0562 (SFD)APPLICANT NAME (L. F, F. MI)
Vie Ile 043ISM
ADDRESS'
40U N. Tustin Avenue, aALe 231
PERMIT APPLICATION
City of La Quinta,
Department of Building and Safety
This permit becomes void.if work,not commenced.within1180 days from date of
ti
issuance. OR, if work has been suspended.or abandoned for a period of 180 days.
JAI
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,perlormance of the work for whichthis-permit is'
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is.in fullJorce -
issued.) shall not employ any.person in any manner,so as to become subjecIto the Workers'Compensation Laws of
and effect.
California.
_License Class Lic. Number
Date Applicant
• -Date Contractor.
NOTICE TO APPLICANT: If..after.making this Certificaticif Exemption, you should becomesubject to the Workers'
OWNER -BUILDER DECLARATION: ' I hereby iffirin'that Vam exempt from the Contractor's License Law for the
Compensation provisions ofAhe 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. provision.s.of the Contra.ctor's License Law
p.1 hereby certify that no excavation five (5) or morefeet in depth into which a person is required to descend, will be
(Chapter 9 (commeqcin.9 with section 7000) of Division ,3 of the Business and Professions Code) or that he is exempt.,
.
made in connection %iith Work authorized by this permit, and that no bui lding. structure, scaffolding, falsework, or
therefrom and the basis,for-the alleged exemption. Any vi olation of Section 70311.5by any applicariffor a permit
demolition ordismantlingthereot.'will bemore than thirty-six (36) feet high. (Chap 3.2,.Grp Z Art 2, Sec341, Titleff,
subjects the applicant to a civil penalty of not more than five hundred dollars (SWO.):
C.A.C.)
0 1, as ownerof 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 which would require a perinit 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
US[FSE OF PEID RMIT
through his own employees, provided that such improvements are . not intended or offered for sale. If, however, the
0 Division of Industrial. Safety Permit No.
building or imploverrint issoldwithin one year of completion, the owner -builder will have the burden of proving that
Date Applicant
he did not build, o.r. improve for the purpose of sale:).
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
10 1,as owner of the,property, am exculsively contracting.with licensed contractors to construct the project (Secy
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
Lend! e'r's - Name
builds or improves thereon, and who contractsior such projects with a contractor(s) licensed pursuant to the
'ZONE ORD 0
Contractor's.License Law.).
Lender's Address
0 1 amexempt under Sec. B. & P.C. (Attached Certificate).
I certify that I have read this application and state that the above information is correct. I agree to comply with,all
date X 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 OF COMPLIANCE AND AUTHORIZATION OF ENTRY:' certify:l have read this application and state that
• Certified copy is hereby furnished..
the information given is correct. I agree to,comply4vith all state laws and county ordinances relating to buidling
• Certified copy is filed with the City Building Inspection Department'or City�, DepartmerrL
construction, and authorize a representative of,the City of La Quinta Department -of Building and Safety to enter
upon the property for which I have applied jar this permit for the purpose of making inspections.
k. Date Applicant
Sionature of Anolicant or Anent Date
APPLICANT NAME (L. F, F. MI)
Vie Ile 043ISM
ADDRESS'
40U N. Tustin Avenue, aALe 231
CITY/COMMUNITY/STATE/ZIP
Santet hiall, LA 92705
.JJI3,SIDRESSISPACE
�4 ILA
4 U11 -Le beV�
q,TY/COMMUNITY/STATE/ZIP
La Quinta# CA 92253
BOK
PAG
PRC
C
Paid
TWN
FING
SE
S
Tr.CT
3640-3
LOT
41 1
Plumbing Fee
1
00
IM
sm
I.S13
TBRCy NAME
De.La paZ, Ltd.
gumEL.
OWNER NAM F
AS Mam
CONTRACTOR -FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE(714 558-,3766
G ef
LICNC 8
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE 0
LICNC o
US[FSE OF PEID RMIT
131.
1
1 ZON
FSB
SSB-
SSB
FISS
OFC
'ZONE ORD 0
LOT SZ
END -
SIDE .
Print Applicant/Agent Name
APPUPRMT DkTE
" 2
Ccrscb'
Permit to construct 1,581 Sq, Ft. of S/r/D
with 400 Sq, Fit, of Garage per aR'=oved pLamc-
ca-1 Fee
18*00
Plan Check Fee.'
Paid
CionstrustjLm Fee
400,00
Elsctrilcal. Fee
30,76-
S& Fee
6.20
Plumbing Fee
51*00
-Property Develcipmt Fee
450000
R E CE V E D
R EER
G ef
Le Qui.nA10
TOTAL.
FEE
BLDG. DEPT. VALUATION Is 88 200.U6
Ah
Ah
NO.
OPERATION ATE
INSPECTOR
NO.
O E ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
-76
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
10A
Fireplace T.O.
❑
NON
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb 99110
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
P/L P/1
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire _ / —TLl
298 Bonding
30 Fixtures
31 Service
32 Final ��CJ_