0545 (SFD)PERMIT APPLICATION
City of La Ouinta
• Department of Building and Safety • ' '
ADDRESS N. TUStin Avenue, Site 231 ~
CITY/COMMUNITY/STATE/ZIP 11 .
Santa Ana, CA 92705
This permit becomes void if work not commenced within 180 days from date of
issuance: OR, ifwork has been suspended or abandoned for a•period of 180 days.
•:4? _ -
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if'
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed,uhder• 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 mylicense is in full force w
' . —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
NOTICE: TO:AP.P.LICANT:Af, after making this Certificate of Exemption, you should become subject to the Workers"
' OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt fromthe Contractor's License Law for the
Compensation provisions ol:the Labor Code, you must forthwith_ comply with such provisions or this permit shall -
be deemed revoked:
following reason (Sec. 7031.5. Business and Professions Coder Any city or county which requires a permit -lo
construct, alter, imprdve,'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.statementthat heislicensed,pursuantto, the provisions oftheContractor'sLicense Law
O-thereby certifythat noexcavation five (5)ormore feet indepth into.wfiichaperson isrequired 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 vriih'work authorized by this permit, and that no building structure, scaffolding, falseworki or
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
demoliCi6n 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.):
'ARC/ENG FIRM NAME •• .
O I: as owner of the property, or my employees with wages as their sole compensation, will do the work, and the,
0 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 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; acid who does such work himself or
' through his own employees, provided that such improvements are not intended or offered for sale. If, however, the
P.Division of Industrial.Safety Permit No.
building or.improvemnt is sold.within one year of completion. 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 agericy for the performance ?
❑ 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.). • b
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•I have read this application and state that -the above.information is correct. I agree to'comply with all ,
Date Owner "f'
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. C.).
•
Signature of Applicant or Agent 'Date
.Policy No. Company
-
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this applic"atioriand state that ,
O Certified copy is hereby furnished.
the information given is correct-) 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 Yepresentative.of the City of La Ouinta 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 Applicant
w.
Signature'of Applicant or Agent p K Date'
r'
Print Applicant/Agent Name t
X. �ttyyAPPPLICANT NAMEs(L-F, MI) +'• '
"�. I.+• I.if
ADDRESS N. TUStin Avenue, Site 231 ~
CITY/COMMUNITY/STATE/ZIP 11 .
Santa Ana, CA 92705
JOB SI, ADDRESSISPACE
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CITY/COMMUNITY/STATE/ZIP
QWn a,rz
ECA 92253
SOK
PAG •
PRC
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Paid
TWIN
AND
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S
7136640-3
L 24
PUmbinq Fee
56400
M
sa
TRACT NAME De la Paz* Ltd` '
Of�'i•[�TI"`M'�M`:'�-E�(L. F. MhYvtive
CONTRACTOR -FIRM NAME'
ADDRESS •. '
CITY/COMMUNITY/STATE/ZIP - - -
PHONE • �
(714) 558-3766
LICNC •
'
'ARC/ENG FIRM NAME •• .
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE •
.LICNC I
PD MI
S7PID IV dcmiaun)
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_ END
APPL/PRMT � I! L DATE S� Wnckl
Peinit to costruct 1,973
Sq. Ft. of S/F/D
with 400 Sq, Ft, of Garage Per Anmixved-Plan
H3fd�1241. Fee \
$ ' 18-000
.Plan.awck Fee
Paid
Cmwt:L =Ucn Fee
455,50
Electrical. Fee
35.66
DIM- Fee
7#60
PUmbinq Fee
56400
Property DeRmlopmt Fee
1450,00
'.
rnyJ
6,1983
ZZ
City Z f
i14
TFEE •.
$ 1,022.76 �
BLDG. DEPT.
VALUATION $108,859.80
'
Ah
r1
NO.
OPERATION ATE
INSPECTOR
NO.
OP ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
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
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 ( —1 .-j, �s
16 Water Piping
17 Rough Plumb •
18 Vents dft
19 Sewage Disposal X 44-
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final 5-19 S ,
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF'PROPERTY LINE
P/L P/I
STREET NAME
26 Power Pole dow Irk
27 Conduit •
28 Service Entrance
29 Wiring
29A Grounding Wire C
29B Bonding
30 Fixtures
31 Service
32 Final
t