0449 (SATT)PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety S.
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.
•
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed it
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 70001 of Division Sof the Business and Professions Cade; and my license is in full force
issued. I shall not employ any person inany manner so asto become subject to the Workers'Compensation laws of
and effect.
California.
License Class Lic. Number
Date Applicant
,Date Contractor'
NOTICE TO APPLICANT: lf,.after making this Certificate of Exemption, you should become subject to the Workers'.
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires,a permit.to
be deemed'r yoked.
construct, alter, improve. demolish, or repair any structure, prior to its issuance, also requires the applicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: '
such permit to file asigned statement that he is licensed pursuant to the provisions of the Contractor's License Law
01 hereby certify that no 6cavatio6five (5) or more feet in depth into which a person is required to descend willbe
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) or that he is exempt
made in connection with work authorized by this permit, arid that no building structure, scaffolding, false work, or
therefrom and the basis for the alleged exemption. Any violation at Section 7031.5 by any applicant far a permit .
demolition or dismantling thereof, will be more than thirty"six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341, Titlell,
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
C.A.C.) - '• `�•
O 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, 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
❑ Division of Industrial Safety Permit No
building orimpeovemntissold within one year ofcompletion. the owner -builder will have the burden of proving that
Date Applicant
he did. not build,or improve for the purpose of sale.). 1 •
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
❑ I, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec'
of the work for which this permit is issued (Sec. 3097, Civ. C.). 4
7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
Lender's Name
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.). _
Lender's Address
0 1 am exempt under Sec. B. & P.C. (Attached Certificate).
I certify that I have read this application and state that the above information is correct. I agree to comply with all
Date Owner
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
SIDE
of this county to enter upon the above=mentioned property for inspection purposes.
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.
Va Certified copy is filed with the City Building Inspection'Department,or,City Department.
Date f I ? Applicant
U f - ---
APPLI ANT NAME _ (L, F, MII�1
ADDRESS
P. 0. Bax 780
CILaCOM_ MUNI ta,,EC 92253
JiOBB�p3SSI�ITE 1LAAOORmE.•{SSSS//S'� P�CEEl�� ,,,', A
49; i99 � l Want o
CITY/COMMUNITY/STATE/ZIP -
Ya (.Amta, CA 92253
BOK
PAG
PRC
C
Plan Ctedc Fee
TWN.
RNG
SE
• S
14496-1
LD169
5.85
Plumbing Fee
P►1
SB
450.00
TTIACT NAMEsarita Rosa ODw
OWNER NAME (L, F. MI)
R•PIRM NAME '
CONS T� NA'C3�7CTOyA
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE
564-1315
a 1' j V F, n
LICNC
333762
, L
r.. J
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP '
PHONE •
LICNC•
USE OF PERMIT
S/F/D with Attached Gar, -M
BL
ZON
FSB
SSB
SSB
RSB
OFC
ZONE ORD N
7.
LOT SZ '
END
SIDE
r
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 complywith all state laws and county ordinances relating to buidling
construction, and authorize a'representativeof the City of La Ouinta Department of Building and Safety to enter
upon the property for which I have applied for this permit dor the purpose of making inspections.
Signature of Applicant or Agent
Print Applicant/Agent Name
Date
APPL/PRMT . DATE
4 12-•28-83
S/F/D
Permit to construct 1,903 Sq. Ft. Of S/F/D
with Attadied Carage
Medb nical Fee- $
31.00
Plan Ctedc Fee
250.25
Constructim Fee
385.00
Electrical� �.-
31.25
RU Fee
5.85
Plumbing Fee
48.50
Prcperty Developmmt Fee
450.00
• • A
a 1' j V F, n
, L
r.. J
City 0 ._via' q•uin.la v ✓TOTAL
$ 1A201.85
VALUATION $ 83,889.80
13LDG. DEPT.
a
NO.
DA
OPERATION 'TE INSPECTOR
NO. OPERATION T 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.
EJ
43 Final
10A
Fireplace T.O.
❑
NON ADDITIONAL INFORMATION
N.
�� f/�,/��
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick "" R
Value
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) L
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B, Bonding
30 : Fixtures
31 'Service
32. Final.
Application Number . . . . . 09-00000199
Permit . . .
RE -ROOF
Additional desc .
Permit Fee
30.00
Plan Check Fee
.00
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
8/30/09
Qty Unit Charge
Per.
Extension
BASE FEE
30.00
----------------------------------------------------------------------------
Special Notes and Comments
RE -ROOF INSTALLATION
OF NEW TILE
UNDERLAYMENT INCLUDES
49-984 49-994 EL
CIRCULO 112007 CODES".
:
-----------------------------------------
Fees . . . . .
. . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged
----------
Paid
----------
Credited
---------- -----
Due
- ----
-----------------
Permit Fee Total
30.00
.00 .00
30.00
Plan Check Total
.00
.00 .00
.00
Other Fee Total
1.00
.00 .00
1.00
Grand Total
31.00
.00 .00
31.00
LQPERMIT