0553 (SFD)PERMIT APPLICATION
City of La Ouinta .
• Department of Building and Safety
ADDRESS
400 N: Tustin Avenue', Suite 231
CITY/COMMUNITY/STATE/ZIP
Santa Ana, CA 92705
This pumit 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.
Y.•
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, l 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' x r.„ ; NOTICE TO APPLICANT: If, after. making this•Certificate of Exemption. -you -should become subject to the Workers'
OWNER -BUILDER DECLARATION: I Hereby affirm that am exempt from the Contractor's- License Law for the
"-' Compensationprovisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
y'be
following•reason (Sec. 7031.5. Business and Professions Code: -Any. city or county which requires a permil'to
• deemed4revoked.
• conslrum.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 statement that he is.licensid pursuant to the prov.isions of the Contra,ctors.License Law
0 1 here6y'tertify ihat no*ex-cavation'five (5) ormbre feet in depth into*which a p6rson is required to descend, will be
(Chapter 9 (commenting with section 7000) of Division 3 of the Business and. Professions Code) or that heisexempt
made in connection with'work authorised by this permit, and that no building structure, scaffolding, falsework: or
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a.permit;^. ',c
`• • demolition or dismantling thereat; 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 penally of not more than five hundred dollars ($500.):
'
O 1, as owner of the property, or my employees with wages as their sole.compensation, will do the work, and the
❑ As owner•builder, I will not employ anyone to do Mork 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 tl 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
LICNC I
c
through his own employees, provided that such improvements are not intended or offered for sale. If, however, the.
❑ Division of Industrial Safety Permit No.
u • y
'bu ilding o r improvemnt is sold within one year of completion, the owner -builder wil I have the burden of proving that .
Date L Applicant
he did not build or improve for the purpose of sale.).
CONSTRUCTION LENDING AGENCY: I hereby affirm that ther6is a construction lehding agency for the performance '
..0 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.). 1.. . •_ . .. '
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
❑ 1 am exempt under Sec. :'B. 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 irispection 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 filed with the City Building Inspection Department 'di City' Department.
construction:' and authorize a'reoesentative of the City of La Ouinta Department of Building and Safety to enter
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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 (L� F. MI)
e Be
ADDRESS
400 N: Tustin Avenue', Suite 231
CITY/COMMUNITY/STATE/ZIP
Santa Ana, CA 92705
JDORESS/SPACE
Calle Seranas
D -1l
CITY/COMMUNITY/STATE/ZIP
La Quinta;, CA 92253 `
BON
PAG
PRC -
C 1
Plumhtng Fee 58,50
TWN
RNG
SE
S
TRACT
13640
LOTOD
ILA
SB
TRACT NAME -
ta9tuia De La Paz, Ltd,
OWN-- ER NAMEas F. MI- 1
CONTRACTOR -FIRM NAME •. .
ADDRESS
CITY/COMMUNITY/STATE/ZIP .. -
PHONE- +
(714) 558•-3766
LICNC 1
'
ARC/ENG FIRM NAME - -
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE 0
LICNC I
USE OF PERMIT
S,/F/D (03 dam;n;um)
'BL
ZON FSB SSB
SSB -
RSB
OFC
- `ZONE ORD'v
. LOT SZ
Print Applicant/Agent Name
APPL/PRMT .. '11
/ yS�
Pert to est =ct 11662 Sq, Ft, of S/F/D
with 400 Sq. Ftw of Garage pek'Ap v Plans
ealc n ca3 fee $ 18,00
'Plan amc ' Fee . Paid
Cmist;ruct ion Fee 412.00
El cal Fee' 31,77
►Sk Fee
Plumhtng Fee 58,50
Party Development Fee 450,00'
,__;101 c.
,ytY
f+LU ti,063.
Tty 4A
.. .-' .• T TAC •
1$'__'976'.75 r .
Y
" . ,. VALUATION $92x461.20
• BLDG. DEPT.
a
Ah
NO.
OPERATION ATE
INSPECTOR
NO.
OP 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.
❑
NO.
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value to
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final r G,
PLUMBING APPROVALS
15 Ground Plumb `/— ! g C-
16
16 Water Piping IS, emb
17 Rough Plumb
18 Vents
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 PiI
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring •
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service -
32 Final .�
i