0578 (SFD)PERMIT APPLICATION
City of La Duinta
• Department of Building and Safety
ADDRESS
t) V N. Mwtin Avenue, Suite 231
,
' This permit becomes void il-work-not commenced within 180 days from date of issuance. OR, if work has-been suspended or abandoned for a period of:180 days.
CIrTV�/COMMe k VNT /S�TA,E21 52253
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed it
'LICENSED CONTRACTORS DECLARATION: I hereby affirm that 1. 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.is in full force
issued. I shall not employ any person in any manner so as to become subject to the WorkersTompensation Laws of... ,
and effect.
California.
License Class Lic. Number
Date Applicant
Date Contractor s
NOTICE TO APPLICANT:•11, after-making•this Certificate of Exemption, you should become subject to the Workers'
r•,u
OWNER -BUILDER DECLARATION,. I hereby'affitmlhat I am exempt from the Contractor's License -Law for:toe • ��'
Compensation provisions of theLabor Code, you must forthwith comply with such provisions or this permit shall -
berevoked.
following reason (Sec. 7031.5, Business and Professions Code, Any city or, county which requires a permit to
.deemed
'
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 Contractor's License Law
'D I heribycertify that hb'excavation five (5) or more feet in depthiRio which a person istiqluired to descend, will be - .-
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) or that he is exempt ',
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
therefrom and the basis tor.the alleged exemptian..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, Art 2, Sec341, Title8,
subjects the applicant to a civil' penalty of not more than five hundred dollars ($500.): •- - .x :zr :di. ' -'
C.A.C.)
• O I. as owner of the property, or my employees.with wages as their sole compensation, will do the work, and the :. ,
O As owner -builder, I will not employ anyone to do work which would require a.permit froin the Division: 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.. -
LICNC N
- through his own employees, provided that such improvements are not intended or offered for sale. If, however -,the
O Division of Industrial.Safety Permit No.
building or improvemni is sold within one year of completion, the owner -builder will have the burden of proving that .•-
Date Applicant
he did not build or improve for the purpose of sale.). w
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
O 1, as owner of. the property, am exculsively contracting with licensed contractors to construct the project (Sec'
7of the work -for which this permit is issued (Sec. 3097, CivJC.)..'•
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
-
Contractor's License Law.).
Lender 's.Address
O 1 am exempt under Sec. B. & P.C. (Attached Certificate).
I certify4hat I have read this application and state that the above information is correct. I agree to comply with all •.
Date °J Owner
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
END
of this county to enter upon the above-mentioned property for inspection purposes. t
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, ora
• 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
O Certified copy is hereby, furnished.
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
,. O Certified copy is filed with the City Building Inspection Department or City Department.
construction, and authorize a' representative of the City of. La Duinta, Department of Building and Safety to enter, ;
upon the property for which l have applied for this permit for the purpose of making inspections.
Date Applicant
Signature of Applicant or Agent Date
APPLICANT NAME (L, F. MI) - •,
1*10 b. r1t�u�liL9[1
ADDRESS
t) V N. Mwtin Avenue, Suite 231
ITV/STA;E/ZI '
SiWitd •KA 02 705
JOSH ODRESS/SPACE
VKyiIie berans
CIrTV�/COMMe k VNT /S�TA,E21 52253
BOK
PAG
PRC
C
-
TNM•
RNG
SE
S
TS 240-3
LOT .35
7.60
Pring Fee
MOD
so
450,00
TRACT NAME -
ttagtm De La Paz, Ltd.
OWSNE_�NAME (Ls F. MI9 )wm .• - .
—i
CONTRACTOR -FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE 0
(71-4) 558•-3765
LICNC N
.6199.3
•1,4
ARC/ENG FIRM NAME -
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE •
TOTAL
LICNC N
T,022..76 .. < .
USE OF PERMIT
S/ /D t --- - -an:i niuQn)
BL
ZON
FSB
SSB
SSB
RSS
OFC
ZONE ORD N
LOT SZ
END
SIDE' '
Print Applicant/Agent Name
APPL/PRMT ' DATE
�.
116
cmxb
Pe=it to construct 1,973 Sq.
Ft.. of S/F/D
with 400 Sq. Ft. of Curage per arwed Plan.°
Ncs�I. nee
$ 18.00
Plan Check Fee
Paid
Qanstn=tim Fm
455,50
.Tea
35..66
'SM Fee
7.60
Pring Fee
'569 00
Propertywent Fee
450,00
-Develo
RECEIVED
FEB
�`Ytl
.6199.3
•1,4
� ice.
TOTAL
T,022..76 .. < .
*
BLDG. DEPT. VALUATION $108,x819.80
• •
Ah
Ah
NO.
OPERATION I ATE
INSPECTOR
NO.
O ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
35
Furnace ComparY:
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
ADD ITIONALINFORMATION
SEWAGE SYSTEM SIZE & ►LOCATION
11 Exterior Lath
12 Internal Lath L
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final a✓ ,
PLUMBING APPROVALS
15 Ground Plumb (/ - / — -41 (f
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 - L5 —
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
P/L P)
STREET NAME
26 Power Pole Co
27 Conduit C
28 Service Entrance
29 WiringAt
29A Grounding Wire
29B Bonding
30 Fixtures .
31 Service
32 Final