sole compensation, will do the workyand the :
:0 As owner -builder, I'will'not -employ anyone to If s work which would require a permit from the Division of
structure is not intended or offered for sale (Sec: 7044. Business and Professions Code: The Contractor's License
Industrial Safety, as noted above, unless such perscn has 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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' 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 orimprovemntissold.withinone year ofcompletion. 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: 1 hereby affirm th it there is a construction lending agency for the performance
❑ 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. 309; Civ. 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'conlracts for such projects with a contractors) licensed pursuant to the .
• Contractor's License Law.)..
Lender's Address
• :. ❑ 1 am exempt under Sec. B. 8 P.C. (Attached Certificate).
- I certify that I have read this application and state that the above information is correct.,I agree to comply with all
Date ' Owner ' rtl
- city and county ordinances and state laws relating to wilding construction, and hereby authorize representatives,, ,
of this county to enter upon the above=mentioned property for inspection purposes..
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell -insure, ora'
certificate of Workers" Compensation Insurance .Or a certified copythereof (Sec: 3800. Lab. C:).
- Signature of Applicant or Agent Date
Policy. No. Co mpany
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CERTIFICATE OF COMPLIANCE AND AUTHORIZATION IF ENTRY: I certify l have read this application and state that'.
O Certified copy.is•hereby furnished.- .:
the information given is correct. I agree to comply wah all state laws and county ordinances�relating to buidling ;
❑ Certified copy is filed with the City Building Inspection Department or City Department.
_construction, and authorize a'representative of the City ofLa Duinta,Department of Building and Safety to enter
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upon the property for which I have applied for this permit for purpose of making inspections.
Applicant -_
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Signature of Applicant or Agent Date
Print Applicant/Agent Name J
APPLICANT.NAME
'y„•ta Jo
La nft Venb=e '
ADDRESS.
P. O. Bloat 780 •
CITY/COMMUNITY/STATE/ZIP • '
La Quints, CA 92263 '
JOB SITE DRESSISPACE - '
5U-08VAildppOSa ita
CITY/COMMUNITY/STATE/ZIP ' -
La Quinta, CA 92253
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•RNG
SE '•.
S.
TRACT .LOT
14496-1
144
242.45
'.
MOD
P-2
s8
31,25
TRACT NAME
Santa p�osa C&ve
OWNER NAME (L. F. MII - '
A�CONTRACTOR-FIRM NAME y,' .. .. . -. -
Silli.it:.il C7ox�aorau
ADDRESS
P. O. Baal 780
CITY/COMMUNITY/STATE/ZIP -
La Quinta, CA 92253
PHONE NLICNC
G19-564-1315
N
333762
.ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE N
`
LICNC N
> 1i031r.77
USEOF PERMIT Single Fanly DA__ • ' .. ,
BL
ZON
FSB
'SS8.
,SSB.'
RSB
OFC
ZONE ORO N
LOT SZ
--, •END
SIDE . •. -:,
APPOPRMT - A 11 ry 7
1"C4T 83 S .
Permit to Gm tract Model. P -2-A
Dwelling
1,390 Sq. Ft.
Porch -.
112 Sq, Ft, .
Garage
422 Sq. Ft. ;
Mechanical Fee
$ 31; 00
Plan Cock Fee'
242.45
Oanst ructim Fee
373.00
Electrical Fee
31,25
.M Fee
5.57 y
Plumbing Fee
48.50 '
Property De�Fee 300,00
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TOTAL
• FEE
> 1i031r.77
BLDG.DEPT.
VALUATION 79,103.2{3: ' ',tJ-,
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*AW
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.
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OP•N ADDITIONAL- INFORMATION
NO.
71,1 7�4
r`)
`Q
(� el
`-/del" Cal
Old
� 665 � J
Ge�xxnr.Q JrC
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION, Thick R Value
7A
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. 3 �{•
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 P/I
f
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final