0556 (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 Is
LICENSED CONTRACTORS DECLARATION: I hereby.affirm that I am licensed under *provisions of Chapter.9. -
(commencing with Section 7000) of Division 3 of.the Business and ProfessionsCode, and my license is in full force
and effect.
License Class Lic. Number
Date Contractor
OWNER -BUILDER DECLARATION:. I hereby affirm.that i am exempG.from.tne Contractor's License Law for the ..
.following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to
construct, alter,.improve, demolish, or repair anystructure, prior to its issuance, also requires the applicant for
such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor'sLicense Law .
(Chapter 9 (commencing with section 7000) of Division. 3 of the Business and Professions Code) or that he is exempt
therefrom and the basis for the alleged exemption. Any. violation of.Section 7031.5 by any applicant fora permit
subjects the applicant io a civil penalty of not more thaw;tiye,hunored dollars ($500.):
0 I. as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
structure is not intended. or offered for sale (Sec. 7044; Business and Professions.Code: The Contractor's License
Law does not apply to an owner of property who builds, or improves thereon, and who does such work himself or
through his own employees, provided that such improvements are not intended or offered for sale. If, however, the
building or improvemnt is sold within one year of completion, theowner•builder will have the burden of proving that
he did not, build or improve for the purpose of sale.).
0.1, as owner of the property: am exculsively contracting with licensed contractors to construct the project (Sec:
7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
-builds or improves thereon, and who contracts for such projects with a contractor(s) licensedpursuant to the
Contractor's License Law.). t -
0 lam, exempt under Sec. B. 8 P.C._(Attached.Certificate).
Date Owner F
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.).. -
Policy No. Company
• -.0 Certified copy is hereby furnished.
0 Certified copy is filed with the City Building'lnspection Department or City • .• Department:
Date Applicant
A,f4CANT NAME M1.) ,
As
40 N. Tustin Avenue, Shite 231
CITY/, COMMUNIT Aria, (A l�•92705 "
JOS,SIT DDORESS/SPACE
CITY/COMMUNITY/STATE/Zipµ(92253
BON
PAG
PRC.
C
Plan Check Fee,.-
TWN
FIND
SE
S
TR13640-3
`46
5,78
Plumbing Fee F
4GD
Sa
4509*00,'.
TeACT NAME .Lagunai De la Paz, Ltd.
OWNER NAME (L. F. MI) •"
Sam • aw anavle
CONTRACTOR -FIRM NAME
ADDRESS - •• ,
CITY/COMMUNITY/STATE/ZIP ..
PHONE 558-3766
FEB 61983
fn .. � � x Ya iCIL 007..
u •
LICNC .
ARC/ENG FIRM NAME
ADDRESS .,
CITY/COMMUNITY/STATE/ZIP
PHONE N
LICNC 11
/�
USE IFID IT(Clondan3nimn) .
l if�
OL
ZON
I
FSB
SSB
SSe
RSB
OFC:
ZONE ORDS • .'_I-
LOT SZ
END
SIDE
suance, OR, if work has been -suspended. or abandoned for a period of. 180 days
CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE: This section need not be completed it
the permit is for.one hundred ($100) o,' less. I certify that in the performance.of the work for which this permit is
issued, I shall not -employ any persod..in any manner so as to become subject to the Workers' Compensation Laws of
California.
Date Applicant
NOTICE TO APPLICANT: If,,after making this Certificateof Exemption, you should become. -subject to the Workers':.
Compensation provisions of the Labor Code, you -must forthwith comply with such provisions or this•permit shall
be deemed revoked. "
DIVISION OF:INDUSTRIAL SAFETY PERMIT CERTIFICATION:
0 I hereby certify that no excavation five (5) or more feet in depth into which'a person is required to descend, will be -
made in corinection with work authorized by this permit, and that no building structure, scaffolding, falsework, or:
demolition or dismantling thereof• will be more than thirty-six (36) feet high. (Chap 3.2. Grp 2. Art 2, Sec 341, Title 8,•
C.A.C.) - '"0
0 As owner•buildei, I will not employ ariyone•to do work which would 'require a permit from the Division of
Industrial Safety, as noted above; unless such person has a permit'to do such work from that division.
0 Division of Industrialkafety Permit No.
Date' Applicant CONSTRUCTION.LENDING AGENCY: I hereby affirm that there is a construction lending'. agency for the performance
of the work for which this permit is issued (Sec. 3097, Civ. C.). .
Lender's Name
Lender's Address
I certify that I have read this application and state that the above.information is correct.) agree to comply with all
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.
Signature of Applicant or Agent ' Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that '
the information given is correct:d agree to comply with all state laws and county ordinances relating to buidling
construction, and authorize a representative of the City of La Ouinta.Depariment of Building and Safety to enter
upon the property for which I have.applied for this permit for the purpose of -making inspections.
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPVPRMT DATE
Q6-•84
carldo
Pezn4t to eonstrucct 11466 Sq. Ft.
of, S/F/D
with 400 Sq. Ft. of Garage Per Aid Plan:
Fee $
18.00
Plan Check Fee,.-
Paid
Construction FX�e
3$2.00
Fle+c.-tt cal Fee `
29.32
SNI Fee
5,78
Plumbing Fee F
40.50
Prapexty Developmt Fee
4509*00,'.
r '
R E C E
I V E D
FEB 61983
fn .. � � x Ya iCIL 007..
u •
'TOTAL
FEE
VALUATION $82,161.60
BLDG. DEPT.
Ah1
NO.
OPERATION ATE
INSPECTOR
NO.
OPW ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
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
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)
126 Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
• ��
17 Rough PlumbAllho
18 Vents fA ills
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/I
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring •
29A Grounding Wire / — / —Sr�t C.
29B Bonding
30 Fixtures
31 Service
32 Final