000985 (SATT)PERMIT APPLICATION
City of La Ouinta
• Department of Building and Safety
This permit becomes void it work not commenced within 180 days from date of issuance,'OR, if work has been suspended or abandoned for a.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 o1 the Business and Professions•Code, and my license is in full force
and effect.
{ License Class �^ Lc umbe� /
Date ����-j-i�! Contractors«/-':/ ''•�►���
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Con'tractor's License Law for the
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to
i 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) o1 Division 3 of the Business and Professions Code) o1 that he is exempt
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant.for a permit
i subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
I ❑ I. as owner of.the property, 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 improvemm is.suld 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.).
O I, as owner of the property, am exculsiveiy 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.).
0 1 am exempt under Sec. . B. B.P.C..(Attached Certificate): .
I ' Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell -insure, or a
certificate of Workers' Compensation Insurance , or a certified copy thereof (SecT3800. Lab. C.).
Policy No. Company
❑ Certified copy is hereby furnished`
O Certified copy is filed with the'City Building Inspection Department or City
Date Applicant
Department.
APPLICANT NAME (L, F. MI) '
ADDRESS
P.O. Haat 780
CITY/COMMUNITY/STATE/ZII P
Lia Qlanta. CA 92253
JOB SITE AOORESWSPACE '
77-150 AmAda Fsxnan_
CITY/COMMUNITY/STATE/ZIP '
La Ouinta. CA 9225.3
BOK
PAG
•PRC
C
TWN
PING
SE
S'
TRACT
14496-3
LOT
54
42.16
MOD
r1r.-1
SB
'
TRACT NAME
Sant:a Posca (WM
OWNER NAME (L. F. MI)
anderit
CONTRACTOR -FIRM NAME
A>nlcien
ADDRESS
CITY/COMMUNITY/STATE/ZIP'
abam
PHONE 0 564-1315
-R E.
333762
-A UITA OF
BUILDING PAR M
EENT
'
ARC/ENG FIRM NAME M=y
_ __� __ _ Bwkus
ADDRESS 15.J1 Chapala ,
CITY/COMMUNITY/STATE/S arita Uatbam, CA 93101
PHONE •
805 963-8901!'
LICNC n
'
USE OF PERMIT Single Swily FjG1elliniq -
BL
ZON
FSB
SSB
SSB
RSB
1.
OFC .
ZONE ORD N
LOT SZ
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed it
the permit is.lor one hundred ($100) o, less. I certify that in the performance of the work for which this permit is
issued, l shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of
California.
Date Applicant
NOTICE TO APPLICANT: If, 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 SAFETY PERMIT CERTIFICATION!
O 1 hereby certify that no excavation five (5) or more feet 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
demolition or dismantling thereof,'will'be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8.
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:
❑ Division of Industrial Safety Permit No.
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: Q. +•
.Lender's Name
Lender's Address
I certify.that.l 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 i�orre'cl?l agree to comply with -all state laws and county ordinances relating to buidling
Cconstruction, and a�horize)a'reprresentative of the City of La Ouinta Department of Building and Safety to'enter
apon the pr perty for which I h ve applied for this permit the purpose of making inspections.
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPL/PRMT n R I � � � h GATE
1Q -1g-84 S.F.D.
Pe= t to crostnu 2,758 sq. ft. of
single fmily dwelling with attached
garage.
Mfechanical Free
26.00
Plan Cehck Fee
326.95
Constructic in Fee
503.00
Electrical Fee
42.16
SMI Fee
8.93
Plumbing Fee
73.00
Prop. Dever.` .Fee ,
450.00
-R E.
-A UITA OF
BUILDING PAR M
EENT
TOTAL .
FEE
1,430_�<
BLDG. DEPT.
VALUATION 127.01J
NO.
OPERATION ATE
INSPECTOR
NO.
OP ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL.APPROVALS ,r
T
Set Back33
Ventilation:System
2
Ftgs & Frms
34
Plenums.& Ducts
2A
Slab Grade
35
Furnace Compart.
3
Steel
S
36
Inlets & Outlets'
4
GroutBlocks
37
Combustion Air y
5
Bond Beams
38
Compressor .
6
Roof Deck
39.,
Appl. Clearance 1
7
Framing
40
Fire Damper•
8
Vents
41'
Smoke Detection .Device
9
Garage Fire Wall
42
Commercial, Hood
10
Fireplace P.L.
❑
43
Final r
.10A
Fireplace T.O.
❑
NoN
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION.
11 Exterior Lath
12 Internal Lath'
12A Drywall
13 Finish Grade
INSULATION Thick R"
Value
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
21 Water Heater
"22 Water Softener
23 Water Service
24 Gas Test
25 Final
Tank Pit L. Line
26
27
28
29.
29A
29B
30
31
32
Power Pole
Conduit
Service Entrance
Wiring
_ouhdin9 Wire•
Bonding` '
$,�}I[u�2s..
Service
Final
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
P/L, P/L
STREET.NAME