0557 (SFD)'APPLICYA�NT NAME yy(L,. �FF,,, �MI) .�jr
M . iJtAYi�XJIl
ADDRESS
400 Ni Tustin Avenue, Suite 231
PERMIT APPLICATION
City of La Ouinta:.
• Department of Building and Safety
CITY/COMMUNITY/STATE/ZIP
La Quanta, < CA 92253
BOK
• - 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. -
• . . r .
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 Divisioh 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.
and effect.
California.
• ' License Class Lic. Number
Date Applicant
Date Contractor a, '
:S ,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 Contractor's License Law for the
Compensation provisions of the 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 provisions of the Contractor's License Law
0 1 hereby'certify that hit exdavation five (5) or more feit in depth into which a perstin 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 connectiori'with work authorized by this'permit, and that no building structure, scaffolding, falsework, or
therefrom andthe basis for the alleged exemption. Any violation of Section 7031.5 by arry-applicant for a permit •
demolition or dismantling thereof, will be more than thirty-six (36) feet -high. (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8,
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.): ae,•
C.A.C.)
O 1. as owner,of the property, or my employees with.wages as their sole compensation, will do the work; and the
p As owner -builder, I will not employ anyone to do work'which would reqmuire a permit frothe 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
✓•
n through his own employees, provided that such improvements are not intended or offered for sale. If, however, the,
O Division of Industrial Safety Permit.No.
building brimprovemnt 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 tor, the purpose of sale.)., ;. _
CONSTRUCTION LENDING AGENCY: I hereby affirmlfiatthere is a construction lending agency for the performance
A t 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 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 certify 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
O Certified copy is hereby furnished,
the4riformation given is correct. I agree to comply with all state laws and county ordinances relating to buidling
.-• O Certif_ied'copy is filed 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
acs T`�ee�
upon tf a property for which I have applied for this permit.for the purpose of making inspections.*
Date Applicant
'
Signature of Applicant or Agent Date
'APPLICYA�NT NAME yy(L,. �FF,,, �MI) .�jr
M . iJtAYi�XJIl
ADDRESS
400 Ni Tustin Avenue, Suite 231
CITY/COMMUNITY/STATE/ZIP
Santa Ana, CA 92705
JOB E ADDRESS/SPACE
711 Calle Seranas
CITY/COMMUNITY/STATE/ZIP
La Quanta, < CA 92253
BOK
PAG
PRC
C
Plan' C h edk Fee
TWN'
ANG
SE
S'
T.3640�-3
so
7,60
Plvrabing Fee
MM
SB
TRACT NAME De La Paz, Ltd* •
L
OWNER NAMEMI
�(L, F )
CONTRACTOR -FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP • '
PHONE •LICNC
x%14) 558-•3766
0
'
ARC/ENG FIRM NAME - ..
ADDRESS
CITY/COMMUNITY/STATE/ZIP ! / • • -
PHONE •
LICNC •
-USE OF PEFMIT�uitilA.LLirti+ai�
BL
ZONFSB
SSB
SSB
RSB
OFC
- ZONE ORD N
.LOT. SZ
END
'SIDE '
Print Applicant/Agent Name
APPL/PRMT k �
* 8 e
Pe ni*t to aonstrwt
1,973 SLS. Ft, of S/F/D
and 400 Sq: Ft.' of Garage Per Approied _P3.ans
kcal Fee
'18,00
Plan' C h edk Fee
Paid
-Construction Fee
455.50
E -i -6 -al Fee•
35;66
SM Fee
7,60
Plvrabing Fee
56100
P=per`y Development Fee 450,00
r
\ 4 •
` . TOTAL'7
FEE
022 s 76
BLDG. DEPT. VALUATION 1 $108,839.80
li
Ah
NO.
OPERATION ATE
INSPECTOR
NO.
OP ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System G
2
Ftgs & Frms
— (—�G�
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
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)
126 Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb • •
18 Vents
19 Sewage Disposal •
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final /�j- �s.
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
p/L PiI
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire T --5,;-4-( E
29B Bonding
30 Fixtures
31 Service
32 Final