0335 (SFD)!' PERMIT APPLICATION "
• '• City of La Ouinta • • -- ` •-
Department of
Building and Safety r
'^ 'This permit becomeswoid if'work not commenced within 180 days'from date of
issuance, OR; if work has been suspended or abandoned fer a period of 180 days. , "J.� '•;
PAG
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPE 4SATION INSURANCE: Thissection need not be completed if;: -�
' LICENSED CONTRACTORS DECLARA710Ni I hereby affirm'.that I am'licensed under provisions of. Chapter 9
:..the permit is for one hundred ($100)o. less: I certify-. at in te.performance of the work.for which -this permit.is
(commencing with Section 7000) of°Division 3'of the Business and Professions Code, and my license is in full force
issued, I shall not employ any person in any mannerscas,to become subject to the Workers''Compensation Laws of . .
and effect.
California. —
_ License Class' Lic. Number
Date Applicant r
Date ° Contractor `- * • •.
NOTICE TO APPLICANT: If; after making this Certifica-e of.Eicemption, you should become subject.to the Workers' + +
' OWNER DECLARATION:- 'I hereby affirm that I am exempt' from the Contractor's License Law for Ih* e' • "'
Compensation provisions of. the Labor. Code, you.muq forthwith comply with such provisions or this permit shall
"�$ -
-BUILDER
following reason (Sec: 7031.5. Business and Professions Code: 'Any city or county which requires.a•permit to . •
be deemedrevoked.. - -
';. '
construct, alter, improve, demolish. or repair any structure, prior to itslisuance;'also requires the applicant for -
DIVISION OF INDUSTRIAL SAFETY PERMIT,CERTIFICATION:'• -
•' such permit..to file asigned statement that he is licensed piqrsuant to the provisions of the Contra.clor's License Law
0 thereby 6erlify that n6excavition live (5) or more feet ih depth into which a peison is required tddesc6nd.will We '
'(Chapter 9(commencing with section.7000) of Division 3 of the Business and Professions Code) or that heis exempt-
made in connection kith work authorized.by this permit; and that no building structure, scaffolding, falsework, or -
therefrom and the basisTor the'alleged exemption: Any violation of Section 7031.5 by any applicant for a'permit.:..,
`demolition or dismantling thereof, will be more than thrty-six-(36) feet high: (Chap 3.2; Grp 2,Art 2, Sec341, Title B„ 3A
subjects the applicant to a civil penalty of not more than five hundred dollars (S500.):
ADDRESS
'0 I, assowner o1 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 dc'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 person rias 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
0 Division of Industrial Safety Permit No.
through his own employees, provided that such improvements are not intended or offered for sale: If, however, the.
• building orimprovemntissoldwithinoneyearofcompletion,the owner -builder will havethe burden of provingthat '
Date- • ' Applicant
he did not build or improve for the purpose of sale.):,
CONSTRUCTION LENDING AGENCY:. I hereby affirm th;t there is a construction lending agency for the performance• `
' S
0 I, 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!•3D9r, , Civ, C•.). ° ' .. •' - - _ ... '
' 7044. Business and Professions Code: -The Contractor,'sLicense Law does not apply to an owner of property who '
.Lender's Name i
builds or improves thereon, and who contracts for -such projects with a contractors) licensed pursuant to the. '
..
Contractor's License Law.).
Lender's Address +
• .0: I 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. ) agree to comply with all''
-
Davl .. Own ' • •er' _
' te' -
city and county ordinances and'state laws relating to Duilding construction, and hereby authorize representatives
•
of -this county to enter upon the above mentioned pnperty for inspection purposes.'
WORKERS' COMPENSATION DECLARATION: I hereby'affirm that I have a certificate of consent to self -insure, ora
7.... 4
'-' 'certificate of. Workers' Compensation Insurance , or a certified copy thereof (Sec. W. Lab. C.). '
Signature of Applicant or Agent ' Date
• Policy _No. Company,
I t _ ,
-CERTIFICATE OF COMPLIANCE -AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
.. 0 Certified'copy is hereby furnished. .. • , - -
' :>'• thOnformation given is correct. I agree to comply wi.h all state laws and county ordinances relating.to buldling :.:.
0 Certified copy is filed with the City BuildingAnspection.Department or City ' Department:.'
; ,construction, and authorize.a representative of the City of La Ouinia Department of Building and Safety to.emer -:
�- -
�Cf �
upon the property for which l have applied for this prmit for the purposeof making inspections. ' 4'
Date - APpficant
Signature of Applicant or Agent Date _ : ,,
Print Applicant/Agent Name
APPLICAN__ T,N t ,(�l„J6i11t ventum
ADDRESS' .. ..
P. O• Box 780
La/`Quint ;TECa 9.22,53'JOB
SITE AODRES&SPACE ,.
CITY/COMMUNITY/STATE/LG�_-•TP '92253
�'
BOK
PAG
PRC
C
422 Sq. Ft.
TWN'- -
RNG
SE
S
TRAC144T96-'1
`OT i42
Cmistnxct m Fee
373.00' �• `:,'
F-2 ,
SB
SML Fee
TRACT Rosa Oom
OWNER NAME (L. F. MI)` . , •.
, M NAM
CON�TRAOlTOR,FIR
ADDRESS
P,. Oe • B= 780
DILA COMM_- UNIta,TE A 92253
61 564+ie•1315 . ,
`3337 2
.. • 4
ARC/ENG FIRM NAME -
ADDRESS
CITY/COMMUNITY/STATE/ZIP '
PHONE 11
LICNC N
'
J.i ggED IT y ing
BIL'
ZONFSB
SSB
SSB
RSB
OFC
,r ,ZONE ORD 0,
LOT SZ
-•Al
P
END
.,SIDE, ,
APPUPRMT - . - •' 11„ 11DATE ,
Ir a :i a 10"1.9'•$3 .,... ...
J
Pezanit to Construct Mod- p, -2 -B
.
y
a°
DWel3ing
1,390 Sq. Ft.
Porch
U2, Sq. Ft. `
Garage
422 Sq. Ft.
VALUATION
MWh. Fee$
31.®0 '. ' r
Pl.,Vi Check Fee
242.45 w
Cmistnxct m Fee
373.00' �• `:,'
Electrics] Fee
31.25
SML Fee
5.57
Plug F�
48.50
Property Developant
'Fee 300.-00 '
• -
.. • 4
' n • * f'` . tis t.. •r '"; • � � � , � . ' . � �, -` « y r � s ' .•''.v � � s ..
•,� . iBLDG. DEPT. _ ...µ.
-w
VALUATION
$79103,20"'
NO.
OPERATION DATE INSPECTOR
NO.
OPERATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
// 7—
34
Plenums & Ducts
2A
Slab Grade
f Sr
35
Furnace Compact.
3
Steel
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
39
Appl. Clearance
7
Framing
40
Fire Damper
8
Vents
41
Smoke Detection Device
9
Garage'Fire Will
42
Commercial Hood
10
Fireplace P.L.
❑
43
Final
10A
Fireplace T.O.
❑
OWN
/'
- ADDITIONI' L INFORMATION
/
7=/jp-8y /DA•r►+. Ga/1rd X, X_ 0• Ft�a
C• �O? S
`
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts) .414
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 F
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/1
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final