0554 (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 issuance, OR, if work has been suspended or abandoned for a period of 180 days
" 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 ($110) o, less. I certify that in the performance of lhe'work.for which this. permit is
(commencing with Section 7000) of -Division 3of the Business and Professions Code, andmy licenseis in full force issued. Ishall notemployany person in any 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; If, after making this Certificate of Exemption, you should become subject to the Workers'..
OWNER•BUILDER DECLARATION: 'I hereby affirm that 1 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 orcounty. 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 permittofileasignedstatement.thatheislicensedpursuanttothe.provisionsoftheContractor'sLicenseLaw 01 hereby certi fy that no excavation five (5) ot 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) orthat he is exempt made in connection with work authorized by this permit, and that no building structure, scaffold ing,.falsework, or
therefrom and the basis for the alleged exemption. Any violation of Section 7031:5 by any applicant fora permit demolition or dismantling thereof, will de:more than thirty-six (36) feet high. (Chap 3.2. Grp 2. Art 2, Sec341, TitleB;
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 solgcompensation; will do the work, and the O As owrier-builder; Iwill 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 .. _ - .
through his own employees, provided that such improvements are not intended or offered far sale:-If,,however, the .., . O DivisioIt of, IndusIrial Safety Permit No.,
If
builingorimproveInntissoldwiIhiItoneyearofcompletion,theowner-builderwilIhavetheburdenoIprovingthat Date Applicant.
he did not build or improve fordhe purpose of sale.).
r 'CONSTRUCTION LENDING AGENCY: I hereby affirm that there is.a construction lending agency for the performance
O 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.). • _ s.
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. B. 8 P.C. (Attached Certificate).. I certify that) 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'countyto 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,.,I certify l 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 filed with the City Building Inspection Department or City Department. construction, and authorize a representative of the. City of La Duinta Department of Building and Safety to enter.
upon the property for. which I have applied for this permit..for the purpose of making inspections.-
Date-
nspections.•Date .. Applicant
Signature of Applicant or Agent Date
it
APPLICANT NAME (L. F. on • • -
• • VV1iL4'i1Ai
400 N. Wstin Avenue, Suite 231
CITY/COMMUNITY/STATE/ZIP
Santa. Arta, CA 92705
5B,SI DDRESS/SPACE
- Calle Seranas,
CITY/COMMUNITY/STATE/ZIP ..
La Quinta, CA 92253
BON
PAG
PRC
C'
,TWN'
Paid
AND.
SE.-
S
TR1 0-3
L45
6.20
Plmbing Fee
5M
$B
.
TRACT NAME
Laguna De La Paz„ Ltd,
) ,
OWNER NAME (L. F. MI_e,IsrG�
3L�iv
CONTRACTOR -FIRM NAME•
ADDRESS .
CITY/COMMUNITY/STATE/ZIP
PHONEII
(714)558-3766
114y
LICNC N
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE N
LICNC N
-
USE OF PERMIT
S/F/D (CioatdaninimN
81.
ZON
FS8
SSB
SSB
.-RSB
-
OFCr
ZONE ORD N .
', LOT SZ
r•
END
SIDE '
Print Applicant/Agent Name
APPL/PRMT GATE
6•�84
's
'
Ooa�do
Pendt to omist=t 1,581 Sq. Ft*
ef•5/F/D
with 400 Sq, -Ft. of Garage Per Approved Plan-
111Cd1 Foe $
18,00
Plan 0mck Fee
Paid
Construction Fee
.400.00
F1ect�cical Fee -
30,76
SIC Fee v
6.20
Plmbing Fee
51,00
Pr cperty Dev+el,opmEnt Fee
450,00
114y
74t _a
-UIn
TOTAL
FEE
$
955.96
-BLDG. DEPT.
VALUATIONI$ 88,200.60
�K
Ah
Ah
NO.
OPERATION ATE
INSPECTOR
NO.
O 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
fireplace T.O.
d14
NPON
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE &LOCATION
11 Exterior Lath L
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents NX gn.
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final Cj.15.p i
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
PSL P/1
STREET NAME
26 Power Pole
.27 Conduit
28 Service Entrance
29 Wiring •
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final