0375 (SATT)PERMIT APPLICATION Y� c.�•
City of La Duinta •• T
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 • 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 w ith section 7000) of Division 3 of the Business and Professions Code) or that he is exempt
therefrom -end 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 Contractor's License
Law does not apply to an owner of property who builds, or improves thereon, and who does such work himseU'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 ofproving that
he did not build or improve for the purpose of sale.). ,
0 1, 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
builQs 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 CT
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
.❑ Certified copy is hereby furnished.
O Certified copy is filed with the City Building'Inspection DepaTtme tor Cit ` Department.
Date �o� Applicant per/
APPLICANT NAME ,(L. F. MI)beveoprient ^____ -__at oll of California_
l�'I"Y�T'[iY'7��i''
ADDRESS
P. 0. Box 1000
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
'77=1349 Awmida Fernarxio
C_ QTY COM__ MUNITYa,TE/ZIP
A 92253
`f"l�+PPAA+GG
BOK
PRC
C
Plan Check Fee :
TWN
AND
SE
S
7RACT 18765
LOT
1
Plying Fee
MB
SB
*1SJ. r j t 2
U
1 ACTT �I, AMS ^E Club Villas.
Or,ER NAME (L. MIt Ci1JrirC�t1 of �.rQi.
Acrrda
CdO`NITRRACTOR-FIRM NAME
Sam
ADDRESS '
P. 0. Box 1000
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
PHONE a
345-2888
LICNC
413636
' TOTAL
FEE
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP ,
PHONE 11
LICNC II
USE F�PERr,'r IFID? W/Attached Garage
l WE.E
BL
ZONFSB
SSB
SSB
RSB
OFC -
ZONE' ORD 0'
-
LOT SZ
- END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE: ,This section neednot 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.Certificateof Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forthwith comply with such provisions'orr1his permit shall
be deemed revoked:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
O I hereby certify thatn o excavation five (5) or more feet in depth into which a person is required to descend, will be
made in connection with work authorized bydhis 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.)
'❑ As owne'r•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.
t•
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
of the work for which this -permit is issued (Sec. 3097, Civ. C.). '
Lendet'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 statethat -
the information given is correct. 1 agree to comply with all state laws and county ordinances relating to buidling
construction• and authorize a representative of.the'City of La Quinta 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
APPL/PRMTDIM. 12DATE
—13-83
Permit to Build 2,078 Sq. Ft. of OoaY3aminii�n
and Garage
Mechanical: Fee $
26.00
Plan Check Fee :
275.60
Cmistruction Fee
424.00
Electrical Fee
33.71
SMI Fee
6.76
Plying Fee
68.50
Property Development Fee
450.00
R 27
' TOTAL
FEE
Is 1,284.57
BLDIG. DEPT.
VALUATION $96,512.80
� f� � -
NO.
OPERATION DATE
INSPECTOR
NO. OPERATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL.AP.PROVALS
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.
❑
NON
ADDITIONAL INFORMATION
/ 1 r_/
jJ
U
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
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,
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring �� l
29A Grounding Wire
29B Bonding ZVI
30 Fixtures
31 Service
32 Final
STREET NAME
..i