000905 (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 OECLARATION:'I hereby affirm that I am licensed under provisions. of Chapter 9
(commencing with Section 7000) of.Division 3 o the Business and Professions Code, and my license is in lull force
and effect.
License Class Lic. Number
Date Contractor
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, improver 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 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 (5500.):
0 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 improvemnt is sold 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.).
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.).
0 I 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 EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
the permit. is for one hundred.(5100) 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'
. Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
be deemed revokeA.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
0 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, w ill be
made in- connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
demolitioKor dismantling thereof, will be more than thirty-six (36) feet -high. (Chap 3.2, Grp 2 Art 2, Sec 341, Title 8,
C.-.):?- _ —,a ,
0 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.-
11
ivision-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
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.
certificate of Workers' Compensation Insurance .or a certified copy'thereof (Sec. 3800. Lab. C.).'
Signature of Applicant or Agent Date
Policy No. Company CERTIFICATE OF COMPLIANCE AND.AUTHORIZATION OF ENTRY: I certify I have read this application and state that
O Certified copy is hereby furnished. /� the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
0 Certified copy is filed with the City Building Inspection Dep rtm nt,or'Cit Department.: construction, and authorize a'representative of the City of La Ouinta Department of Building and Safety to enter
�_�•,y- „ , upon the property for which I have applied for this permit for the purpose of making inspections.
Date Applicant
\Signature: of Applicant or -Agent Date
Print Applicant/Agent Name
APPUC_ AtrT NAMEa�
Cb
ADDRESS
P.O. Holz 780
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
JOB SITE ADORESS/SPACE -
77-215 Avenida Fernando
CITY/COMMUNITY/STATE/ZIP
La Quinta; CA 92253
1 31
PAG
'�,
PRC
7!/
C
433 sq. ft.
TWN
RNG
SE
S
TRACT
4496-3
LOT-
46
Plan Qc. Fee
291.20
MOD
P-3
SB
Elect. Fee
TRACT NAME Cu
��7G1• Lwl•\F.G�i FcW
OWNER NAME (L. F. MI)
CONTRACTOR -FIRM NAME '
above
ADDRESS
CITY/COMMUNITY/STATE/ZIP '
PHONE•
564-1315
450.00
LICNC
333762
-
ARC/ENG FIRM NAME
r•
ADDRESS
CITY/COMMUNITY/STATE/ZIP '
PHONE •
LICNC N
•.
USE OF PERMIT
simle family dwellini
BL ZON
FSB
SSB
SSB
RSB'
I
OFC
- ZONE ORD • 's �,;
LOT SZ
..END
SIDE
01
APPUPRMT nnn i'+S * DATE
Mi 8-15-$4 S.F.D.
permit to voaistn ctt Model P► -3 B
Dwelling (1st floor)
1,616 sq. ft.
(2nd floor)
277 sq. ft.
porch - ' ,�� �
1.12 sq. ft.
Garage
433 sq. ft.
t
Vachanical Fee
31.00
Plan Qc. Fee
291.20
>r
Const. Fee'
448.00
Elect. Fee
31.25
SkU Fee,
7.39
Plzmibing Flee
52.50
Prop. Dev. Fee
450.00
C ' '.V E. ®
-
AUG_
11 1U)
TOTAL
FEE $ 1,311.34
VALUATION ) 10J,699.40
,♦
r-1
NO.
OPERATION LATE
INSPECTOR-
NO.
OPER TION DATE INSPECTOR'
BUILDING APPROVALS.
MECHANICAL APPROVALS
1
Set Back
33-
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
Q
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.
❑
NP'N
ADDITIONAL INFORMATION
"
SEWAGE SYSTEM SIZE &. LOCATION
11 Exterior Lath,
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
v
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
ELECTRIC APPROVALS
REAR, OF PROPERTY LINE
P/L P/L
"
T
t
o, STREET.NAME. ri
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
298 Bonding
30 Fixtures
31 Service
32 Final
N