0374 (SFD)I
I
� PERMIT APPLICATION
City of La Ouinta T
I 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
ays.-
LICENSED'CONTRACTORS DECLARATION: I hereby affirm that 1. 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 Contractor's License Law.
(Chapter 9(commencing with section 7000) of Division 3 of the Business and Professions Code)orthat 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 (SWO.):
0 1. 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
builds 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 a
iii t 1 W k "Com ensation Insurance or a certified co thereof (Sec 38007 Lab C )
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 inany manner so asto 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:
0 I 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 tie, more than thirty-six (36) feet high. (Chap 3.2. Grp 2, Art 2, Sec 341 Title 8,
C.A.C.) �a�•.5,.,.
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 Divisionof Industrial SafetyPermitNo.
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. '
ce Ica e o or ers p pY
Signature of Applicant or Agent Date
Policy No. Company CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
0 Certified copy is hereby furnished. the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
0 Certified copy is file with the City Building Inspect ion,•D,e�p/artym mt ocCity Department. construction, and authorize a'representative of the City of La Ouinta Department of Building and Safety to enter
te / 0upon the property for which I have applied for this permitlor the purpose of making inspections.
DaApplicant
Pd PLICAN7T- MME'(L, F. MI) ��scn of Califoniia
�i/GYC�. •L
+�®O
�dS
10QOl�n+0c�
VD(�irR�E _ `.
CITY/CMO_ MUNITy/ST,TE/ZIP_ 92253
JO r 7-13811 W���da Fernaruio
CIN Cg;; nt&,TE/ZP A 92253 .
BOK
PAG
PRC
C
-
TNM
FIND
SE-
S
8 165
LOT 1
P1izrbing Fee
_
MOO
SB
Vial.
Unit 1
'
11141iyNi. 6 Club Villas�
Dtiv.�llR iJCv . F, Ml�lt Wrporatim of WifQnda
..
bam
CONTRACTOR -FIRM NAMEADDRESS
k, U, DCDC 1000
cA Win &,TEA 92253
J4�2888
L4Y`3636
$ 1,346.19
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE M
LICNC Ir
RMPT
,WE0 F/D I Attached C,aragfe
BL
ZON
FSB
SSB
SSB
RSB
OFC
ZONE ORD N
LOT SZ
END
SIDE
Signature of Applicant or Agent
Print Applicant/Agent Name
Date
APPL/PRMT n,
124S-83 �
Ss
Pemit to build 2,382
Sq. Ft. of CA¢x :init
and garage
Melianical Fee
$ 28.50
Plan Check 'Fee
296.08'
Oomstruetian Fee
455.50'
Electrical Fee
37.51
SMI Fee
7.60'
P1izrbing Fee
71.00
Property Development Fee 450.00 '
10 A IV
V
Ly :
1983
u
A
TFEE
$ 1,346.19
BLDG.DEPT
VALUATION $108„249.20
NO.
OPERATION DATE INSPECTOR
NO.
OPERATION DATE INSPECTOR
BUI.LDING.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
1 Final
10A
Fireplace T.O.
❑
NON®®ADDITIONAL INFORMATION
T/V
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath'2i"'�(/C/
12 .Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick Vaall ue
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb j
16 Water Piping
17 Rough Plumb Af
18 Vents
.19 Sewage Disposal,
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test 7
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
P/L P/I
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring ... j
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 F inal
STREET NAME