000988 (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 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 of the Business and Profe sions Code>and my license is in full force
and effect.
License Class Num of
Date ��!� _ Contractor
f�
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the'06'ntractor's License Law for the
following reason (Sec. 7031.5, Business and Professions Code: Anycity 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) orthat he is exempt
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant,for a permit -
subjects theapplicantto a civil penalty of not more than five hundred dollars ($500.): ' .;,r.,rI, '
O 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 applyto 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 orimprovemntissold within one year ofcompletion, 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 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.).
0 1 am exempt under Sec. B. 8 P.C. (Attached Certificate).
Date a 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,
❑ Certified copy is hereby furnished.
❑ Certified copy is filed with the City Building Inspection Deparlment or City Department.
Date Applicant
APPLICANT NAME (L. F. MD,
ADDRESS"
P.O. Hot 780
CITY/COMMUNITY/STATE/ZIP
La Quints, CA 92253
JOB SITE ADDRESS/SPACE
77-190 Avenida Fernando
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
BOK
I PAG
I PRC
I C
26.00
TWN
PING
SE
S
TRACTLOT
14496-3
-
58
SM Fee
_.
MOD
Cr3.
SB
Prop. Devel. Fee
TRACT NAME
Santa Rosas. Clove
OWNER NAME (L. F. MI) ��``3��
A)lel
CONTRACTOR -FIRM NAME
Andlen
ADDRESS
above
CITY/COMMUNITY/STATE/IIP
above
PHONE a
564-"15
LICNC /
333762
1,332.49
ARC/ENG FIRM NAME n��,.��
J1�11..[� N.A.R.
ADDRESS mow_
3.531 S.i.l�rL-XaU
CITY/COMMUNITY/STATE/ZIP '
eta. Via. CA 93101
PHONE 0
805 963-8901
L7`
USE OF PERMIT '
Simle falmily dwelling
BL
ZON
FSB
SSB
SSB
RSB
OFC
ZONE ORD N
LOT SZ
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not 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 is
issued, I 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'
Compensaliomprovisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
be deemed revoked. 1 "
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
derriblilion 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.
0 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. C.).
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 COMPEIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
• :'s the informati6n given is correct. 1 agree to comply with all state laws and county ordinances relating to buidling
construction, and authorize a're�pfsentative of the City of La Ouinta Department of Building and Safety to enter
upon the proper. �iqr which.l= ave applied for this permit for the purpose of making inspections.
Signature Qf�Applicant or Agent Date
Print Applicant/Agent Name
APPL/PRMT �i y�/
DAT
V 7C7
10-1.A-84 S.F.D.
Pe=t to o mstnictt 2,326 sq. ft. of
single family flvse f witba attached
garage.-
Mech. Fee
26.00
Plan Check Fee
291.20
C7Dnst. Fee
448.00
FAlect. Fee
36.90
SM Fee
7.39
Plumbing Fee
73.00
Prop. Devel. Fee
450.00
ILDIN6 DEP UINTA T
TOTAL
FEE
1,332.49
BLDG.DEPT.
VALUATION 7{�jjt ►(�«�
Ah
A&
NO.
OPERATION
ATE INSPECTOR
NO.
OP ATION DATE INSPECTOR.
BUILDING.API ROVALS
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
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. ❑
NPON
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)
147 Final
PLUMBING APPROVALS
15 Ground Plumb '7
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
ELECTRIC APPROVALS -
REAR OF PROPERTY LINE
PL P/L
STREET NAME
26 Power Pole
27 Conduit
28 Service Enirartc( —
'Wiring- is
29A Groundirig:VUire
296 _' Bonding.,
30 fixtures `
31 Service
32 Final