0560 (SFD)PERMIT APPLICATION + '
City of
La Ouinta
• Department of Building
and Safety •. ..
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. `
,PRC
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 is in full force .. •
issued, I shall not employ any person in anymannerso as to,become subject to the Workers' Compensation laws of- '
and effect.
California.
License Class Lic. Number
Date Applicant
Dated Contractor,. - _
NOTICE TO APPLICANT: If, after making this Certificate oUlixemption, you should become subject to the Workers'
" 5•-
• OWNER -BUILDER OECL"ARATION: l hereby affirm'that I am exempt.from the License Law for the"
Compensation provisions of. the Labor Code, you must forthwith comply with such provistons'or this permit shall
-
-Contractor's
following reason (Sec., 7031.5, -Business and Professions Code:'Any city or county which requires a permit to
be deemed revoked. '
L
• 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 tofileasigned statement.that he is licensed pursuant to the provisions of the Contractor's License Law
0* 1 Neirebycertifi thatno excavatioh five (5) or more feet in depth into which a person is required 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 workauthorized by this permit, and that no building structure, scaffolding, falsework, or
therefrom and the basis for the alleged exemption,.Ani 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.):
C.A.C.)
❑ I, as owner of the property, or my employees with wages as their sole compensation; will do the work, and the
❑ As owner -builder, Twill not employ anyone• to do 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
of IBdustriaf Safety,' Permit No.
through his own employees., provided that such improvements are not intended oroffered for sale. If, however, the
...0;Division
building orimprovemntissold within one yearofcompletion; the owner -builder will have the burden of provingthat
Date. Applicant
he did not build or improve for the purpose of sale.). -
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is &construction lending agency for the performance
❑ 1., 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. C.).
7044, Business and Professions Code:' The Contractor's License Law does not apply to an owner of property who
Lender's Name
buitos 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. : A. 8 P.C. (Attached Certificate).
I,cerlify that 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 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 I 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
O Certified copy is fifed'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
' . c, � w
upon the property for which I have applied for this permit for -the purpose -of -making inspections..
Date Applicant, •�'---' �
.. -
Signature of Applicant or Agent Date
APPLICANT NAME . F•F MI)� .. ,.
ADDRESS
in Averump %(Adte 231
CIT„aMMM'UNITY/S Aria, L 92705 -
JOBS AODRESS/SPACE / '
1f �'ni llcilJL� �� .. /
CITY/COMMFS49„/a,E/E 92273' .
r
BON
PAG
,PRC
C ,
-
TWN .
RNG.
SE
S
T13640-3
:32
7,32
28
61, 00
sB
450.00
TRACT NAME
lldgw)a De Ia Paz l, Ltd.
OWNERNAMEF,M
cu )OM
CONTRACTOR -FIRM NAME
ADDRESS ,.
CITY/COMMUNITY/STATE/ZIP
PHONE4) 558-•3765
LIr Nc l
ARC/ENG FIRM NAME ('y
ADDRESS
CITY/COMMUNITY/STATE/ZIP • '
PHONE M
LICNC •
USSVEI F PERMIT
�L4i17.L�a�4YY .
BL`
ZON
FSB
SSB
SSB
RSB
OFC .
ZONE ORD •
LOT SZ •'
• .
END
SIDE
Print Applicant/Agent Name
APPL/PRMT - P 1A26-84
Ccndo
Pe.n at to omst =t 1*894 Sq.
Ft, of S/F/D
and 400 Sq. Ft, of Garage Per Approved Plans
Mr cha a cal Fee
$ 18.00
Plan Check Fee
Paid
Cbmstroctilcn Fee
445.50
Electril Fee '
34.67
SMI Fee
7,32
Plumbing Fee
61, 00
Property Dimmlopment Fee
450.00
FEB
1983
City f La Qui:.0
Its.—
• �,;.-
:TOTAL
FEE
$.1.,016.49
1
BLDG. DEPT. VALUATION $104,664.40 r _
r-1
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
�— ! —�s�
L1
34
Plenums & Ducts so
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.
❑
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)
128 Ceiling (Batts)
12C Ceiling (Blown)
.14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents t
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final 76.
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
P!L P!I
STREET NAME
26 Power Pole
27 Conduit • •
28 Service Entrance
29 Wiring
29A Grounding Wire ¢-C
29B Bonding
30 Fixtures
31 Service
32 Final g