0537 (SFD)PERMIT APPLICATION
City of
La Ouinta "
Department of 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 o1.180 days.
. . . ' ' • I '
• CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if .
' 'LICENSED CONTRACTORS' DECLARATION^ 1 hereby affirm that I am licensed -.under provisions of Chapter 9
the, permit is for one hundred (SIOO) o, less. I certify that in the performance of the work for which this permit is
' (commencing with Seition 7000) of•Division .3 of the Business and Professions Code; and my Iicense.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
'.Date " ' • .Contractor "
-NOTICE TO APPLICANT:'.If:;after. making. this.Certificate of Exemption, you should become subject to the Workers'
OWNER=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
' following reason (Sec?7031.5. Business and Professions Code: 'Any city. or county which requires a.permit to
be deemed revoked'. t
construct, alter, improve:'demolish, or repair any structure, prior to its•issuance; also requires the applicantfor
DIVISION OF INDUSTRIAL. SAFETY PERMIT CERTIFICATION:,.
+ such permit to.1i le a si�gned.slalement that he is licensed pursuant to. the provisions of the Contra.ctor,s License Law-
01 hereby certify that no excavationfive (5)ormore feet indepthihtowhich a'personisrequired 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 with work authorized by thispermit, and that no building structure, scaffolding, falsework, or '
therefrom and the basis for the alleged exempt ion..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 8,
subjects the applicant to a civil penalty of not more than five hundred dollars (5500.):
C.A.C.)
0.1. as owner o1 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, 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
0 Division of Industrial. Safety Permit;No.
building orimprovemntissold .within one year ofcompletion, the owner -builder will have the burden of provingthat -
Date Applicant
he did not build or improve for the purpose of sale.)..
CONSTRUCTION LENDING AGENCY: I heieby affirm that there is a construction lending agency foi.tlie performance
0 I, as.ownerof 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 to an owner of property who
Lender's Name -
builds or improves thereon, and who contracts'for such projects with'a contractor(s) licensed pursuanLlo the
r
Contractor's License Law.). _
Lender's Address wA
• 0 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
•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 thereo4(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
0 Certified copy is hereby furnished.. I.
the information given is correct. I agree to complywith+all state laws and county ordinances relating to buidling
' 0 "Certified copy is filed with the City Building Inspection Department or City Department.
• :."''= �*�,,sy{ j
construction; and authorize a'representative of the City of La Ouinta Department of Building and Safety to enter
upon the property for which I have applied for this permit far the purpose of making inspections. ..
Date Applicant
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPLICA T NAM MI) .. '
1 . �. t I i.L7r. n .
SS
4UU N. Tustin Avenue, Suite 231
CrTV`H/'UNI� „7'TiTE/Z-_ IP 92705 '
7
dO�cAci�E4ALf �00RES���AC.LcE
CLITT/COMK, „,
.a
MUMt•iTY/ST;T,E7f/Z3A 92253 •
BOK
PAG
PRC
C
Qonstructiaai Fee -
TWN.:•
RNC.
SE.'.
S
' i940-3
`18
61;00
Pipperty Dre�nt Fee
2B
SB
TRACT
g De La Paz, Ltd
OWNER NAME (L F MI)
CONTRACTOR -FIRM NAME . ,• •-
ADDRESS '
CITY/COMMUNITY/STATE/ZIP -
P014) 558-3766 \
Cit :f L-
LICNC .
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE
LICNC•
- -
USE OF PERMIT
daGjij.m\
4
BL
ZON
FS8
SSB
SSB
RSB
OFC
ZONE ORD ._ ,
, LOT SZ
:. END
•SIDE'
APPL/PRMT • `"'J -J 1p46-84
coridy .
Peamit to construct 1,,894 Sq. Ft. of S/F/D
and 400 Sq. Ft: of Garage per I Plans
MadvI tic lel Fee $ .18.00
Plan Check Feb
Paid
Qonstructiaai Fee -
445.50
Electrical Fee
34.67.
SMC Fee
'71,32
Plumbing Fee
61;00
Pipperty Dre�nt Fee
4509,00
' t
FEB `6
Cit :f L-
TOTAL
$3.,016„49
t
BLDG. DEPT. VALUATION $ 104,664.40 ,
•
A
r1
NO.
OPERATION ATE
INSPECTOR
NO.
OP ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System'
2
Ftgs & Frms
JI
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.
❑ IL
NON
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE &LOCATION
11. Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick al
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final —rc—
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 _ v� �G
29B Bonding
30 Fixtures
31 Service
32 Final ., G ,