0447 (SATT)PERMIT APPLICATION
• City of La Quinta
•
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 3 of the Business and Professions Code, and my license is in full force
and effect.
License Class Lic. Number
Date Contractor-
OWNER-BUILDER
ontractorOWNER-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 Contractors 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.): '
O 1: as owner o1 the properly, or my employees with wages as their sole compensation,will clothe 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 mprovemnt 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.).
O I, as owner ot.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
builQs or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.). . .
O I am exempt under Sec. - - 0. & P.G. (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
O Certified copy is hereby furnished. • -
WC ertified copy is filed with the City Building Inspection;Department or City Department
a
Date r /� Applicant �1
APPLICANT NAME (l, F. MI)
.►.i /K,1n�A•w•r.�y��.li.Q„i`.•iiV�lwi
L7,,R�1ESSS
DDD-
ADDRESS
P. O. BOK 780
CITY/COMMUNITY/STATE/ZIP -
la Quinta, CA 92253
JOB SITE ADORESS/SPACE -
49-973 El Circulo
CITY/COMMUNITY/STATE/ZIP
la Quinta, CA 92253
BOK
PAG
PRC
C
$ 31.00
TWN
FIND,
SE
•S
TRACT
14496-1
LOT
167
SMI Fee
7,39
MOD
P-3
SB
Property Dev+ellognent Fee
TRACT NAME
Santa Rosa Cove
OWNER NAME (L. F. MI) -
CONTRACTOR -FIRM NAME
Sams As Above
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE •
564i11315
�y
LI_CN 34762
33j
ARC/ENG FIRM NAME
l
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE •
`-- -T T
LICNC °
$ 1,311.34
?;FO`JPERMIT
D With Attached Garage
BL
ZON
FSB
SSB
SSB
RSB
OFC
ZONE ORD a
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:
O l 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.)
O 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. -
O Division of Igdustrial Safety Permit No:.
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
l.of the work for which this permit is issued (Sec.•3097; Civ. Q. _
Lender's Name
Lender's Address
,.. I certify that:l 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 ANO' AUTHORIZATION OF ENTRY: I certify I have read this application and state that
the information given is correct. I agree to comply with all stale 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 I have applied for this permit for the purpose of making inspections.
Signature of Applicant or Agent
Print Applicant/Agent Name
Date
APPL/PRMTDATE
1 B 4 471L�C��83
►7/F/L
Pemit to construct 2,326 Sq.
Ft. of S/F/D
With Attached Garage
Mechanical Fee
$ 31.00
Plan Check Fee
291.20
Oonsttiuctim Fee
448.00
Electrical Fee
31.25
SMI Fee
7,39
PlumbirV Fee
52,50
Property Dev+ellognent Fee
450.00
�y
G t
19983
`-- -T T
$ 1,311.34
BLDG. DEPT. VALUATION $105,699.40
NO.
OPERATION ATE INSPECTOR
NO. OPERATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set -Back
33
Ventilation System
2
Ftgs & Frms
1p 9
34
Plenums & Ducts
2A
Slab Grade•
35
Furnace Compart..
3
Steel
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
313
Compressor
6
Roof Deck
Q
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
C;,p �/ b
2/c,2,7/9T
f K
SEWAGE :SYSTEM -SIZE &LOCATION .
11 Exterior Lath
12 Internal Lath
1.2A Drywall
13 Finish Grade
'/
INSULATION Thick Value ' ��0?0 �%t
7A Walls (Batts)
126" 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 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