0536 (SFD)PERMIT APPLICATION
• City of La Dg a
Ogoartment o'ri3uilding and Safety
This permit becomes void if work not commenced. within 180 days from date of issuance, OR; It work has been.suspended or abandoned.for a period ofA80.days.
APPLICANT
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CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
LICENSED 'CONTRACTORS -DECLARATION: I hereby. affirm, that' I -am 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 isfn full force
issued, l shall not employ any person in any manner so as to become subject to the Workers' Compensation laws of
and effect.
California.
License Class Lic. Number
Date Applicant
Dale Contractor- ,
NOTICE TO APPLICANT: If, after making this Certificate of Exemption; you should become subject to theWorkers
OWNER -BUILDER DECLARATION: Thereby affirm that I am exempt from the Contractor's-License•Law •tor'the'- •
',",Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall .,
',",Compensation
revoked. '•,
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 ..
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
such permit to file.asigned statement thathe is licensed pursuant to the provisions of the Contractor's License Law
0 1 fiereby.certifythal'noe . xcavation five (5) or Morefeet in deothinto.which a pergon is required to descend, will be
' (Chapter 9 (commencing with section 7000) of Division -3 of the Business and.Professions Code) orthat he is exempt
made`in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or •• '
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for arpermit
demolition or dismantling thereof; will be more than thirty-sini (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341; Title 8,
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
C.A.C:)'
I. as owner o1 the property, or my employees with wages as their sale compensation, will do the work, and the
DAs owner -builder; I will not. employ anyone to do work which would require a permit from the Divisioin.of '
,structure is not intended or offered for sale (Sec. 7044. Business and Professions Cade: 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
' ' .. I r
through his own employees, provided that such improvements are not intended or offered for sale. If; however, the :,;•r
D Division.of Industrial Safety Permit No. ,•
building or improvemnt is sold within one year of complelion, the owner. builder will have the burden of proving that
Date Applicant'
he did not build or improve for the purpose of sale.)?,,y
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency far the performance -
D I, as owner of the properly, am exculsively contracting -with licensed contractors to construct the project (Sec:
of the work for which this permit is.issued.(Sec.3097,.Civ: C.)_. •': .• - ,
7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
Lender's Name
builds or improves thereon, and.who contracts for such projects with a contractor(s) licensed pursuant to the.-
SSB ,
-Contractor's License Law.)...
:..Lender's Address --
0 1 am'exempt under Seca Bi8 P.C. (Attached Certificate). -
I certifythat I have read this application and state that the above information is correct. I agree to comply with 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 1 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 OF COMPLIANCE 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
. _Department or City Department'
D'Certified copy is filed with the City Building Idspection
: , �. 1
construction, and authorize a'representative of the City of La Ouinta Department of Building and Safety to enter - .-.
upori•the pioperti for which F have applied for this permit for the purpose of making inspections- -.
Date Applicant
.. ... ...
Signature of Applicant or Agent Date
APPLICANT
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TUU N. Tustin Avlemn e, Suite 231
CITY/COMMUNITY/STATE/ZIP '
Santa Ana, LA 92205
JOB SITE C: ADDRESS/SPACE '
..�. UM berates;
CITY/COMMUNITY/STATE/ZIP
+ nta-
1A, U 92253
BOK'
PAG
PRC
C
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TWN•
RNG.
SE
S
TYsi�90-3
41
6.62
Plumbing -Fee
MOD
se
TRACT NAME
�u De %a Paz, Ltd.;
OWNER NAME (L F MI)
balae
CONTRACTOR -FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
I
P (1J.4) 558--37661
LICNC .
6'1983
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE 1
LICNC I
yy/�•.A
US/P`Lyy PERMIT . , um)
BL
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FSB
SSB ,
SSB
RSB
/-ZONE ORD N
LOT SZ
NO
Print Applicant/Agent Name
APPL/PRMT.16' 1--D
^ ^
Pendt to a =7i tn=t 1 f704 Sq. Ft.
of S/F/D
t4th 400 Sq. Ft: - of Garage Per Approved Plans
Mad on cal Fee $
18.00
Plan Cheek Fee
Con m Fee
418..00
Electrical. Fee
. 32,20 '
Sl+ Fee
6.62
Plumbing -Fee
56,00
Pxq)erty Developbent Fee " 450,00
4U FEB
6'1983
Cit - .. _t -
.:f La Cain"--
BLDG.DEPT.
VALUATIONI$ 94,670.40
Y,
P
Ah
F1
NO.
OPERATION ATE
INSPECTOR
NO.
OP ATION I DATE INSPECTOR
BUILDING APPROVALS
MECHANICA PPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
%i-/rR(
`tG
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 �s� . G,
10A
fireplace T.O.
❑
NPON
ADDITIONAL INFORMATION
`
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 / — (— $ cE CT C_
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
PW P/I
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance •
29' Wiring - •
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final -•1 s� G.