0546 (SFD)PERMIT APPLICATION
• City of La O2 a
Department of Building and Safety
This permit.becomes void if work not commenced within A80 days -from dale of issuance, OR, if work has been suspended or abandoned for a period of 180 days. '
LICENSED CONTRACTORS. DECLARATION: I hereby affirm that I am 'licensed under provisions of <Chapter 9.•
(commencing with Section 7000) of Division 3 of the Business and Professions Code: and my license is in full force . • .
and effect. -
License Class Lic. Number,
=,Date' • ' Contractor,
dWNER-BUILDER' DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the- "
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;
such permit to file a signed statementthat he is licensed pursuant to the provisions of the Contractor's License Law
(Chapter 9 (commencing with section.7000) of Division 3 of,the Business and Professions Code) or that he is exempt .
therefrom and the basis for.the-alleged exemption. Any violation of Section.7031.5 by any applicant for a permit
subjects the applicant to a, civil penalty of not more than five hundred dollars ($500.): .
❑ 1, as owner of the property, or my employees with wages as their.sole I ompensation, will do the work, and the .
structure is not intended or_offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License .
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 for sale. If, however; the, ^
building or improvemnt is sold within one year of completion, the owner. -builder will have the burden of proving that, - .
he did not build or improve for the purpose of sale:);
❑ I, as owner of the property, am excufsively contracting with licensed contractors to construct the project (Sec. „ ..
7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who contracts for such, projects with a contractor(s) licensed- pursuant,to the•*
Coniractor's License Law.).
❑ Pam exempt under Sec. . B. 8 P.C. (Attached Certificate).
Date Owner' y
WORKERS' COMPENSATION DECLARATION: I hereby affirmthat I have a certificate of consent to self -insure, ora • .
certificate of Workers! Compensation Insurance, ora certified copy thereof (Sec. 3800. Lab. C.). Cit.
Policy No. Company
O•Certified.copy is hereby furnished. c
'O Certified copy is filed with the City Building Inspection.Department or City i • Department.'.. r
Date Applicant low
`_
APPLICANT NAM l.'F MI) -
AAM N. 1%istin Avenwe, Suite 231
CI.T�V/�aCOM`MUNI,Ty/STA zl 92705 .
JO14I•5TE ADDRESS/SPACEMmaS
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GT�Y/�COMMr wyyUNIT,3/_S, ar /LIA 92253
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BOK •
PAG
PRC
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TWN .
RNG
SE
s.
�C`�T640-3
SMI Fbe
6162
Plumbing Fere
Mb
SP
450,00
T.� T4�3 yam.
TRACT NAME De lit Paz, �LWL. •
CONTRACTOR -FIRM NAME
ADDRESS
i
CITY/COMMUNITY/STATE/ZIP ..
PHOIO S5&-3766`
FEB 6 '1983
LICNC •
Gety i
ARC/ENG FIRM NAME
ADDRESS -
CITY/COMMUNITY/STATE/ZIP -
PHONE 0
.LICNC •
-
U� JJOF �i'PERMIT�
'I
BL
ZON
FSB.
SSe
SSB
RSB
OFC
ZONE ORD •. •'
.; LOT SZ
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if .
the'permit is for one hundred ($100) o, less. I certify that in the performance of the work for which this -permit is
issued, I shall not employ any person. i n any, manner so as to become subject to the Workers' Compensation Laws of
California.
Date Applicant -
NOTICE TO APPLICANT: If, after making this Certificate,of,Exemption,•you.should become subject to the Workers'
Compensation. provisions- of the Labor Code, you must forthwith°comply with,such provisions or this permit shall.
be deemed revoked.. • '
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:" ,
•0 I hereby certify that no excavation five (5) or more feet in depth'into which a person is required to descend; will be
made in connection with work authorized by this permit, and that no -building structure; scaffolding, falsework, or.
demolition or dismantling thereof, will be more thanthirty;six (36) feet high. (Chap 3.2, Grp 2; Art 2; Sec 341, Title 8.•
C.A.C.) �� •;. a
0 A owner -builder, I will not employ anyone to do work which would require a permit from the Division of -
Industrial'Safety, as noted above, unless such person has a permit to do such work from that division: '
❑ Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: 1 hereby affirm that there is a construction lending agency for the performance
of the work for which' this permit is issued (Sec. 3097, Civ. Q.
Lender's Name "
Lender's Address
I certify that•I have read this application and state that the above information is correct. I agree to comply with all,
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.
Signature of Applicant or Agent Date -
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
construction, and authorize a' representative of the City of La Ouinta.Department of Building and Safety to enter
upon the property for which Lhave applied for.this permit tot the purpose of `making inspections:
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPL/PRMT , R lr 1•x•26-84
.
CM1110 -
Pe= i t to =stract 1,704 Sq. Ft. of S/F/D
with 400 Sq. Ft.of 1 a 4w
Medbani cat Fee
$ 18.00
Plan Curk Fee ,'
Paid
C MWI=ctaCn Fee
418.00
lectrifcal. F�;e
32,30
SMI Fbe
6162
Plumbing Fere
56.00
Property Dwelopment Fee
450,00
RECEIVED
FEB 6 '1983
Gety i
;,4T
"TOTAL`
-FEE
$ 980.92 s
BLDG. DEPT. VALUATION $ 94,670.40
/
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s
Ah
Ak
NO.
OPERATION ATE
INSPECTOR
ANO.
OP TION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
— I -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 15 SLS 5+'yG,
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
RV
7A Walls (Batts) C%
12B Ceiling (Batts) •
12C Ceiling (Blown)
14 1 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb 4
To
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 .,;, �.� - ,�� G
29B Bonding
30 Fixtures
31 Service
32 Final r �_
r