0384 (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 7000) of Division 3 of the Business and Professions Code, and my license is in full force
and effect.
-License Class Lic. Number
Date Contragtor.,
OWNER -BUILDER DECLARATION: I hereby affirA+that•l 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 h e is licensed pursuant to the provisions of the Contractor's License Law
(Chapter.9 (commencing with section 7000) of Division 3 of the Business and.Prof essions 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.):
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 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 r
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 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.).
❑ 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 a.
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.):
Policy No. Company
O Certified copy. is hereby furnished. -
❑ Certifi (J -co is fi eedd with the City Building Inspection Deep/art�r'ent(oyr/►C,ity� Department.
bate �����t �a Applicant as'a/Y'iT�C�ll.
. T-- d c c..� We
APIMT NAME ,.F. M_ I) t W.cn of ailifanxia
�rCZ-
ADDRESS '•�..VG'hL�7"�"��9
P. o. BOX 1000
CITY_/COMMU_ IJY/STAT;ZIfCA 9^2,25�3„�,,y,,,
JO@lT/1�,/.0C.}61DOOii�+E+r•.S�PSS/ `a FGLi LGIiX.aRJ
CITE'/COMMUg„ r�IJT/j ta,, ICA 92253 .
BOK
PAG
PRC
C
Plan Check Fee
TWN
AND
SE
S
TRACT
18755
LOT
1
6.34
Plying Fee
MOD
CR
SB
Unit 11'
TRI N_ AME, Club Vinas
OWNER NAME (L. F. MI '
�, T�VPyO�iil of California
CO 9ACTOA-FIRM NAME
pT(•1
ADD�iE. O. BCZ 1000
CITjj�YlCOMMUNITY/STATE/ZIP__ta,,CA 92253
x
P"2. -228888813636
,u
TOTAL
FEE
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE 0
LICNC a
..
uSE.OE_PJA! T SJF/D W/Ati-.a hed Garage .
BLWd
ZON
FSB
SSB
SSB
RSB
OFC -
ZONE ORD
I
' 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 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:..
❑ 1 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) feethigh. (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8.
C.A.C.) '
O 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. r
^ 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
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 ori 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
APPVPRMT 03 8 4 0 !3-83
Okxb
Penuit to build 2,083 Sq. Ft. of Oo�adomizsiiun
and Garage
Madk dlcal Fee.
$ 28.50
Plan Check Fee
263.90
Canstructillon Fee
406.00
Electrical•Fee
33.78
SMI Fee
6.34
Plying Fee
68..00
Property) Development Fee
450.00
UCU 1 411983
,u
TOTAL
FEE
$1,256.52
BLDG. DEPT.
VALUATION $90,705.80
NO.
OPERATION DATE
INSPECTOR
NO. OPERATION DATE I INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVAL'S
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.
❑
OWN
ADDITIONAL INFORMATION
, p -
-l9 -8 y C/ �`C
/ cry
SEWAGE SYSTEM SIZE & LOCATION
11�
Exterior Lath / /iL%�
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
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
298 Bonding
30 Fixtures
31 Service
32 F final