0542 (SFD)PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
ADDRESS N. Tustin AveTme,'Suite 231
CIJY/COMMUNI.TY/STATE/ZIP - -
aanta Ana, (A 92705 '
This permit becomes void if work not commenced within 180 days from date of
issuance, OR, if.work has. been.suspended"or abandoned fora period of 180 days. ,
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CERTIFICATE OF EXEMPTION FROM WORKERS`COMPENSATION INSURANCE:..This'section need not be completed if ,
LICENSED CONTRACTORS DECLARATION: d hereby affirm that I am licensed: under provisions of -Chapter 9
the.permq is -for one hundred ($100).o, less. I certify that in the performance of the work for which.this permit is r�
.(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
'issued, I shall not employ any person inany.manner spas to become subject to the Workers' Compensation Laws of.
and effect.
California.
• License Class. Lic. Number ..
Date Applicant, _ -
.;Date s Contractor
NOTICE TO APPLICANT: If, after making this Certificate of Ezemption,.you should become subject to the Workers',-
`+ OWNEfi-BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
be deemed revoked.. '
following reason (Sec. 7031.5. Business and Professions Code: Any. city or county which requires a permit.to .
construct, alter, improve: demolish, or repair any structure, prior to its issuance, also requires the applicant for.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:,
rsuch permit lofile asigned statement that he is licens.0 pursuant to the provisions of.the Contractor's License Law
"❑ 1 hereby certify that no excavWion five (5) or more feet in depth into which a person is required to descend, will be '
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) orthat hers exempt
made in connection'with work authorized by this permit, and that n6 building structure, scaffolding, falsework, or • • .
therefrom and the basis for the alleged exemption, Any violation of.Section.7031.5.by,any applicant for a permit
demolition or dismantling thereof; will be more than thirty-six (36) feethigh. (Chap 3.2, Grp 2, Art 2i Sec341, Title 8, > .
subjects the applicant to a civil penalty of not more than five hundred dollars ($SOb.): =
C.A.C:)
❑ 1, as owner.of the property, or my employees with wages as their sole compensation, will do the work, and the
O. 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,'unfess such person has.a permit to do such work from that division.
Law does not apply town owner of property who builds, or improves thereon, and who does such work himself or .;0
.
through his own employees, provided that such improvements are not intended.oroffered for sale. If, however, the -
11 Division of Industrial Safety Permit No.
building orimprovemniissold within one year ofcompletion; _the owner -builder will havetheburdenofprovingthat •,
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 theproperty, 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
ContractoCs License Law.).
Lender's Address
❑ I 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.) agree to comply.with all
Date Owner I4
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
SIDE
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. 3800: 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 given is correct. I agree to comply with all state laws and county ordinances relating to buidling
' '0 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
Date Applicant
upon the property for which I have applied for this permit for the purpose of making inspections.. _
Signature of Applicant or Agent Date
APPLICANT NAME -(LIF. MI)
144 b* uG 1i iK�dl
ADDRESS N. Tustin AveTme,'Suite 231
CIJY/COMMUNI.TY/STATE/ZIP - -
aanta Ana, (A 92705 '
�BJ,S ADDRESS/�SPAC _
J Seraroz
cl /s ,E/Z�P
Lia %juw 92253
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PRC-
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1,�1�A' T' 4�0�-3
LD2 2
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58,50
'MOD
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39
• . ♦ ..
Tj Laguna NAME De la �i�ii+�(, Ltd.
OWNERNAME
d15 F. Ml e - "
CONTRACTOR -FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP -
P� UQ 558-3766
B' 6 1IQ, gB
FEB'
LICNC M
City ck Ole I;", -
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE N
.. , .. i" :
.LICNC •
$976; 75
"
USE OF PERMIT�� - •
a7�1, iJ r
BL
•ZONFS8
SSB
SS8
RSB
OFC'
ZONE ORD 11
LOT SZ '•
y END
SIDE
Print Applicant/Agent Name
APPL/PRMT''•j DATE H� �ncb
Pe=.t to omsU t 1,662
Sq. Ft. 'of S/F/D
with -400 Sq. Ft,.of-Garage Per approved Plans
NieGfilaniC�1,F't
S .18,00'
Plan Check Fere
Pa;Ld
%ctz+ari Fee
412.00
�eCtr1Cal Fee
31,77
SM Fere
6948
Plumbing Flee
58,50
Pr6p rty WveZopment Fee
4509" 00
R E C E d 1YJ E D
B' 6 1IQ, gB
FEB'
City ck Ole I;", -
.. , .. i" :
TOTAL' •' •
FEE
$976; 75
"
I.
BLDG. DEPT. VALUATION $92,461.20
r --I
Ah
NO.
OPERATION ATE
INSPECTOR
NO.
OPWAtION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back,
33
Ventilation System C
2
Ftgs & Frms
/(.— (— YK
g C
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.
❑
NPON
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value •
7A Walls (Batts)
128 Ceiling (Batts)
12C Ceiling (Blown)
14 Final +fir
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 cls/9-fs / r (� .
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 (- (-S� �}- C-
29B Bonding
30 Fixtures
31 Service
32 Final