0380 (SATT)PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
-7?' 33<*-.
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 OECLARATIONaI 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 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, 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 Contra ctor'sLicense Law
(Chapter 9 (commencing with section 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 for a permit .;
subjects the applicant to a civil penalty of not.more.than five hundred dollars ($500.):
O I. as owner o1 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 i mprovemnt 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.).
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,properly who .
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
❑ 1 am exempt under Sec. B. B P.C. (Attached Certificate).
Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell -insure, or a:
certificate of Workers' Compensation Insurance , ora certified copy thereof (Sec. 3800. Lab. C.).•
.Policy No. Company .
O Certified copy is hereby furnished. n
❑ CertifieQ�co/py is filed' ith the City Building Inspection a aOment or ity 'Department.
Date v/�3 3 Applicant ��- CERTIFICATE
�-
AP„PIIM NT N� SAME (_ • F, Ml,� __ � __ _ t Of �foril .
% .P.��l'[�Yt1Y'0�T1F00
ADDRESS
P..0.
CIT�YV/^OMM.-_-UNJTV/�STA , ZIP 2253
JOli�i���E�SS[S��PAC�E . a FP.xnan Io
CI•TrV/COMMr �ta
�+I T/(SAT, 21La CT 9'2253
�:'f J
BOK
PAG
PRC
C
Plan .Check -Fee
TWN
RNG
SE
S
T 10765
LOT,
4.59
Plumbing Fee
MODS
SB
V331
U t 7
TRACT NAME
l act
lwmis C� Villas
GW,J{ERyNAME (,L�F,-M � C orporatim of C ali,f mia
j��jOfjTRAC1(,+
C OR -FI NAME -
ADP. DRESS
00 Bax 1000
CITY/CO BR /'ZP& 92253 .
PHJ
06-2888
, , ; 'J. 4 1983
..
3A �IG.
rt +v
9 '
`413 636
ARC/ENG FIRM NAME
ADDRESS -
CITY/COMMUNITY/STATE/ZIP
PHONE.
LICNC .
uW ITS/F/D W/Attached Garage
BL
I
I ZONFS8
SSB
SSB
RSB
OFC,-
, ZONE ORD .
LOT SZ
END
., SIDE
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'
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 l 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
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp Z Art 2, Sec 341, Title 8,
C:A.C.) '
❑ As wkne}-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 1pdustrial. 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,
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 properly 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 fl
l.z-T .3-'83 K.iLB,7
P+etait to build ' 1, 250 Sq. Ft. of Cocx3aty ni tan
Cnd Garage
Mem .Fee
$ 26.00
Plan .Check -Fee
215.15
Construction Fee
331.00
F1ectrical. Fee
27.50
SMI Fee
4.59
Plumbing Fee
56.00
Property Development Free 300.00
J
-11 It , 9 11
�
, , ; 'J. 4 1983
..
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9 '
.-TOTAL
Ts
960.,24 y
BLDG. DEPT.
VALUATION $65,840.60
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
2
40 Fire Damper
8
Vents
41 Smoke Detection Device
9
Garage Fire Wall
42 .Commercial Hood
10-
Fireplace P. L.
❑
43 Final
1OA•
fireplace T!O.
❑
NOADDITIONAL INFORMATION"
c,2
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb /oL
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/1
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32_ Final