001067 (SATT)PERMIT APPLICATION
• City of La Og and
Department of Building and Safety
This permit becomes void if work rot 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: I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Profession; Code, and my license is in full force
and effect.
License Class Lic. Number
Date Contractory , 1 Y
OWNER -BUILDER DECLARATION: I hereby affirm that Ilam exempt from Contractor's L� ense Law for the
following reason (Sec. 7031.5. Business and Professions Code: Any city o 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 provi ;ions of the Contractor's License law
(Chapter 9 (commencing with section 70001 of Division 3 of the Business and Frotessions 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 (5500.):
❑ 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 Professors 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 or offered for sale. If, however, the
building or improvemnt is sold within one year of completion, the owner-builde, will have the burden of proving that
he did not build or improve for the purpose of sale.).
❑ 1, 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 nol apply to an owner of property who
builds or improves thereon, and who contracts for such projects with a cortractor(s) licensed pursuant to the
Contractor's License Law.).
O 1 am exempt under Sec. 8. 8 P.C. (Attached Certificate).
Date Owner -
WORKERS' COMPENSATION DECLARATION: I hereb affirm that I have a certift'We ofco to sell -insure, or a
'certificate of Workers' Compensation Insurance;, or a certified copy thereof Sec. 3800. ab. C.).
Policy No. Company
O Certified copy is hereby furnished.
o Certified copy is filed with the City Building Inspection Department or Citv Department.
Date J 0' Applicant
%A�a( Z _ 37
APPLICANT NAME (L. F. MI) N
N.D. JAnes, Co
ADDRESS -
29:50 Airway Ave. Suite
CITY/COMMUNITY/STATE/ZIP
Costa Mesa, CA 92626
JOB SITE ADDRESS/SPACE
I l
,
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
BOK
PAG
PRC
C
24.L30
TM
PING
SE I
S
TRACT
18915
LOT
SMI Fee
3.64
MOO
iB
450.00
l►
rr
TRACT NAME f
n.eflections
OWNER NAME (L. F. MI)
plicant
CONTRACTOR -FIRM NAME
Aonlicant
ADDRESS
abo .re
CITY/COMMUNITY/STATE/ZIP '
above
PHONE N
LICNC N
1,066.14
345-1436
ARC/ENG FIRM NAME
Alan Snapp frchitect
ADDRESS
3400 Irvine Ave. # 205
CITY/COMMUNITY/STATE/ZIP
Newport Beach. CA 92660
PHONE N
LICNC N
714-979-as4Z
1
USE OF PERMIT
Sinale family dwelling
SL
ZON
FSB
I SSB
SSB I
RSB
I
OFC
ZONE ORD N
LOT SZ
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
the permit is for one hundred (5100) 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 /IF r/ Applicant _-��(%_ i✓i /
NOTICE TOA LICANT: If, after making this Certificate of Exemption, you should become subjectJo 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 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, Sec341, Title 8,
C.A.C.)
❑ As owner -builder, I will not employ anyone 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. C.).
Lender's Name
Lender's Addrr
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 Safety to enter
upon the property for which 1 hove applied for this permit for the purpose of making inspections.
1/I/[irl/" ;j
,
r `' r _Signature of App�an`ror AgAt� Date
1
Print Applicant/Agent Name
APPL/PRMT 1 /
12 DATE
— S 4 �.F.D.
Permit to construct 926 sq. ft.
of S.F.D. and 235
sq. ft. of garage
as per approved plans.
Mech. Fee
24.L30
Plan Check Fee
246.00
Const. Fee
289,00
Elect. Fee
23.50
SMI Fee
3.64
Plumbing Fee
30.00
Prop. Devel. Fee
450.00
l►
rr
- F, 1
TOTAL
FEE
1,066.14
VALUATION 51, 661).88 0.
BLDG. DEPT. ..,
NO.
OPERATION "MATE.
INSPECTOR
NO.
0P!RAFT10N DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
— _C
33
Ventilation System
2
Ftgs & Frms
Si(�
34
Plenums & Ducts
2A
Slab Grade
35
Furnace Compart. •
3
Steel
_ � _ y
�—�
36
Inlets & Outlets •
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
39
Appl. Clearance
7
Framing.
AIMMM
40
Fire Damper
8
Vents
1111115.41
Smoke Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P.L.
❑
43
Final
10A
Fireplace T.O.
❑
NPON
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 —$S'-ro
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
P/L P/I
STREET NAME
26 Power Pole
27 Conduit 7
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final