000983 (SFD)PERMIT APPLICATION h
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 for a period'of 180 days.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter'9
(commencing with Section 701X1) of Division Sof the Business and P Bions Code, and my license is in full lone
and effect.
License Class �Lie�NyIn, rr�
Date-� Contractor
r
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 Professions 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 (S500.):'
O.I. as owner of the property, or my employees with wages as their sole compensation, will do ihe'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 sold within one year of completion, the owner-builderwil I 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 excufsively 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 lor.such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
O 1 am exempt under Sec. B. & 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.
O Certified copy is filed with the City Building Inspection Department o"r City Department.
Date Applicant
APPLICANT NAME (L, F. M•I•)���������� /��,•
An&m � •
ADDRESS '
P.O. Boat 780
CITY/COMMUNITY/STATE/ZIP
La Quinta,�CA.� 92253p�
JOB SITE ADDRESS/SPACE
77-170 Avenida ndo '
CITY/COMMUNITY/STATE/ZIP
la Quints, CA 92253
BOK
PAG
PRC
C
6 _ on
TWN
RNG
SE
S
TRACT
14496-3
L07
SMI Fee
7.39
MOD 3
SB
Props D�s Fee'-
TRACT NAME Santa RcmJ a ' am
OWNER NAME (L. F. MI)
An&m
CONTRACTOR -FIRM NAME ' • '
ADDRESS abom
CITY/COMMUNITY/STATE/ZIP_ -
PHONE ��
564-1315 1
c►rY
DEP RTMENT
LICNC •
133376i
'
ARC/ENG FIRM NAME
Ba=y
ADDRESS
1531 Chapala Street
CITY/COMMUNITY/STATE/ZIP - -
Santa Barbara, CA 93101
PHONE .
805 963-8901
LICNC
'
USE OF PERMIT -
A Singla FAmily Dwelling
BL
ZON
FSB
I SSBSSB
RSB
OFC '
ZONE ORD , ,
LOT SZ
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE: This section neednat be completed If:
the permit is for one hundred ($100) o, less. I certify that in the performance of the work for.which this permit i5
issued, I shall not employ any person i n any manner so as to become subject to the Workers' Compensation Laws of,
California.
Date Applicant
NOTICE TO APPLICANT: If, atter 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: ti
r
'0 I 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 th'afno 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.)
O 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.
O Division of Industrial Safety Permit No.
Date. Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance IS
of the work for which this permit is issued (Sec. 3097, Civ. C.). '
Lender's Name s
Lender's Address t�
I certify that I have read this application and state that the above information is correct. I agree to comply with all E
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 is:corrreit. I agree to comply with all state laws and county ordinances relating to buidling
construction, and utoiorize.a'representative of the City of La Ouinta Department of Building and Safety to enter
.. �upon thenpperty foorr whic2l have applied for this permit for the purpose of making inspections.
f.►/..���i� /.:iJ3 'meq
Sig naturSdf Applicant or Agent Date
Print Applicant/Agent Name
APPL/PRMT ll l l n i
DATE
10_1.4-41A S.F.D.
Perit o cjo� nst ift 22..326 sr_ ft.ca
of
J.
s�R A ily 11in 7 t t _
Med ca
6 _ on
Plan L *
Qoist. Fee
448.00
Elect. Fee
36.90
SMI Fee
7.39
Plumbing Fee
73.00
Props D�s Fee'-
�
450.0/ 0
.•„ .REC
EIVED
c►rY
DEP RTMENT
TAIL
TFEE
1,332.49 '
1
BLDG. DEPT. VALUATION 3,05.867.60
.a
26
Power Pole
27
Conduit
NO.
OPERATION ATE
INSPECTOR
NO.
OP ATION DATE INSPECTOR
„ .Grpunding Wite:.-
29B
BUILDING APPROVALS
30
Fiietures.'
MECHANICAL.APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts r.
2A
Slab, Grade
LM&
35
Furnace Compart. ~ .
. 3
Steel
36
Inlets'&.Outlets
4
Grout Blocks
37
Combustion:Air ,
' 5
Bond Beams
38
Compressor
i
6
Roof Deck
//
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
f=ireplace T.O.
❑
ADDITIONAL INFORMATION
NO
11
Exterior Lath
12
Internal Lath
12A
Drywall
F
13
Finish Grade
INSULATION
Thick "RIS
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
3175
21
Water Heater
22
Water Softener
23
Water Service
2 47
Gas Test
25
Final
SEWAGE SYSTEM SIZE & LOCATION
26
Power Pole
27
Conduit
28
Service Entrance
29
Wiring
29A '
„ .Grpunding Wite:.-
29B
Bonding
30
Fiietures.'
31
Service
32
i;
LECTRIC APPROVALS
Tank Pit L. Line
REAR OF PROPERTY LINE
STREET NAME
il