0543 (SFD)PERMIT APPLICATION
City of La Oumta
• Department of Building and Safety :•
This permit becomes void it work not commenced within 180 days from date of.
issuance, OR; if work has-been suspended or abandoned fot a period of 180 days.
•
CERTIFICATE -OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: •This'seetion need not be completed if
• LICENSED CONTRACTORS .DECLARATION: I -hereby"affirm that I am .licensed under' provisions o1.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 employ any person inany mannersoas to become subject to the 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 Workers::-.-
OWNER -BUILDER DECLARATION: l hereby affirm that�l am exempt from the Contractor's License'Law tor'the •
Compensation'provisions of 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 Code: Any city or county which requires a permit to
M�
- construct, alter, improve. demolish, or repair anysiructure, 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
0 the ireby 6�'rtify'that no ekawation five (5) or more feet in depth into which a person is required to descend, will be "
(Chapter 9(commencing with section .7,600) 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 ..
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2. Grp 2. Art 2, Sec341; Title 8.,%��
subjects the applicant to a civil penalty. of not more than five.hundred dollars ($500):
C.A.C.)
O 1. as owner -of the properly, or my employees with wages.as their sole compensation, will do the work: and the • :
O As owner•builder3l I will not employ anyone to do work.which would require a permit from the Division of-
fstructure
structureis not intended,or offered for sale (Sec. 7044, Business and ProfessiowCode:.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, 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
O pivision of, Industrial Safety Permit No.
• building orimprovemnt'issold within one year ofcompletion, the owner -builder will have the burden ofprovingthat.
Date '• Applicant'
he did not build or improve for the purpose of sale.).
CONSTRUCTION LENDING AGENCY: I hereby affirm That there is a construction lending agency for the performance
O'I, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Seca •-
of the work for which this permit is issued (Sec. 3097, Civ. C:).
• 7044, Business and Professions Coder The Contractor's License Law does not apply to.an owner of property who .
Le`nder's Name
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant 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
city'and county ordinances and state laws relating to building construction, and hereby authorize representatives
'purposes.
of this county to enter upon the above-mentioned property for inspection
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 cettify I have read Ihisapplicationand state that
- O Certified copy Whereby furnished.. .r
the information -given is correct. I agree to comply with all statedaws and county ordinances relating to buidling .-
O Certified copy is filed with the City Building Inspection,Depactment or City Department. '
. construction, and authorize.a.representative of the City of La Ouinta Department of Building and Safety to enter
•Applicant ^' '^
upon the property for which I have applied for this permit for the purpose of making inspections.-
nspections.Date
Date•-�- —�+�..
Signature of Applicant or Agent Date
APPLICANT NAME (LL.. F. MI))
m '
e t7. LW UYTwi
ADDRESS N. TUStin Avenue, Suite 231
CITY/_- COM(MU.�NI�y ;E/M 92705 .
JOB,§FE ADDRESS/SPACE
CITY/COMMUNITY/STATE/ZIP . C 92253
BOK
PAG
PRC
C
Cbnstruct m Fee
TWN
RNG
SE:
S
T13640=3
23
61.00
..
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SB
TRACT NAME 7rn""mDe Ia Paz,.L {i.l• .
OWN_,. ER NAMam E (L. F. MI)
om
CONTRACTOR -FIRM NAME
ADDRESS '
CITY/COMMUNITY/STATE/ZIP
PHONEA
(714) 558-3766
LICNC •
ARC/ENG FIRM NAME ••
ADDRESS -
CITY/COMMUNITY/STATE/ZIP -
PHONE M
LICNC •
'
USE
S/ ` /LMI (
BL
ZONFSB
SSB
SSB•.
RSB
OFC
ZONE ORD N-
LOT SZ
.END
SIDE:. -
Print Applicant/Agent Name
APPUPRMT n S 43 1;DATE
•26-84
Pemit to =mt mat 1,894 Sq. Ft, of S/F/D
vrith 400 Sq. ,k't. of Guwje per approved plans
1�iec1lanCal. Fee ' $ 18.00
Plait Check Fee
Paid
Cbnstruct m Fee
•445.50
I.e�-.ical Fee'
34„67
SII Fee
7.32 '
Plumbing Fee
61.00
Property Develaplimt Fee
450.00'.
1
TOTAL
FEE
1,016.49
BLDG. DEPT . VALUATION 1 $104,664.40
7
Ah
r -j
NO.
OPERATION TE
INSPECTOR
NO.
OP ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts ro
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
16 Water Piping
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• P(I
STREET NAME
26 Power Pole
27 Conduit •
28 Service Entrance
29 Wiring
29A Grounding Wire 1 — (r a�.� i V
29B Bonding
30 Fixtures
31 Service
32 Final