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0393 (SATT)PERMIT APPLICATION City of La Ouinta Department of Building and Safety 717'3°9 -"f-- This permit becomes void if -work notcommenced within 180 days from date of issuance,.OR, if work has been• suspended' or abandoned for a period of 180 days. LICENSED CONTRACTORS. DECLARATION: 1, hereby affirm that I am ~licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic. Number Date Contractor OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from.fhe Comractor'siicense 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 Ousiness 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 ($500.): ' 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 builgs 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 Owner WORKERS' COMPENSATION DECLARATION:' I hereby affirm that I have a certificate of consent to self -insure, or '. certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.). Policy No. Company :O Certified copy is hereby furnished... �• O Certifi d co 0ry iswitwith the City Building Inspection (D(epartmeentlorr City +• Department. Date e, Applicant 7' — / APPUT NAME (l. : MI� bf ADDRESS P.O. B= 1000 .. ... . CIT�p/COMMU__ COMMUNITY/STATE/ZIP ta, ZI A �9222255,3��..,�^ JOB l S7;;--i�IU7�KyGPLACV Fenix do `I�°�"Qaiinil a; Z m 92253 BOK 'PAG PRC C - TNM RNG SE S TRACT 18765 IOTMOD 1 6.76 BR I SB Mit 20 TRACT NAME Club Villas• ' OWNER .i((NAME P.� C=. po tion of [`tel t fo=ia CO Tfl RYAJCTYJ OR -FIRM NAME Sam 0. Elm 1000 CI /COMM._ UNITY t ,/zIP _ 92253 . PHONE it �1 345•-2888 LICNC 1 413636 q ARC/ENG FIRM NAME ' ADDRESS CITY/COMMUNITY/STATE/ZIP PHONE n LICNC USE OF PERMIT Off. S/F/D W/Attached Garage BL ZON FSB SSB SSB RSB OFC - ZONE ORD 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 inany manner so asto become subjectlo 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: 0 thereby certify that no excavation five (5) or more feet in depth into Which a person ig 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.) 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. 0 Division;ot.lndustrial 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 fof 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 7 • [ 1 J 12�T 7_p3 carb Ni t to build 2, 078 Sq. Ft. of OcrAdmi ni tun and Garage Mechanical Fee $ 28.50 P2an.Oheck Fee. 275.60 Oonstructi an Fee 424.00 Electrical Fee 33.71 SMI Flee 6.76 Plumbing Fee 68.50 Property Dweldpment Fee 450.00 lY L j� � 4ea Lw M U .a CJ La 0f'aA�� q OTAL TFEE 1$ 1,284.57 BLDG. DEPT. f VALUATION $96,512.80 NO. OPERATION DATE INSPECTOR NO. OPERATION DATE INSPECTOR BUILDING APPROVALS 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: ❑ NO ADDITIONAL INFORMATION `,2%L�et/✓ /k 'w [ / � �eA -A } L 8 y Lcl� a,-\ V--Ia-Q Z� f SEWAGE SYSTEM SIZE &LOCATION L 11 Exterior Lath 5 12 Internal Lath 12A Drywall 13 Finish Grade R INSULATION Thick Value 7A Walls (Batts) 128 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 PyI STREET NAME 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring . 29A Grounding Wire a /`L p" 29B Bonding 30 Fixtures- 31 Service 32 Final