000904 (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 70D0) of Division 3 of the Business and Professions Code, and my license is in full force
and effect.
License Class Lic. Number
Date Contractor
s OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the,
followingreason (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 sectidn 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 fora permit -
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):i*, -
❑ 1. 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.). , -
❑ I, as owner of the property, am exculsively.cgntracting 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.).
O 1 am exempt under Sec. B. 8 P.C. (Attached Certificate).
Date Owner
WORKERS' COMPENSATION DECLARATION: 1 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.
O Certified copy is filed with the City Building Insp461iip�n)!�Department.or-City — Department. r -
Date '� ' Applicant
APPLIC_ ANT NAM (L. F. MI)
naw
ADDRESS
P.O. B= 780
CITY/COMMUNITY/STATE/ZIP
La Qutanta, CA 92253
JOB S TE d10DRESS/SPACE
71135 Ahijhida Fernando
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
BOK
PAG
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PRC31
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ft.
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RNG
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9496-�3
44
MOD
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TRACT NAME mow,,, /�� '
Santa Rosa C&tre
OWNER NAME (L. F. MI) -
CONTRACTOR -FIRM NAME
Abow
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE .
564-1315
LICNC .
333762
448.00
ARC/ENG FIRM NAME '
ADDRESS '
f
CITY/COMMUNITY/STATE/ZIP
PHONE M 1
SMI Fee
LICNC
USE OF PERMIT
S1=1e Fainly Dwellim
BL
ZON
450.00
FS8
SSB
S58
RSB
P n.� er.3.1. ,' . 0a rig??
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OFC
ZONE ORO 11
• LOT SZ
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed it
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'
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 thatn o 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
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.
CONSTRUCTION LENDING -AGENCY: I hereby affirm that there is a construction lending agency for the performance
of the'work for which this permit isissued (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'COMPLIANCE AND AUTHORIZATION OF'ENTRY: I certify I have read this application and state that
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
construction, and authorize a *representative of the City of La Ouinta Department of Building and Safety to enter
upon the property for which I have applied for this permit for the purpose of making inspections.
Signature of Applicant or Agent
Print Applicant/Agent Name
Date
APPUPRMT
n n n 11 8 n 4
DATE
8-16_84 S. F.6.
Permit to cimstruct Model P-3 A
Dwelling (1st floor¢)
1,616 sq.
ft.
(2nd floor)
277 sq.
ft.
Parch , \ : '. \
112 sq.
ft.
Garage
433 sq.
ft.
Mechanical Fee
31.00
Plan Ck Fee-
291.20
Const. Fee
448.00
Elect. Fee
31.25
SMI Fee
7.39
Plunbincr Fee
52.50
Prop. Dev. Fee -
450.00
J o ,/A
P n.� er.3.1. ,' . 0a rig??
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TOTAL `
•FEE
VALUATION �t r
BLDG. DEPT.
NO.
OPERATION ,iTE INSPECTOR
NO.'
OP . TION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
-Ventilation System
2
Ftgs & Frms
/Q N
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
/T.
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)
128 Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING. APPROVALS
15 Ground.Plumb ZDZ& z
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
PSL P/L
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service -
32 Final