0526 (SFD)PERMIT APPLICATION
City of La Duinta
• 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.of 180 days.
. • -
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed it, -
LICENSED CONTRACTORS DECLARATION: Ihereby 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
Date • 'Contractor , •.
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to Ihe.Workers;-„
OWNER -BUILDER DECLARATION:"'Ih'ereby 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.
construct, -alter, improve. demolish, or repair any structure, prior to -its issuance, also requires the applicant for y
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
'> such permit to file a signed statement that he is licensed pursuant to the provisions of the Cantractor_sLicenseLaw
O'IherebycertifylhatnoekcavatfonfiJe(5)'ormore.leetindepthintowhichapersonisrequiredlodescend,willbe `-
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code)orthat he is exempt , -
made in connection with work authorized by.this petmit, and that no building structure, scaffolding, falsework, or
therefrom and the basis for the;alleged exemption. Any.violation,at 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, Sec341, Title B,
subjects the applicant to a civil penalty of not more than five hundred dollars•(5500.): -
C.A.C.) : r" - < r`t �• '
O I, as. owner. of the property, or my employees with wages as their sole compensation, will do the work, and the.
❑ As ovTner•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•,.,
"
. : n
through his own employees, provided thatsuch improvements are not intended or.offered for sale. If, however, the :,c a.
Division of Industrial Safety Permit No. 4,x
building orimprovemntissold within oneyearofcompletion, the owner -builder willhavetheburdenofprovingthat.-
Date' Applicant
he did not build or improve for the purpose of sale.).
CONSTRUCTION LENDING AGENCY: I hereby'affirnr thatthereisaconstruction lending agency for the performance
0 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 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
SSB
Contractor's 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: I agree to comply with all .
"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 sellAnsure, ora
-
ti 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 I have read this application and state that
.O Certified copy is hereby. furnished..
the information given is correct.) agree to comply with all state laws and county, ordinances relating to buidling .
0 Certified copy is filed with the City Building'hispection 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.
APPLICA3�T NAME (L, F, MI) -
Ci. . .irss�ll'1
A b sN. Tustirn -Avenue, Suite 231
OIT��r/GY�iNIlux",E2� 92705 "
,oa140 AD PACaranas ' LA 9_05
jf�� —151
cicoMuM�yuN.I�r�r/;erzl 92253
BOK
PAG
PRC
C
Mecharucal Fee
TV
FIND
SE
S
T S640i3
LO2.2
34.67
SMI Fee
T
se
61.00
1=3ISM De La Pae, Ltd• ..
O! iA,NA M�L; FrM" II,
CONTRACTOR -FIRM NAME -
ADDRESS ..
CITY/COMMUNITY/STATE/ZIP '
PHONE05583166,
r
FEB 1..
C«y.s:
LICNC
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP -
PHONE N •
LICNC I
/�
(Y/
U:J�SPEFMIT(V�+++a: ).
81.
ZON'
FSB
SSB
SSB
RSB
OFC
ZONE ORD 0
LOT SZ
END
,SIDE'
Signature of Applicant or Agent . Date .
Print Applicant/Agent Name
APPUPRMT
AS R 1--N-84 A^
Permit to construct.1,894 Sq. Ft.
of S/F/D
with 400 Sq. Ft. of Garage per approved
Plarls
Mecharucal Fee
$ 186'00
Plan Check Fee
-Paid'
Clanstructi.nn Fee
445,50
Electrical. Fee
34.67
SMI Fee
7.32
Plumjbirig Fee
61.00
Property Develvpthent Fite . '
450.00
a t
FEB 1..
C«y.s:
V TOTAL
T
x.,016.49
IV
VALUATION §1U4*bb4.4� •
BLDG. DEPT.
••f
Aft
NO.
OPERATION ATE
INSPECTOR
NO.
O .CATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
/ (— — 5��
7-- c.
34
35
Plenums & Ducts •
Furnace Compart.
2A Slab Grade
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.
❑
NO
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 +/ .,1.
PLUMBING APPROVALS
15 Ground Plumb C.
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 '7
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
P/L P/1
STREET NAME
26 Power Pole Aoop
27 Conduit •
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final