0559 (SFD)PERMIT APPLICATION
• City of La Quinti
Department of Building and Safety
This permit becomes void if work not commencedwithin 180 days from date of issuahce.'OR, if work has been suspended or -abandoned for a period of 180 days
• . • -• • T •' _
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
LICENSED CONTRACTORS- DECLARATION: I'hereby. affirm'lhat I am licensed under provisions of Chapter -9'
the permit- is for one hundred (5100) o, less. I certify that in the performance of,the work for which this permit is
(commencing with Section 7000) of Division 3 o1 the Business avid Professions Code, and my license is in full force
issued: I shall not employ.any person inany manner so as to'become subject tothe .Workers Compensation Laws of
and effect.
California. ,
License Class Lic. Number
Date Applicant
Date - - '=• - •` % Contractor • . •
NOTICE TO APPLICANT: It, after making this Certificate of Exemption, you shpuldbecome subject to.the Workers' -
•�
OWNER -BUILDER DECLARATION: I hereby aflirrn that'I am exempt�from-the Contractor's License Law for the
Compensation provisions of the Labor Code., you must forthwith comply with such provisions or this permit shall,
deemed revoked. '
following reasbn'(Sec.n7031.5. Business and'Professions Code: Any.city'or county which requires.a permit to
.be
„ .
• 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 asigned.statementthat heislicensed pursuant totheprovisions oftheContractor'sLicense Law " •
❑ Ihereby certify that noexcavation five (5)ormore feet indiipth'into Which iperson isrequired tode'scend,will be •'i,
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) orthat he is exempt ',
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
q,'..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-six (36) feet'high. (Chap 3.2, Grp 2, Art 2, Sec341, Title B: -
x1sublects 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, willdo the work, and the
O' As owlier•ouilder, I will riot 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 nbted-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
a .. . . 1.
through his own employees, provided that such improvements are not intended or•otfered for sale: If, however, the
.O Division of Industrial.Satety Permit No.
building or improvemnt is soldwithin one yearof completion, the ow.ner-4uilder will havethe 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 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. C.).
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 contractors) licensed pursuani'to'the.
- - -
Contractor's License Law.).
Lender's Address
O 1 am exempt under Sec. B. d 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 Owner ' +n'
city and county ordinances and state laws relating to building'construction, and hereby authorize representatives
of this county to enter upon above=mentioned property for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that l 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: I certify I have read -this applicationand state that '
O Certified copy is hereby, furnished; '. - t \
the' information given is-correct.I agree to comply with all state laws and county ordinances relatinoo buidfing
O'Certilied copy is filed with the City'Building Inspection De�par_tm—enrt or City. Department.
construction, and authorize a representative of the City of La Ouinta Department of Building and Safety. to enter
�""""'e"'•
upon the property for which I have. applied for this permit for the purpose of making inspections.
Date Applicant
APPLICANT NAME (l. F. MI) - - -
bl; kl, johns it
A400 N. `Astin, ate 231
CITSanta
Y/COM�UNITAVMS^AfE/LI� 92?05
4RADDDRR'E31SS//SLPACE
JOB,SI -
A eu LAIle 5exams
C)TY/CGM,-_MUNITV�STA�E/LIP• CA 92253
BOK •-
FAG
PRC I
C
Plumbing Fee 58,50
TWN
FIND
SE
S
Ti"3640-3
3l
MOD
Lt7f
liI'
sB
TRACT NAME
Lagum De La P=, Ltd.
OWNS EM M� F. MI
WANe
CONTRACTOR -FIRM NAME -
ADDRESS ..
CITY/COMMUNITY/STATE/ZIP.-
PHONE It -
(77.4) 558,,3766
^
"LICNC 8
'•
ARC/ENG•FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP -
PHONE •
LICNC'n
USE OF PERMIT
\
BL
I
I ZON
FSB
SS8.
SSB '•
RSB
OFC ..
•' ZONE ORD •-
LOT SZ
END.
.SIDE
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPL/PRMT
Sq
Pe=dt to CMSt =t 1,662 Sq; Ft: of S/F/D
with 400 Sq. Ft. of Garage Per Approved Plans
N10C.rl cal Fee $ 18.00
Plan Check Fee- _ Paid
Cbnstruc.'t� Fee 412.00
Electrical. ` Fee 31:77
;SMI Fee 6.48
Plumbing Fee 58,50
Pxapertx Development Fee 450,00
• ft1K •
N
t- t 8 b '1983
aty v'7 MLLiJ
r TOTAL
FEE
$ 976.75
BLDG. DEPT.
VALUATION $ 92,461.20
•
r1
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
_ —�`�
fi
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 77—G,
10A
fireplace T.O.
❑
OP'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 19 -!S 7y
PLUMBING APPROVALS
15 Ground Plumb ^ / — (.( g
16 Water Piping
17 Rough Plumb
18 Vents AND
19 Sewage Disposal•
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final ��Gf�aS— G
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
29B Bonding
30 Fixtures
31 Service
32 Final