000980 (SATT)_ PERMIT APPLICATION
•
City of La Ouinta •�
Department of Building and Safety
This, permit becomes void if work not commenced within 180 days from date of. issuance, OR, if work has been suspended or abandoned fora period of 180 days.
LICENSED CONTRACTORS DECLARATION: .I hereby affirm that I am licensed under. provisions,of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code, -and my license is in lull force .
and effect.
License Class-0c'Nu her _ --L
Date ` Z:;4 Contractor • 1 /Z
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to
construct, alter, improve. demolish, or repair any structure, prior to its issuance, also requires the applicant for.
such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
(Chapter 9 (commencing with section.7000) of Division 3 of the Business and Prof essions.Code) or that he is exempt
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars (5500.):
❑ I. as owner of the prope;ty, or my employees with wages as their sole compensation, will do the work, and the
structure is not intended or offered for sale (Sec. 7044. Business and Professions Code: The Contractor's License
Law does not apply to an owner of property who builds, or improves thereon, and who does such.work himself or
through his own employees, provided that such improvements are not intended or offered for sale. If, however, the
building or improvemnt is so Id within one year of completion, the owner -builder will have the burden of proving that
he did not build or improve for the purpose of sale.). ,4
0 I, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec.
7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
❑ 1 am exempt under Sec. B. 8 P.C. (Attached Certificate).
Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby 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.).
Policy No. Company
O Certified copy is hereby furnished.
❑ Certified copy is filed with the City Building Inspection Department or City Department.
Date Applicant
APPLICANT NAME L. F. MI)TT,,,�,l^^YY W' -
ADDRESS P.O. Bax 780
CITY/COMMUNITY/STATE/ZIP -
la Cha, CA 92253
JOB SITE AOORESS/SPACE • -
77-130 Avenida F+ernancb
CITY/COMMUNITY/STATE21_P Quinta' CA 92253
BOK
PAG
PRC
C
TWN
RNG •
SE
S
144'96--3
LGT52
Oanst. Fee
448.00
6r 3
SB.
ME Fee
TRACT NAME r��,�.� }�..��
Santa Rosa �..bw
OWNER NAME (L, F. MI) ��a, -
CAL iLC�4 A
CONTRACTOR -FIRM NAME -
Ariden
ADDRESS above. '
CITY/COMMUNITY/STATE/ZIP_ -
me
PHONE •LIC
564-1.3]5
33 9
C 1
333762
ARC/ENG FIRM NAME �'�'•'�Z
ADDRESS
1531 YK Chapala Street
CITY/COMMUNITY/STATE/ZIP '
Santa Barbara, CA 93101
PHONE •
805 963-8901
1
LICNC •
USE OF PERMIT '
Single family dwelling
BL
ZON
FSB
Sse
SSB
RSB
OFC
ZONE ORD •+
LOT SZ
-
END
SIDE.
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if a.
the permit is for one hundred ($100) o, less. I certify that in the performance of the work for which this permit is r
issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of -0
California. 'A
Date Applicant
NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you should become subject to the Workers' .
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
be'deemed revoked.
DIVISION OF INDUSTRIAL.SAF.ETY PERMIT CERTIFICATION:
0 I hereby certify that no excavation five (5) or more feel in depth into which a person is required to descend, will be
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
:i+4. ''demolition or dismantling thereof, will be more than thirty-six (36) feet high'. (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8,
*-X TM, C.A.C.)
❑ As owner -builder, I will not employ anyone to do'work which would require'a permit from the Division of
Industrial Safety, as noted above, unless such person has a permit to do such work from that division.
0 Division of Industrial Safety Permit No.
y
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is'a'construction lending agency for the performance
of the work for which this permit is issued (Sec..3097, Civ..C.). i.
Lender's Name
Lender's Address
I certify. that I have read this application and state that the above. information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives/
of this county to enter upon the above mentioned property for inspection purposes.
Signature of Applicant or Agent Date
CERTIFICATE OF'COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
the information given its correct. I agree to comply with all state laws and county ordinances relating to buidling
construction, and a tocizea'representative of the City of La Ouinta Department of Building and Safety to enter
• upon`the property or which I have applied for this permit for the purpose of making iinspection[st.
Signaturerof Applicant or Agent Date
Print Applicant/Agent Name
APPL/PRMT ■ R ■
OAtF
i0=19-84 S.F.D.
1mit to mnstLmt 2„326 sa. ft. of
4?11K7f7 P fa11rn1' v X11 nor with atter~
r'7;�YS�f71A.
Mechanical Fee'
26.00
Plan Check Fee
291.20
Oanst. Fee
448.00
Fiect. Fee
36.90
ME Fee
7.39
Plu43ing Fee •
73.00
Prop, Devel. Fee
450 OQ
33 9
IIINTA
'11, FEEL
1,332.'0
$UILpOG DEP RTPFNT
BLDG. DEPT.
VALUATION 1 105,867.60
ELECTRIC APPROVALS
26
Power Pole
27
Conduit
28
Service Entrance
29
NO.
OPERATION
` uATE
INSPECTOR
NO.
t OPIRATION DATE INSPECTOR.
30'
BUILDING APPROVALS
• 31
Sergice,,.
MECHANICAL APPROVALS`
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums&Ducts
2A
Slab "Grade
35
Furnace Compart.
3
Steel
7
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
f—
39
Appl. Clearance
7
Framing
40
Fire -Damper i
8
Vents
41
Smoke Detection Device
9
Garage Fire Wall
42-
Commercial. Hood
10
Fireplace P.L.
❑
43
Final
10A
Fireplace T.O.
❑
NON
ADDITIONAL IN -FORMATION
11
Exterior Lath
12
Internal Lath .
12A
Drywall
- 13
Finish Grade
7A
INSULATION
Walls (Batts)
Thick
.Value
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
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ELECTRIC APPROVALS
26
Power Pole
27
Conduit
28
Service Entrance
29
Wiring
29A
r'Ground(n�Wire
29B
Bonding
30'
,F.'ixtures
• 31
Sergice,,.
'.r•7d
Tank Pit L. Line
P
RFAR nF PROPFRTV LINF
STREET NAME