0540 (SFD)r r
.. _
PERMIT APPLICATION
t
a City
of La Og
• a Department
•
of Building and Safety
a •
.PRC
C
This permit becomes void if work not commenced within -190. days from date
of issuance, OR, if work has been suspended or abandoned for,a period f 180 days.
re:
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section.need not be completed if =
LICENSED •CONTRACTORS DECLARATION: I 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 in full force
t issued, I 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 APPLICANT:.If, after making this Certificate of Exemption, yooshould become subject to the Workers'
OWNER-BDILDER DECLARATION: •1 hereby affirm that I am eirempi fiohie Contractor's License Law': for the ' .
-•+ Compensation provisions of the Labor Code,.you must forthwith comply with such provisions or this permit shall
following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to
„ be deemed revoked:'
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 of the Contractor''sLicense Law.
..O Ther`ebycertifythatnoexcavation five (5)ormore feet indepth into which aperson is.required tddescenit. 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.with.Wodrk auihorized"by this permit, and that no building structure, scaffolding, falsework, or ".
therefrom and the basis.for the alleged•exempiion: 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, Sec 341; Title B. '
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):-t4' t
C.A.C.)
.Oat: as owner of the property, or my employees with. wages as. their sole compensation, will do the work, and the,
O Wowner-builder• I will -not employ anyone to do work which would require a permit from the Division of
structure is not intended of 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, and who does such work himself or
w•r
through his'own employees;, provided that such improvements are not intended or offered4or sale. If, however, the
Division.ol Industrial Safety Permit No.
building orimprovemniissold withinone year of,completion,the owner -builder . will have the burden of proving that
Date Applicant•
he did not build or improve for the purpose, ol.sale.).
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency 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. Q. .
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.)7
Lender's Address
O I-am.exempt under Sec. .8. & P.C. (Attached Certificate)...,
.I certity"that I have read this application and state that -the above information is correct. I agree to comply with all . .
r. •
' Date; ' Owner '
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, ora
certificate'ot Workers' Compensation Insurance , or certified copy thereoM(Sec. 3800. Lab. C.).
Signature of Applicant or Agent' Date',,
•Policy. No, Company , ,
L'. CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF' ENTRY: Icertify l.haveread this application and state that .- .
❑ Certified copy is hereby, furnished..
the information given is 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,ot•the City of La Ouinta Department of Building and Safety to enter .
Date Applicant
upon the property for which Lhave-applied for this permit for-lhe.purpose of making inspections.
Signature of Applicant or Agent Date
J
APPLICANT NAME (L, F M1) - - C A
Jai• D* Vt ify�
ADDRESS
Ai V N. Tastin Avemze, & i to 231,. .
CI7�N17 �E/Z A
wita92705
24.10 ADD�R�E� AC`ie
CITY/COMMUNITY/STATE/ZIP • • - ,
1A =ta, KA ' 92253
BOK
PAG
.PRC
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TWN
RNG
SE
'S'
T1,3T640-3
L20
S'1,022ir76' _
SB
TRACT De La Paz, Ltd,
OWN`ER_ME�(L�, F. MI)-
aNyve
CONTRACTOR -FIRM NAME •••
ADDRESS -
CITY/COMMUNITY/STATE/ZIP
PHONE 4) 558-3766
LICNC .
ARC/ENG FIRM NAME ..
ADDRESS
CITY/COMMUNITY/STATE/ZIP ..
PHONE n
LICNC. a
USE OF PERMIT '
s/F/� t�c�nnii� •
BL
ZONFSB
SSB"
SSB
RSB:-,.
OFC
ZONE ORD II
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END
SIDE .
Print Applicant/Agent Name
APPL/PRMT DATE
Permit to construct 1,973 Sq. Ft. of S/F/D
with. 400 so. Ft. of Garage Per Appxmrdd Plan_
Mecizanical Fee $ 18.00
Plan Check Fee Paid
C onstructian Fee 455950
Electrical Fee . 3546
SMI Fee 7,60
Plumbing Fee 56.00
aperty DIvplpmtt Fie 450; 00
% a
F I"City
'J 7
.. TOTAC
FEE
S'1,022ir76' _
�. VALUATION-S,108,13Y9.8CU
- - • BLDG. DEPT. -
Ah
r-1
NO.
OPERATION ATE
INSPECTOR
NO.
OP ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
t — (—
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. 0. ❑
NPON
ADDITIONAL INFORMATION
;
SEWAGE SYSTEM SIZE & LOCATION
1,1 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish .Grade
INSULATION Thick Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final(;Cr ,Irr'
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents IL
19 Sewage Disposal •
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final /9--6 9.
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
PSL N
STREET NAME
26 Power Pole
27 Conduit w
28 Service Entrance
29 Wiring •
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final