0281 (SATT)PERMIT APPLICATION
r City of La Ouinta n v pi,�
Department
of Building and Safety e U
JOB SITE ADOR_ ,__ __ S1ES Si a CNort^ -
Norte
CITGG' /C MIUN�ITyl/ta, ZIF�b
�'�
BOK
PAG
This permit becomes void it work not commenced within 180 days from date of issuance: OR, if work has been suspended or abandoned for a period of 180 days.
"•-+' - J
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed it
• LICENSED CONTRACTORS. DECLARATION:•I hereby affirm that Iam licensed~ under, provisions of Chapter 9 •
+ the permit is for one hundred ($100) o. less. I certify that in the performance of the work for which this permit is .
(commencing with Section. 7000) of Division 3 of the Business and Professions Code, and my license is in full force
issued, -I shall not employany person inanymannerso as to become subject tothe Workers'Compensation Laws of
and effect. •
California.
License Class Lic. Number
Date Applicant
' • Date -- Contractor •
,-.:. t'_NOTICE•TO APPLICANT: If. after making this Certificate of Exemption, you should become subject to the Workers'
OWNER -BUILDER DECLARATION: I hereby alfirin that I am exempt from the Contractor's License Law for the
Compensation provisions of the Labor Code, you must forthwith°comply with'such provisions or this permit shall
following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to' .
be deemed revoked.
construct, alter, improve, demolish, or repair any structure: prior to its issuance, also requires the applicant for •
`DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
such permit to file a signed statement that he is licensed pursuant to, the provisions of the Contra ' clor's License Law
D'Ihereby certify that'no exca4ion five (5) or more feet in depth into which apersonis required -6 descend. will be
' (Chapter 9 (commencing with section 7000) of Division 3 ofthe Business and Professions Code) or that heis.exempt
made in'connection with work authorized by this permit.and that no building structure:scaffold Ing: falseAfork, or "
!;,
therefrom and the Lasts lor•the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
•'.demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2. Art2, Sec 341, Title 8•
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
4 a•'s C.A.C.);
0 1. as owner of the properly, or my employees with wages as their sole compensation, will do the work; and the •,
p As owner -builder, I will not employ anyone to do work which would require a permit from the D'i'vision of
' structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License _
, Industrial Safety'. as noted above,' unless such person has a permit to do such work from that division.
Law:does not apply to an owner of property who builds, or improves thereon, and who does such work himself or
+ r` , r •
through his own employees, provided that such improvements are not intended or offered for sale. If, however, the
• 0: Division of Industr_ial.Safety. Permit No.
• building or improvemnt.is sold within one year of completion, the owner -builder will have the burden of proving that,
Date Applicant
,pe. did not build or improve for the purpose of sale.).
CONSTRUCTION LENDING AGENCY' I hereby affirm that there is'' -a construction lending agency for the performance'
❑ 1, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec:
- - of the work for which this permit is issued (Sec. 3097, Civ. C.). - . s
7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who -
'builds
Lender's Name
or improves thereon, and who contracts for such projects with•a contractor(s) licensed pursuant.to the
LOT SZ
Contractors License Law.).
Lender's Address
❑ 1 am exempt under Sec. - .. B. d P.C. (Attached Certificate)..
- I certify that I have read this application and state that the above information is correct.I agree to.complywith all
Date " Owner'
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. • .
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.).'
Signature of Applicant or Agent Date
Policy No. Company
CERTIFICATE OFTOMPLIANCE AND AUTHORIZATION OF ENTRY: I -certify l have read this application and state that -•
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 iled with the City Buildirig Inspection Department or City, '' " Department.
construction, and authorize a' representative. of the City of La Ouinta Department of Building and Safety to enter -
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upon the property for which'I have applied for this permit for -the purpose of making inspections.
Date
Z�/ Applicant
3 / C-
•
Signature of Applicant or Agent Date '
•
Print Applicant/Agent Name
APPL•IC�A•,NT•WM._E,,(L!EF MI�-J,„_�y� 0=para ,.�M
t+
�V�Box
•{�G��.j�.,GlL.i�Xli
ADDRESS 0, 0 000
1000
CITY/COMMU_ _ NI,Tr/A7Ctaj, ZICA 92253
JOB SITE ADOR_ ,__ __ S1ES Si a CNort^ -
Norte
CITGG' /C MIUN�ITyl/ta, ZIF�b
�'�
BOK
PAG
PRC
C
Ctru3tructim Fee ' • '
TWN
PING
SE
S'
TR1CT 8767
LOT �
Property Developnent Fee
600,00
MOD
SB
/,e ..� •�- '
TRACT NAME ,
OWNER,gNAME (L, F. r) ••
1tv�fL (L. F. !i1f11nMt Corporate-
CONTRA CCTTOR-FIRM NAME -
ADDRESS
0. Banc 1000
GI Y/COMM 9N'ITH�TA�T�,ZIQ.A 92253 .
PHONE(r 1
:45-2888
LICNC /
4.;3636
,
ARC/ENG FIRM NAME
ADDRESS -
CITY/COMMUNITY/STATE/ZIP
PHONE N
LICNC' •
• .
USE OF PERMIT
UfxbElec.; Ply, Bldg;
BLZON
FS8
SSB
Sse
RSB
.OFC••'
-
ZONE ORD t.-•
LOT SZ
-.
•END
SIDE
APPVPRMT rmXA • 3
5-0(yam ' •
,Peit to build 3,523 -Sq.1 t.. of
carl-dacmu1un \ .• ...
.
gmchaniral Fee,
19;000 '
Plan: 0161 �c Fee • • •
330.20
Ctru3tructim Fee ' • '
508,.00
Electrical' Flee
.47,27.
SHM Fee 9407
Plumbing Ftp
• 73#00
Property Developnent Fee
600,00
Ili;iiaO uiota
A
TOTAL
_FEE
'
1$1.586.54
• .VALUATION $129,628.00 T•-
BLDG.DEPT.
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 Deckle-
AS
7141-
39
Appl. Clearance
7
Framing
Sj
!
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.
❑
NO. ADDITIONAL INFORMATION
%/y�.C% �k
--/f�
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall 7 O
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 Z-0/1
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)
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final