0531 (SFD)PERMIT APPLICATION `'••
City of La Du
Department of Buildingg 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 fora period of 180 days.
LICENSED CONTRACTORS DECLARATION: I hereby 'affirm that 'I amlicensed under provisions of'Chapter 9' .
-(commencing with Section 7000) of Division 3 of the Business and Professions Code; and my license.is in full force
and elfect.
License Class' Lic. Number
Date Contractor
OWNER -BUILDER DECLARATION:• I hereby affirm that I am exempt"iroW a Contractor's License Law for the y
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,
such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law .
(Chapter 9 (commencing with section -7000) of.Division 3 of the Business and Professions Code) or that he is exempt ,
therefrom and the basis for the alleged exemption. Any violation:of Section 7031.5 by any applicant for a permit .
subjects the applicant to a civil penalty of not more than five, hundred dollars ($500.):
❑ I. as owner of the property, or my employees with wages as their sole compensation, will do the work, and the.
structure is not intended or offered for sale (Sec. 7044,•Business and Professions Code: The Contractor's License
Law does not apply to an owner of property who builds, or improves thereon, acid who does such work himself or
through his own employees, provided that such improvements are not intended or offered for sale. If. however; the .
building of improvemnt is sold within one year of completion, the owner -builder will have the burden of proving that
he did not buil.oAr improve for the purpose of sale.).
❑ I, as owner of the property., am exculsively contracting with licensed contractors to construct the project (Sec.,.'
7044. Business and Professions Code: The Contractor's License Law does,not apply to an owner of property who
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the `
_ Contractor's License Law,).
'O 1 am exempt under Sec: B. B P.C. (Attached Certificate).
Date Owner' "
WORKERS' COMPENSATION DECLARATION: I hereby affirm'that I have a certificate of consent to self -insure• or a
certificate of Workers' Compensation Insurance , ora certified copy.thereof (Sec. 3800. Lab. C:)::.. "
Policy No. Company
O Certified copy is hereby furnished. . x
❑Certified copy is filed -with the City Building Inspect DepartmenttCit Department.
Date Applicant
CERTIFICATE OF. EXEMPTION FROM WORKERS' COMPENSATION'INSURANCE: This section need not -be completed if •
the permit is for one hundred ($100)'o, less: I certify that. in the performance of,the work for which this permit is
issued. I shall not.employ any person In any manner so as to become subject'to the Workers' Compensation Laws of
California.
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the.Workers'
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall-
be,deemed revoked.
DIVISION OF. INDUSTRIAL SAFETY PERMIT CERTIFICATION: .
O t hereby -certify that no excavation five (5) of moie.feet in depth into which a person is required to descend, will be
made in connection with work authorized by this permit, and that rio building structure, scaffolding, talsework, or
demolition or dismantling' thereof, will be more than thirty-six'(36) feet high. (Chap 3.2, Grp 2, Art 2, Sec341, Title8.
C.A.C.)
O As'owner-builder, I will not employ anyon6l.to'do work which would require a•permit from the Division of
-Industrial Safety, as noted above, unless•such person has a permit to do such work from that division.
❑ Division of Industrial Safety Permit No. .
Date — Applicant '
CONSTRUCTION LENDING AGENCY:. I hereby affirm that'there is a construction lending agency for the performance '
of the work for which this permit is issued (Sec. 3097, Civ. Q.
Lender's Name _
Lender's Address
I certify that I have read this application and state that the above information.is correct. l agree to comply with all
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.
Signature of'Applicant or Agent `' Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that•
the information given is correct. I agree to comply with all state laws and county ordinances relating to'buidling:
construction, and authorize a'representative of the City.of Laouinta Department of.Buildingand Safety to enter ,
upon the property for which I have applied for.this•permit for the purpose of making inspections.
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPL/PRMT ,,,DATES4
400 Ile Awe, Suite 231
,Uistln
CITY/COMbmit, STATE/ZIP
a� NITL'll tA 92705 ..
ADW ADy Dzze S aTaArSi ✓J '
CIS/ Y1LQ1 ECA 72253Gy
BOK
PAG
PRC..
C
-
TWN
RNG
SE
S
Ti lo40�3
LD75
61.00.
61,00•
PrgPerty Development 'Fee
M
sB
,
TRACT.�N1AM'Ea DB L3 Paz, Ltd, .
0LRNAMEtI. F„
CONTRACTOR -FIRM NAME '
ADDRESS .
CITY/COMMUNITY/STATE/ZIP -
`CDr"14) 558-3766
`I°"° "
$ 1 016.49
ARC/ENG FIRM NAME
ADDRESS -
CITY/COMMUNITY/STATE/ZIP
PHONE 0
LICNC I
157 r+'MITVL+SJIA�auYa{.
BL
ZON
FS8
SSB.'
SSB
RSB
OFC..
"
. ZONE ORD*'
- LOT SZ
END
SIDE
CERTIFICATE OF. EXEMPTION FROM WORKERS' COMPENSATION'INSURANCE: This section need not -be completed if •
the permit is for one hundred ($100)'o, less: I certify that. in the performance of,the work for which this permit is
issued. I shall not.employ any person In any manner so as to become subject'to the Workers' Compensation Laws of
California.
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the.Workers'
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall-
be,deemed revoked.
DIVISION OF. INDUSTRIAL SAFETY PERMIT CERTIFICATION: .
O t hereby -certify that no excavation five (5) of moie.feet in depth into which a person is required to descend, will be
made in connection with work authorized by this permit, and that rio building structure, scaffolding, talsework, or
demolition or dismantling' thereof, will be more than thirty-six'(36) feet high. (Chap 3.2, Grp 2, Art 2, Sec341, Title8.
C.A.C.)
O As'owner-builder, I will not employ anyon6l.to'do work which would require a•permit from the Division of
-Industrial Safety, as noted above, unless•such person has a permit to do such work from that division.
❑ Division of Industrial Safety Permit No. .
Date — Applicant '
CONSTRUCTION LENDING AGENCY:. I hereby affirm that'there is a construction lending agency for the performance '
of the work for which this permit is issued (Sec. 3097, Civ. Q.
Lender's Name _
Lender's Address
I certify that I have read this application and state that the above information.is correct. l agree to comply with all
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.
Signature of'Applicant or Agent `' Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that•
the information given is correct. I agree to comply with all state laws and county ordinances relating to'buidling:
construction, and authorize a'representative of the City.of Laouinta Department of.Buildingand Safety to enter ,
upon the property for which I have applied for.this•permit for the purpose of making inspections.
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPL/PRMT ,,,DATES4
Condo'
Pennit to construct 1,894 Sq. Ft, of S/F/D
with 400 Sq, Ft, of Garage Per h� Pians
Mechanical Fee $ 18,00
Flan {. Free .' ..,
Paid
Construction Fee
445,50
E%ctrical Fes
34;67
Ma Fee
7,32-
,32-
61.00.
61,00•
PrgPerty Development 'Fee
450.00
t
,
. '�M . EB
1 Ciry ;;I•r{/ Iti/uw
. _ TOTAL
FEE
$ 1 016.49
BLDG. DEPT. VALUATION $104,664.40
a
Ah
NO.
OPERATION ATE
INSPECTOR
NO.
OP TION 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/5�s t✓,
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)
126 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 AVOW
27 Conduit •
28 Service Entrance
29 Wiring dL
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final