001071 (SATT)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 of 180 days: ' -
LICENSED -CONTRACTORS: DECLARATION: •1 hereby affirm that I am licensed 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 effect.
License Class Lic. Number
Date �= Contractor V � �: .9444
OWNER -C ILDE DECCARATION: I hereby affirm that I amexempt from*the Contractors License La fv/ or the
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 391 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, and who does such work himself or
through his own employees, provided that such improvements are not intended cr offered for sale: If, however, the
building or improvemnt is sold within one year of completion• the owner -builder will have the burden of proving that
he did not build. or improve for the purpose of sale.).
0 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 a_oply to an owner of property who
builds or improves thereon, and who contracts for 'such projects with a contractor(s) licensedpursuant to the
Contractor's License Law.). _
0 1 am exempt under Sec. B. 8 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 , or a certified copy thereof (Sec. 3800. Lab. C.).
Policy No. Company '
0 Certified copy, is hereby.furnished.-
`0 CertifIedd co y is filed Ith t/e City Building Inspection Department or.City Department.. '
Date i, co
APPlicant �v�.�%r+�✓ O14ir+%O/♦�
APPLICANT NAME(C. p•anes Co.
ADDRE1950 Airway Ave. Suite D9
CITY/COMMUNITY/STATE/ZIP '
Costa mesa, CA 92626
JOB SITE ADDRESS/SPACE
✓1 . , n,- r t P
CITY/C(a"1 /uint'a; CA 92253
BOK
PAG I
PRC
I C
24.00
TWN
RNG
SE
S
TRA g 915
LOT 1
SMI Fee
-
MOD
�
SB
Prov. Devel. Fee
TRACT ME r
%flections
OWNER �NAppriicant - .
°°NTRApplicant
ADDRESS -
above
CITY/COMMUNITY/STATE/ZIP
above
PHONE 31145-1436
LICNC .
•
ARC/ENG QRM AlaNAMESnapp Architect
ADDRESS
3400 Irvine Ave. # 205
CITY/COMMUNITY/STATE/ZIP
Newport Beach, CA 92650
PHONELICNC
714-979-8842
USE OF PERMIT '
Single amily dwelling
BL
ZON
FS8
SSB
SSB'
4SB
OFC
ZONE ORD .
LOT SZ
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not 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. lshallnot emplo any per son in any manner so as to become subject to the Workers'Compensation Laws of
California,,�//// ff7 t% J/�//
Date�� U Applicant 1 Cf ",="a"/
NOTICE TO APPLICANT: It, after making this Certificate of Exemption, you should berme subject.to the
Compensation provisions of the Labor Code, you musrt'forthwith comply with such provisions or this permit shall
be deemed revoked. ;
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
0 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8,
C.A.C:)
0 As'owner-builder, I will not employ anyone tb 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 divisiori.
0 Division of Industrial Safety,permit No. r Y
Date Applicant
CONSTRUCTION LENDING AGENCY.: I hereby affirm that there is a construction lending agency for the performance
of the work fodwhich this permit is issued (Sec. 3097, Civ. CJ.
Lender's Name "
Lender's Address
I certify that I have read this application and state that the above information is correct. I 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 La Ouinta Department of Building and Safely -to enter
upon the property for which I have ppli�this permit for the purpose omking inspe tion
!� Sfgnature of Applicantr Agent / Date
Print°Applicant/Agent Name
"APPL/PRMT
Hnl
DATE
12-4-84 S.F.D.
Permit to construct 912 sq. ft. of
S.F.D., 26 sq. ft. of Oorch and
235 sq. ft. of garage as per
a roved plans.
Mech. Fee
24.00
Plan Check Fee
246.00
Const. Fee
289.00
Elect. Fee
26.76
SMI Fee
3.64
Plumbing Fee
28.00
Prov. Devel. Fee
450.00
TFEE
1, 066.40
BLDG. DEPT. VALUATION
r-7
Ah
NO.
OPERATION ATE
INSPECTOR
NO.
OP ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
35
Plenums & Ducts •
Furnace Compart.
2A Slab Grade .L _! y_
3
Steel
_ �.j _ yY
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-gS-
10A
Fireplace T.O. ❑ 44,
UW—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
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal ::d X-.
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
PSL P/1
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final