0385 (SFD)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 heieby•affirm that I amlicensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3of 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 the Contractor's License Law for (he
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 o1 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 ($500.):: ?-
�. 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 Contractors License
Law does not apply to an owner of property who builds, or improves thereon, avid who does such work himself or
through his own employees. provided that such improvements are not intended or offered for sale. It, 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 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 for such projects witha contractor(s) licensed pursuant to the
Contractor's License Law.).
O.1 aril exempt under Sec.- B. & P.C. (Attached Certificate).
Date" Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell -ensure, or a
certificate of*Workers' Compensation Insurance . or a certified copy thereof (Sec. 3800. Lab. C.).
Policy No. Company.
OCertified copy is hereby'furnished.
O Certifted'c'Y is fit d with the City Building Inspection Department or Cit Department..
Date.�d%i2Applicant .%f/7 .aI Y� 1
APP�LIC, yNT AM�I,�,E (L�.F, MII t
corporatimof califoxnia
1T—Tb-83
CITY/COMMUNITY/STATE/ZIP_a_ 92253
roe/maACE
y=SAL���+A+rs•��/S�P�cIa T enwxkj
CITY/COMMUNITY/STATE/ZIP
La Winta, CA 92253
BOK •
PAG
PRC
C•.
TWN
RNG
SE
S
TRACT 765
LOT 1
296.08
Cbanstruct,dOrui Fee
MOD
i
.so
"= t 12
`jj}�
TRACT NAME,
7ta� Club Villas
OWNER,_.yAME (L, F. MI)
y . �. �+ �,� �`�yf+f ��
N�t ��L.il�ti Of Cal J.lw.aaaa•r
CONTRACTOR -FIRM RACTOJ RR-FFIIRRMCNAAMJE
ADDRESSRE[S '
P. 0. Box 1000
CITYLa /COMMUNITY/STATE/ZIP
ta,ZICA 92253 .
PHONE , M88
`413636
Property Development Fee
ARC//E/tlN...CG777—FFIIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP - '•
PHONE •
LICNC M
RITUS E.S/F'T J/Lyy4shed Garage
,
BL
ZON
FS8
SSB
SSB'
RSB
OFC
ZONE ORD II,
TOTAL
FEE
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 td'lhe 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 that no excavation five (5) or more feet in depth into which a person is required to descend, will be
made jd 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, Sec341, Title B,
C.A.C.)
O As owner -builder, Twill 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, •a
of the work for which this permit is issued (Sec: 3097, Civ: C.).
Lender's Name
Lender's Address
I cenify.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 butdling
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
1T—Tb-83
-
Comb.
Pe=rt to build 2,382
Sq. Ft. of
with Garage
Mechanical Fee"
$ 28.50
Plan Check Fee
296.08
Cbanstruct,dOrui Fee
455.50
Electrical Fee
•37.51
SMI Fee
7.60
PImbing Fee
71.00
Property Development Fee
450.00
.$tea % tlyg €; • d .,•( t
f I
Ute 14 1983
CRY ( P_a (IminEt
TOTAL
FEE
$ 16,346.190.
BLDG. DEPT.
VALUATION $108,249.20
NO.
OPERATION DATE INSPECTOR
NO. OPERATION DATE INSPECTOR
BUILDING APPROVALS
'MECHANICAL APPROVALS
1
Set Back
33 Ventilation System
2
Ftgs & Frms
r
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
n2 02 y /
40 Fire Damper
8
Vents
41 Smoke Detection Device
9
Garage Fire Wall
42 CommercialHood
10
Fireplace P.L.
❑
43 Final ' .
10A
fireplace T.O.
❑•
NOON ADDITIONAL INFORMATION
c2
4 , ^
C
l) jRj $q
PSVv
"
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)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb p2 9
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/I
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final