0563 (SFD)PERMIT APPLICATION - -
City of La Duinta
• Department of Building 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 of 180 days.
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CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This -section need not be completed it,
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 is in full.force
issued, l shall not employ -any person inany mannerso asto become subject to the Workers' Compensation Laws of
and effect.
California.
License Class Lic. Number
Date Applicant
'Date, Contractor
NOTICE TO APPLICANT: -If, -after making this Certificate of Exemptionyou should become subject to the'Workers'
�--Compensation
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the '
provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
be deemed 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 a signed statement that he is licensed pursuant to the provisions of the Contracto,r's'License Law -
0.thereby cer(ifythatno excavation five (5) or more feet in ddpth into which a person is requi - red 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, falsewoik, or '
'therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
demolition or dismantling thereof, will be more than thirty-six0(36) feet;high: (Chap 3.2, Grp 2,.Art 2, Sec341, Title 8,
subjects'the applicant to a civil penalty of not more than five hundred dollars (S500.): -
C.A.C.) '.r • `
❑ 1. as owner of the property; or my employees with•wages'as their sole compensation, will do the work, and the.
0 As owner -builder, I will not employ anyone to do work whiohwould require a permit from 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. r,
Law does not apply to an owner of property who builds, or improves thereon, and who does such work himself or, o'
ADDRESS
through his own employees, provided that such improvements are not intended or offered for sale..lf, however, the
0 Division of Industrial Safety Permit No. 9
building orimprovemntissold within one year ofcompletion. the.owner-builder will have the burden of proving that
Date Applicant
. he 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
0 I, as owner of the'property, am exculsively contracting with licensed contractors to construct the project (Sec.
of the work for whichdhis 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 ..
"pursuant
'� Lender's Name - - -
builos or improves thereon, and who'contracts for such projects with a contractor(s) licensed to the
- - - - - - - - -
Contractor's License Law.).
Lender's Address
' O I am exempt vndenSec. B. 8 P.C. (Attached Certificate).
•1 certify,thatl have read this application and state.that the above information is correct. I agree tacomply with all
Date. Owner 01
city and county ordinances and state laws relating to building construction, and herebyauthorize representatives'
LOT SZ
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, ora
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' certificate bt'Workers' Compensation Insurance , ora certified'copy'thereof'(Sec. 3800. Lab. C.C'' •" "`•.
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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
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
0 Certified copy is -filed with the City Building Inspection Department or City Department.
construction, and.authorize a'representative of the City of La Ouinta Department of Building and Safety to enter
..e
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upon the property for -which I have applied for this permit for the purpose of making inspections.
- Date Applicant
• .,
APPLICANT NAME (L. F. MI)
B.
A400 N. Mistin Avenue, &dte 2314
CITY/COMMUNITY/STATE/ZIP .
Santa Ana, CA 92705
JOB SITE 606RESSISPACE '
1� (Alle sermumLa
CL V/COQuisTa, /=IC
QuintA 92253 , ..
BON
PAG
PRC
C I-
Phrnbng F+ee 61.00
TYYN-•
FIND
.SE
S
TRACT
13640-3 1
LDT
34 1
r. • -' TOTAL'
FEE
1 2A
SB
r
TRACT NAME -
][agmia De - La Paz ita.
ON�ME�JRwME�(LS, F. Ml) -9 m
VG
CONTRACTOR -FIRM NAME •• '^ '
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE #LICNC
?i.4) 558»3766
(714)5.
• .
ARC/ENG FIRM NAME -
ADDRESS
CITY/COMMUNITY/STATE/ZIP -
PHONE 6
LICNC
USE OF /pL1 RMIT
S(��)
BL
ZON
FSB SSB
SSB
RSB
OFC
ZONE ORD # -
LOT SZ
- END
SIDE -
Signature of Applicant or Agent
Print Applicant/Agent Name
Date
APPL/PRMT 1 x2&_84 0=10
Fer�t to c rostxuct 1,894 Sq. Ft. of S/F/D
with 400 Sq. Ft, of Garage Per Appy Pl is
Aechwd cal Fee $ 18.00
Plan Check Fee. Paid "
t7omtxuctlan Flee -445,50
Electrical Fbe u 67
Sly Fee 7*32' .
Phrnbng F+ee 61.00
Pzvperty Development Fee 450.00
RECEaVED
6 '1983
• d f1 N ,rw > Zd•
r. • -' TOTAL'
FEE
$ 1 (016.49.
VALUATION $104#664.Q
BLDG. DEPT.
Ah
Ah
NO.
OPERATION ATE
INSPECTOR
NO.
OP ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL PPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
—
"y G
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 Detect ion.Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P. L.
❑
43
Final
10A
Fireplace T.O. ❑
NO.
NO.
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
16 Water Piping LOEM
17 Rough Plumb •
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final '9 �..
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
PSL PyI
STREET NAME
26 Power Pole
27 Conduit •
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final