0561 (SFD)t.
PERMIT APPLICATION '
City of La Ouinta
Department of Building and Safety i
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.•
' ... . t. . ' • 1. . .
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
LICENSED CONTRACTORS DECLARATION: Thereby affirm that I' am licensed under, provisions of Chapter 9 • '
Ahe 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 Workers Compensation Laws of -: r
and effect.
California.
License Class Lic. Number
Date Applicant
Date Contractor
NOTICE TO APPLICANT: If; atter making this Certificate of Exemption, you should become subject to the Workers'
OWNER -BUILDER DECLARATION: 'I hereby affirm that I am exempt from the Coritractor's License Law fob the • `
"� Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this per 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 permitlofileasignedstatementthatheislicensedpursuanttotheprovisionsoftheContractor'sLicenseLaw
O thereby - certify I - hat no excavation five (5) or more feet indepth into which a person is required tocldscend;will 'be
(Chapter 9(commencing with section 7000) of Division 3of 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 for the alleged exemption. Any violation of Section 7031.5 by any applicantJor'a permit
demolition or dismantling thereof,"will'be more thanthirty-six j36) 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 (S500.): �!, "". ' -
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. anyonetodo-work which would 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.
Law does not apply to an owner of property who.builds, or improves thereon, and who does such work himself or
CITY/COMMUNITY/STATE/ZIP
through his own employees; provided that such improvements are not intended or offered.for sale: Ifehdwever, the
❑Division of Industrial Safety Permit No.
building orimprovemnt 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:).
CONSTRUCTION LENDING AGENCY: I heretiy affirm that there is a construction lending agency for the performance
'.O I, 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. Q. _
• 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.). .
4- Lender's Address
• O 1 am exempt under Sec.. B. 8 P.C. (Attached Certificate).`
• 1 certify that•I have read this application and slate that the above information is correct. I agree to comply with all ,
' Date I Owner '
city and county ordinances and state laws relating to building construction, and hereby authorize 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 sell'•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
'i CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
.O Certified.copy is hereby furnished:, , SI
'Y! I' 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 InspectionDepartment or City Department.construction•.
and authorize a' representative of the City of La Ouinta Department of Building and Safety to enter.
upon the property'for which I have applied for this permit for the purpose of making inspections.
Date Applicant '"" T "_•—
Signature of Applicant or Agent - Date
AY�1.CAbo t�iyaa. MI)
a + ..
A4UU N. Tustin Avenue, su to 231
CITY/COMMUNITY/STATE/ZIP�,. '„ _6
a� 9^705
na,,
JOB SIT OORESS/SPACE�
1�.. 1t 1 e Seranas
ITY/COMM_-. UNITY+/a p /Z 92253 .
nLF�:PRC t.i�
BOK- PAG
C
- . .TWN
Plan Cwk Fee
RNG
SE
S
TRACT
LOTB
SMT Fee
7„60 -
IMOD
SEI
Property Deve1cp rent Flee
TRACT De La Paz, Ltd.
1!
OWNME (�L.�F, MI�erCi�4
- , -
CONTRACTOR -FIRM NAME - -
ADDRESS '•
CITY/COMMUNITY/STATE/ZIP
PNC714) 558-3766
Y
LICNc .
L
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE •
•
TOTAL'
LICNC II
,
USE OFFP/RtIMIT
L 1J
BL
ZON
FSB
SS13
SSB
RS8
OFC
ZONE ORD Ill
LOT SZ
END
- SIDE .
Print Applicant/Agent Name
APPL/PRMT �' 1wa"8/I
WdA�R.7
condo
.
Pendt to oomstruct 1,973 Sq,
Ft.. 'of S/F/D
and 400 Sq. Ft. of Garage per ApWaved Plans
Medbanical Fee
$ 18,00 '
Plan Cwk Fee
Pam
OM traction Fee
455,50
El trical Fee
35.66
SMT Fee
7„60 -
Pbz bing Fee
56,00
Property Deve1cp rent Flee
4509'00
r
Y
4%J AIhi
Jr &91
L
•
TOTAL'
$ '"I,022.76
1
BLDG. DEPT. VALUATION $108,819.80
• '
rl
U
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
_ ( —5,41
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 Detection Device
9
Garage Fire Wall
jew
42
Commercial Hood
10
Fireplace P.L.
❑ %
43
Final
10A
f=ireplace 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 71 ,� g G,
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb •
moot
18 Vents
19 Sewage Disposal Cn
20 Sewer •
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final Q
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
P P1
STREET NAME
26 Power Pole
27 Conduit 0
28 Service Entrance
29 Wiring •
29A Grounding Wire 7 1
29B Bonding
30 Fixtures
31 Service
32 Final