001072 (SATT)' PERMIT APPLICATION
City of La Duinta _
Department of Building and Safety �.
This permit becomes void if work nu::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 need not be completed if,
LICENSED CONTRACTORS DECLARATION: I hereby 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.
• 4 California.
License Class Lic. Number IDate
Applicant
Date Contractor - `.•�• - f � 7
u,,.:,NOTICE TO APPLICANT: If, aftermaking this Certificate of Exemption, you should bec a subject to the Wd kers'
�
OWNER- BUILDER DECLARATION: I hereby Tlfrom the Contracto�License.law tors he
i Y t Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
affirm that am exempt
following reason (Sec. 7031.5. Business and Profess'ion's Code: Any city or county which requires a permit to
t be deemed revoked. V
construct, alter, improve. demolish, or repair any "structure, prior to its issuarce, also requires the applicant for -
DIVISION 6F INDUSTRIAL SAFETY PERMIT CERTIFICATION:
such permit to file a signed statement that he is licensed pursuant to the proyisinnsofthe Contractor's License Law. •
O 1 hereby certify'that no excavation five (5) or more feet in depth into which a person is required to descend, will be
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Prcfessions Code)or that he is exempt
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
. therefrom and the basis for the alleged exemption. 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 ($500.): !,,el :
s C.A.C:)
❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
❑ 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, aid who does such work himself or
CONTRACTOR -FIRM NAME
Avolcteant
through his own employees. provided that such improvements are not intended or offered for sale. If, however, the
❑ Division of Industrial Safety Permit No.
building or improvemnt is sold within one year of completion, the owner -builder vill have the burden of proving that
Date Applicant
he did not build or improve for the purpose of sale.). ;.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
_ O .l, as owner of the property, am exculsively contracting with licensed contra:tors 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 zpply to an owner of property who
Lender's Name
builds or improves thereon, and who contracts for such projects with a cont actor(s) licensed pursuant to the
Contractor's License Law.). _
❑ 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
❑ Certified copy is hereby furnished.—
❑ Certified copy is filed with the City Building Inspection Department or City Department.;,
Date ... Applicants �`7!.!��•!r—{.,aA Al
t t/ !
APPLICANT NAME(I.J. MI)
1.2. U. .Manes, Co.
ADDRESS
Airway Ave. Suite D9
CITY/COMMUNITY/STATE/ZIP
Costa Mesa, CA 92626
JOB SITE ADDRESS/SPACE
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
•SE
BOK
PAG
PRC
C
TVW4
RNG
" Plan Chhck Fee
- S
TRACT
1891 5
LOT
^�
26.76
MOD
2
58
'ZOO
27.00
Prop. Devel. Fee
450.00
TRACT NAME., 1
Rexlections
OVMER NAME (L. F. MI)
Applicant
CONTRACTOR -FIRM NAME
Avolcteant
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP -
above
PHONE a
'345-1436
TFEE
LICNC .
ARC/ENG FIRM NAME
Alan Snapp Architect
ADDRESS
3400 Irvine Ave. #205
CITY/COMMUNITY/STATE/ZIP -
Newvort Beach. CA 92660
PHONE 11
LICNC
714-979-8842
USE OF PERMIT
Sintle Familv Dwelling
BL
ZON
FSB
SSB I
SSB
RSB
1,
OFC
ZONE ORD N
LOT,SZ
J I
END
SIDE
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. w
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 Safety to enter
upon the propeity for which,l ave ap led-f4fthis permit for the purpose of making i spectioris.� //
VSign Lure of Applican�or Agent / /Date
ow, ), . 2-14
Print Apptican°tlAgent Name
APPL/PRMT nDAT
_n 12 -E4 - � 4 S.F.D.
Permit to,construct 912 sq. ft. of
S.F.D., 26 sq. ft. of
porch and
235 sq.'ft. of garage
as per
approved plans.
Mech. Fee
24.00
" Plan Chhck Fee
246.00
Const. Fee
289.00 ,
Elect. Fee
26.76
SMI Fee
3.64
Plumbing Fee
27.00
Prop. Devel. Fee
450.00
TFEE
BLDG. DEPT.
. VALUATION 51,140.00
r1
NO.
OPERATION TE
INSPECTOR
NO.OP,•.
TION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1 •
Set Back
—1 -TV,
33
Ventilation System
2
Ftgs & Frms
2—/.L city'
f�
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
400,
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.
❑
NP'N
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
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 PiI
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance •
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final -,ze7,r- Ig�