0538 (SFD)YYoICAV�N:NAM� (L . M� 1
ADDRESS4N. Tustin Avexiid,' Shiite 231
/ .PERMIT
APPLICATION
City of
La Ouinta <
Department o' -Building
and Safety
This permit becomes void if work not commenced within 180 days from date of issuance, OR, if work has been suspended or abandoned for a period of 180 days. :.
.- I
CERTIFICATE OF EXEMPTION FROM WORKERS, COMPENSATION INSURANCE: This section neednot be'completed if
LICENSED CONTRACTORS DECLARATION: Thereby .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.: •
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 t
...,;Dale • - . '- ' Contractor.
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you�should.become subject to the Workers'
•�-' -+� -
OWNER�BUILDER DECLARATION: �l hereby affirm than 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
following reason (Sec. 7031.5. Business and Professions Code: Any city 'or 'county which. requires a.permit to ..b.'
be deemed revoked:
construct: alter, improve, demolish, or repair any structure, prior.to its issuance, -also requires the applicant for ;
DIVISION OF INDUSTRIALSAFET.Y P,ERMIT,CERTIFICATION:
such permitto fileasigned statement,that he is licensed pursuant to the provisions of the Contractor's License Law
01 hereby certify that no.ex0vation five (5) or more feet in depth intowhich a personis requ'ired to descend, 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 work authorized by this permit, and that no building structure, scaffolding, falsework, or
,oereirom and, the basis.for the alleged exemption. Any violation of Section 7031;5.by any applicant for.a permit
demolitionbr'dismantling thereof, Will be more than thirty-six (36) feet high:'(Chap 3.2• Grp 2. Ah 2; Sec341; Title B,•
G1M•subjects the applicant to a civil penalty of not more than five hundred dollars ($500.): ••
C.A.C.) .. •• ^^
O I. as owner of the property, ormy employees with wages,as their sole compensation, will do the work, andthe •
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, and who does such work himself or
w
through his own employees, provided that such improvements are not intended or -offered for sale. It, however; lhe.
❑ Division of Industrial Safety Permit_ No.
building orimprovemntissold within oneyearotcompletion,the owner -builder will have theburdenofproving that ..
Date Applicant
' he did not build or improve for the purpose of sale.).1. - 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. C.).
7044, Business and Professions -Code: The Contractor's License Law does not apply loan 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 I am exempt under Sec: . B.1 P.C. (Attached Certificate).;:
I certify that I have read. Misapplication 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
•
`0 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 sell: insure, ora'.
• '
certificate of Workers' Compensation Insurance : or a certified copy thereof (Sec.'3800. Lab. C.):
+ • Signature of Applicant or Agent Date
Policy No. r Company
.,CERTIFICATE OF COMPLIANCE ANDAUTHORIZATION OF ENTRY. I certify I have read lhisapplicalionand state that
0 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 Ceitified 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 - Y � Applicant.
upon the property for which I have applied for this permit for -the purpose of risking inspections.- y
_.
•
Signature of Applicant or Agent `1 Date
YYoICAV�N:NAM� (L . M� 1
ADDRESS4N. Tustin Avexiid,' Shiite 231
01Trii�ini NItTY�/`E/ZI„ QyL 92705
JOBMS ADORE �SPAC��.�� ..
JJLL x/13
CITY/COMMUNITY/STATE/Zip�•_�A 92253
BOK-
PAG
PRC
C
Plan Check Fee
TWN -;
RNG
SE-
S
.01340-3
LG42
5:78
PImbing Fee
4D
S13 '
4509-00-
50,00•
TRACT NAME De La Paz, Ltd, .
OJWJN�patiaNAME �t�L�, Faaxm •
CONTRACTOR -FIRM NAME '
ADDRESS
CITY/COMMUNITY/STATE/ZIP. -
°1 110 558-+3766 `
LI�Nr .
City of La Qui *w
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE •
$925160
LICNC •
USE �OFyPERMIT
�W�tin, -
BL'
ZON
FSB
SSB
SSB
.RSB
,OFC-
i
ZONE ORD • •
LOT SZ
END
} SIDE -
Print Applicant/Agent Name
APPUPRMTfJrJR I•'•CTt;,w 4
b ,-
PlenTd.t to canstn t 1,466 Sq.
Ft. of .S/F/D
with 400 Sq. -Ft. of Garage Per Approved Plans
chatiicai Foe
$ _ 18.00
Plan Check Fee
° Paid
Cbns•truction Fee
382.00
Pl ectfii,ca]. Flee'
29.32
SMI Fee
5:78
PImbing Fee
40.50
P gams Development Fde
4509-00-
50,00•
r �
A
R1EVEx 5311
City of La Qui *w
u TOTAL- 'i
FEE •
$925160
- VALUATION $82,161160
BLDG. DEPT. - r:;►'
n
Ah
NO.
OPERATION ATE
INSPECTOR
NO.
OP ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
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
16 Water Piping SL oaw
17 Rough Plumb •
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final �� S ,,
Tank Pit L. Line
-
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
PSL P(I
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire Fj
29B Bonding
30 Fixtures
31 Service
32 Final