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0446 (SATT)PERMIT APPLICATION • City of La Og a • 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 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�sLicense 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 applicanttor a permit .subjects the applicant to a civil penalty of not more than five hundred dollars ($500.): . . 0 I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the.: structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor:s License Law does not apply to an owner of property who builds, or improves thereon• and who does such work himself or through his own employees, provided thatsuch improvements are not intended or offered for safe. If, however, the building orimprovemntissold within one year ofcompletion, the owner -builder will have the burden of proving that . he did not build or improve for the purpose of sale.). x 0 I, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec: 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.). 0 1 am exempt under Sec. B. 8 P.C. (Attached Certificate). Date Owner WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a' certificate of Workers' Compensation Insurance , ora certified copy thereof (Sec. 3800. Lab. C.). . Policy No. Company `Certified copy is hereby furnished. �jOCertified copy is filed with tlye City Building Inspection ^Department or City Department. "Dae .7 fA %, ' Applicant.y lf7 i iT�r9 APPL, I NA(L F -1ICI_)a� . ESS P.ADDu. Bow 780 CITY/COMMUNITY/STATE/ZIP La Quinta, CA 92253 49-914 RES$/SPC rcu_ CITY/COMMUNITY/STATE/ZIP - La Quinta, CA 92253 BOK PAG PRC I C Plan Check Fee TNM RNG SE S TRACT 14496-1 LOTMOD 166 7„39 Plumbing Fee P-•3 -SB 450,00 TRACT NAME , Santa Rasa Com OWNER NAME (L. F. MI) Cw�+O�NNTT�A�AACTOR-F I RM�L{NAAMEE,,,� Sam As Abbe ADDRESS CITY/COMMUNITY/STATE/ZIP .. I PHONE • 564-1315 utu , Q LICNC e 333762 ARC/ENG FIRM NAME - ADDRESS CITY/COMMUNITY/STATE/ZIP PHONE 0 LICNC • ' syy{{,,,, E'.�OF��ERMlwii h Attached ._ .__—i_d Garalge 111. ZONFSB Ssa. Sse RSB OFC ZONE ORD • 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: It, 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 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 conneclion: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, Grpr2, Art 2, Sec 341, Title B, C.A.C.) +Y-"- 0 As ownef-builder, I will not°employ anyone to do work which would require a permit from the Division o1 Industrial"Safety, as noted above, unless 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 _ Icertify 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 Appljcarrt 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 relatingAo�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/PRMT 44 10A 28•-83 s/F/D . P=4t to cims ruc , 2,326 Sq. Ft. of S/F/D with Attached Garage Merl n cal Fee $ 31.00 Plan Check Fee 291.20 Fee 448.00 F1ectrical F* _ 31.25 8M Fee 7„39 Plumbing Fee .52.50 Property Dev+elognent Fee 450,00 QTIt POO" [,uBrJn utu , Q TFEE $ 1,311.34 BLDG. DEPT. VALUATION I $105,699.40 NO. OPERATION ATE' INSPECTOR NO. OPERATION DATE INSPECTOR BUILDING APPROVALS ,MECHANICAL'APPROVAL'S 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. . ❑ OWN ADDITIONAL INFORMATION NO. ' ✓ t ✓ �� �/� l SEWAGE SYSTEM SIZE & LOCATION 11 Exterior Lath 12 Internal Lath/�/L%/y` 12A Drywall o� 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 PSL 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