001235 (SFD)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: I hereby affirm that I am licensed under provisions of Chapter 9'
(commencing with Section 7000) of Division Sof the Business and Professions Code• and my license is in full,force
and effect.
License Class '•-Ric. Number
Date Contractor
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for 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 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.):
0 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 or offered for sale. If, however, the �•+
building or i mprovernm 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 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.).
0 1 am exempt under Sec. !� -� ! .'B. 8 P.C. (Attached Certificate)
Date ' ,t Owner - '' R f " —1l . . f i Ar"'v its
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
certificate of Workers' Colhpensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.).
Policy No. Company
0 Certified copy is hereby furnished.
0 Certified copy is filed with the City Building Inspection Department or City Department.
Date Applicant
APPLICANT NAME (L, F-&DsephCu?jni
ADDRESS '
CITU/COMMUNITY/STATE% .
JOB SITE ADDRESS/SPACE
52-270 Avenida Carranza
CITY/COMMUNITY/STAT SCu+mtea, CA '92253
B
173
P G
P Col
C
TWN
, FIND
SE
S
TRACT
LOT 22
Elect. Fee
61.78
MOD
SB
Plumbing F*e
TRACT NAME
OWNER NAME (L. F.
CONTRACTOR -FIRM NAM_E,,,��11.'L�Li:GQ•
L
ADDRESS abo
CITY/COMMUNITY/STATE/ZIJ Pyx '
PHONE 0 564-3175
200.00)Deposit Pd
LICNO 0
1,099.01
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE 0
LICNC 0
1.299.01 '
USE OF PERMIT Singlefamily doel,=vY
BL
ZON
FSB
SSB
SSB
RS8
OFC ,
ZONE ORD 11
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:
0 I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, w ill 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 to do'work which would require a permit from the Division of
Industrial Safety, as noted above, uhless such person has a permit to do such work from that division.
0 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 Address
I certify that I have read Misapplication 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: 1 certify I have read this application and slatethat
1' the information given is -correct. I agree to comply with all state laws and county ordinances relating to buidling
construction; and authorise a representative of the City of La Ouinta Department of Building and Safety to enter
on the -p operty for>wt c6 I have applied for th""is'pgitrtor• the purpose of making. inspections.
Signature of Applicant or Agent y Date
Print Applicant/Agent Name -
ij
APPL/PRMT.nni-
S.F. D•
Permit- to constnict 1216 sq. ft. of house
'150 sq.- ft: of porch, 442 sq. ft. of
garage and 130 ft.
of wall, as per
approved plans.'
Mech. Fee
47.00
Pian Check Fee
318.54
omst. Fee
334.00
Elect. Fee
61.78
gni Fee
4.69
Plumbing F*e
83.00
Prop. Devel. Fee
450.00
1,299.01
200.00)Deposit Pd
1,099.01
TOTAL
T
1.299.01 '
A 0 5 6 9 4 3 l�
VALUATION 6G, 101.00
BLDG. DEPT.
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION 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
10A
fireplace T.O.
❑
NPON
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOC ATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb A 5
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 APPROVAL
REAR OF PROPERTY LINE
P/L .P/L
STREET NAME
!
.26 Power Pole OX, `f
27 Conduit
28 Service Entrance
29 1, Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
r�