0551 (SFD)PERMIT APPLICATION
City of La Duinta
` Department of Building and Safety
CITY/COMMUNITSanta Y/STATE/ZIP
•C7
CA 92705
'JOB SI,T DORESS/SPACE
�. CYke seranas ► a �
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
r LICENSED CONTRACTORS DECLARATION: I hereby affirm that' 1 -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, I shall not employany person inany.manner so asto 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 Workefs'
•�'Compensation
. OWNER -BUILDER DECLARATION: I, hereby affirm that I am exempt from'the Contractor's License Law for the =
provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall: y
- -. -.
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 "'
Olhereby certifythatnoexcavation five (5)ormore feet indepth intowhicfiapersonisrequired todescend, will be
•. (Chapter 9 (commencing with,section 7000) of Division,3 of the Business and Professions Code) or that he is exempt
made in connection'with work authorized by this permit: and that no building structure, scaffolding, falsework, or
• therefrom and the ba;is for, the alleged exemption. Any violation of Section 7031:5Ityanyapplicant for a permit.
demolition or dismantling thereof, willbe more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art-2pSec341, Title 8,
subjects the applicant.to a civil penalty of not more than five hundred dollars ($500.): -'
CAC )
o I. 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' 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'Satety; 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 .
USE/ F PERMIT .
S F D
through his own employees: provided that such improvements are not intended or offered for sale. If; however, the
O Division ot.lndustrial Safety Permit No.
building orimprovemniissold within one year .ofcompletion,theowner-builder will have theburdenofproving that-
Date Applicant
he did not build or improve for the purpose of sale.). ,c
CONSTRUCTION LENDING AGENCY:` I herebiaffirm that there is a construction lending agency for the performance '
❑ 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.).
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 e
O I.am. exempt under Sec. B. 8 P.C. (Attached Certificate).'
I certify that 1 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, or a
certificate of Workers' Compensation Insurance', or a certified'copy thereof (Sec. 3800. Lab. Q. ' ..
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. • ym: ••
'.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 Ouinta Department of Building and Safety to enter
• >' s.e
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
Print Applicant/Agent Name
AyyP�PPfLICANT NAME (pL. Fes, SMI) - -
A400 Ni TUStin Amim, Suite 231
CITY/COMMUNITSanta Y/STATE/ZIP
•C7
CA 92705
'JOB SI,T DORESS/SPACE
�. CYke seranas ► a �
CITY/COMMUNITY/STATE/ZIP-- EA La 92253- ..
BOK
PAG
PRC
C
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TWN
RN
SE
S
TRACT
26
7.4,60
Plumbing Fee
8 3A
SB
.
TRLaqUACTNAMEMDe La Paz, Lied. .
OWN-_.- ER NAMEa(LS, F. MI) - -
j
CONTRACTOR -FIRM NAME
ADDRESS `
CITY/COMMUNITY/STATE/ZIP - +
PHONE • '
(714) 558--3766
city v�
LICNC' U
ARC/ENG FIRM NAME
ADDRESS '
CITY/COMMUNITY/STATE/ZIP '.
PHONE •
1.022.76
LICNC •
-
USE/ F PERMIT .
S F D
BL
ZON•
FSB
SSB
SSB.
RSB'::
OFC `:•
' ZONE ORD • -
LOT SZ
END' ::
SIDE
DTE
APPL/PRMTns�'"'� J 1'
CIME1d0 ' .
Permit to cWnstn=t 1,973 Sq.
Ft. of S/F/D
with 400 Sq. Ft. of (gage Per Approved Plans
Nk�CPLat;iCal. Fee'
$ 18.04
Plan Check Fee
Paid
C lmi truc tiM Fee
455.50
Electrical Free
35.66
Sfa Fee
7.4,60
Plumbing Fee
56.00
Property DevelgMmt Fee
454.00
V
EID
f
city v�
C,8 �a lU9aaLltid
>.. :TOTAL
FEE
1.022.76
BLDG.DEPT.
. VALUATION 108,819.80
n
Ah
NO.
OPERATION ATE
INSPECTOR
NO.
OPRATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL PPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
G - (may
�f G
34
Plenums & Ducts doom
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
AW
42
Commercial Hood
10
Fireplace P.L.
❑
43
Final .� _gs g -G•
10A
fireplace T.O.
❑
NON
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
PLUMBING APPROVALS
15 Ground Plumb f (-
16 Water Piping C
17 Rough Plumb
18 Vents •
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 -Gas Test
25 Final-!S�$,=- /��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