0549 (SFD)PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety '
This permit becomes void if work not commenced withim180 days from date of issuance, OR, if work has been suspended or abandoned for a period of 180 days.
CITY/COMMUNITY/STATE/ZIP•
Santa Ana, CA 92705
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
LICENSED CONTRACTORS' DECLARATION: [-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 indull force -
issued, I shall not employ any person in any manner so as to become subject tothe Workers'.CompensationLaws 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'. k .
OWNER -BUILDER DECLARATION: Iherehy affirm that I alit exempt from Elie Contractor's License Law for the `•'�
Compensation provisions of the Labor Code, you must forthwith comply with such'provisionsor this permit shall
be deemed revoked,
following reason (Sec: 7031.5. Business and Professions Code; Any. city or county which requires a permit to
..
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 oftheContractor's License Law
01 hereby certify that no ezcavationfive(5)'ormorefeet indepthinto whichaperson isrequiredlodescend,will be -e •
(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 basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit.-,
:
A 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.): " . .. •
,`•'�y`CtA.C.) ' . . .. - '
O L.as owner o1 the property, oUmy 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 Contractors 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, avid who does such work himself or
PHONE A
' through his own employees. provided that such improvements are not intended or offered.for sale. If, however, the -:
0 Division of Industrial Safety Permit No. s
building orimprovemntissold within one year ofcompletion. the owner -builder will have the burden of proving that
Date Applicant
he did not build or improve for the purpose of sale.).
• • .' ^' '
r+,-
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
t 01. as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec:,
oft 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 r. '
0 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 �I
•
.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. 38110. -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'
o Certified copy is hereby furnished.
the information givemis correct. I agree to comply with all state laws and county ordinances relating to buidling
' ❑ 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
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upon the property for which l have applied for this permit for the purpose of making inspections.
Date Applicant
Signature of Applicant or Agent Date
APPLICANT NAME (L, F; MI)'
M* B. JO�lF}S+J11
ADDRESS '
400 N. 'Amtin.Mmue, Suite 231
CITY/COMMUNITY/STATE/ZIP•
Santa Ana, CA 92705
J, SMITE ADDRESS/SPACE
e 5erams
cITY/CDZIP
La _"MMUNITY/s
(?1PP`M• CA 92253 .
BOK
AGG�TAfl,
PRC
C .
Plan C heck . Fee
TWN
RNG
SE -
S
_TRACT_ •: ��
LOT_
1.71tif7
Plmbbinq Fee
MOD
SB
450.00
TRACT NAME
TDe la Paz, Ltd. ..
OWNER NAME (L, F. MI)
Smme a ,
as � cw
.CONTRACTOR -FIRM NAME -
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE a .
(714) 558--3766
.
AA
LICNC •
'
6.
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP - -
PHONE A
LICNC M
-
USE OF PERMIT
S/F%D (Condcminium)-
81.
ZON • FSB'-. SSB
SSB
RSB
OFC
• ZONE ORO N :. •r,,
: -LOT SZ •
-
END
.• SIDE
Print Applicant/Agent Name
APPVPRMT - DATE
1-26-$4
-
Owido
Penni t to =wtruct 1, 662 Sq.
Ft. of S/F/D
and 400 Sq. • -Ft, of Garage Pet Approved P],ans
(i} Feey�
3A..00
Plan C heck . Fee
Paid
CbnstmctiAn Fee
412.00
Electrical Fee
31.77
Sim Fee
6,48'
Plmbbinq Fee
58.50
Property-Develorment Fee
450.00
t". ,
.
AA
e
6.
TOTAL
FEE
$ 976.75 • -
BLDG. DEPT.
VALUATION $92,461.20
Ah
Ah
NO.
OPERATION ATE
INSPECTOR
'NO.
OPWATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICA PPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade..
35
Furnace Compart.
90
3
Steel
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
39
Appl. Clearance
7
Framing
Xe,
40
Fire Damper
8
Vents
41
Smoke Detection Device
.9
Garage Fire Wall
42
Commercial Hood
10
Fireplace -• P.L.
❑
43
Final. • �� �, G,
10A
Fireplace T. 0. ❑
OWN
ADDITIONAL INFORMATION
1
SEWAGE SYSTEM•SIZE.& LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R C
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final-��.f'�
PLUMBING APPROVALS
15 Ground Plumb — G.
16 Water Piping Cob
17 Rough Plumb •
18 Vents _
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service -
24 Gas Test
25 Final 9 `.
Tank Pit L. Line
ELECTRIC APPROVAL'S
REAR OF PROPERTY LINE
P/L P/l
STREET NAME
26 Power Pole
27 Conduit •
28 Service Entrance •
29 Wiring. �A
29A Grounding Wire (. _ $K G
29B Bonding
30 Fixtures
31 Service
32 Final