0873 (CONR)PERMIT APPLICATION
(4 °
City of La Ouinta
^ _ Department of Building and Safety • '
This permit becomes void it work not commenced within 180 days from date
of issuance. OR; if work has been suspended or abandoned for a period'of 180 days:
"a ' .
" •' CERTIFICATE OF EXEMPTION FROM WORKERSCOMPENSATION INSURANCE: This section need not be completed if
" ICENSED CONTRACTORS' DECLARATION: I heredy°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 -. '
w(commencing with Section 7000) of Division 3o1 the Business and Professions Code, and my license is in full force
,. . LLa issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of "
„and effect. ,
California.
License Class Lic. Number
Date Applicant
-` Date, Contractor !.
-. - . NOTICE TO APPLICANT: II,'atter making this Certificate of Exemption, you should,become subject to the Workers,
r; :
OwNER-BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law torthe
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 ' -
' I_ ,•be.deemed revoked. ,
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 a signed statement. that he is licensed pursuant,to the provisions of the Contractor's License Law
o lhereoycertdythat noexcavation five (5)ormore feet indepthinto which aperson isrequired todescend,will be—
e—(Chapter9(commencing
(Chapter 9 (commencing% ith section 7000) of Division 3 of the Business and Professions Code) or that he is exempt ' •
; made in connection with work authorised by this permit, and that no.building structure, scaffolding, falsework; or '
- therefrom and.the basis.for the alleged exemption, Any violation of Section 7031.5 by any applicant for a per
demolition or dismantling thereof; will be more than thirty-six (36) feet high (Chap -3.2. Grp 2 Art2,'Sec341, TitleB;
subjectslhe applicant to a civil penalty of not more than five hundred' dollars ($500.): ` : - '
•' C.A.C.)_ - '• "'
0 I, as owner of the properly..or my employees with wages as their sole compensation,.will do the work, and the c- +'
: , 'Ij As'owner-ouilder,'t .will n;t'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 ..
x
through his own employees, provided that such improvements are not intended or Uttered for sale.df, however, the Y,
0 Division of-IndustriaLSafety Permit No. .
building orimprovemntissold within one year ofcompletion, the owner -builder will have the burden of proving that.
- 'Date Applicant '
he did not buildoa improve for the purpose of sale.).
CONSTRUCTION LENDING AGENCY: I hereby 01irm'Ihat there is a construction lending agency for the performance'. ..'
.0 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. G): - �:
° 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
750.00
• Contractor's License Law)
Lender's Address
• 0 1 am exempt under Sec., B:-8 P.C. (Attached. Certificate).x.'.,r
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
SSB
F of this county to enter upon the above-mehtioned'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.).
Signatureof Applicant or Agent Date 1
Policy No. Company,.
u.
, CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
O Certified copy is hereby furnished.
the information given is correct. I agree to comply with all state laws and county,ordinances relating to'buidling
0 Certified copy'is filed with the City. Building_Inspection Department or.City '�' Department. •
• ' I .., ,-
construction, andauthorize a 'representative, of Ihe.City7ol La Ouinta Department of Building.and Safety to; enter 4
upon the property for wti ch I have applied"for this permit for the.purpose of•making inspections. r.
Date APPlicant.
/
•
Signature of Applicant or Agent Date
-
r
Print Applicant/Agent Name —
APPLICANT NAME (L, F, MI)
(HURM of ST. FRA S - PARIS`H HATZ,
ADDRESS
47-225 Washinaton
CITY/COMMUNITY/STATE/ZIP ,
La Qinta, M 92253*
JOB SITE ADDRESS(SPACE
SAME '
CITY/COMMUNITY/STATE/ZIP `
BOK
-PAG
PRC•
C
.' ..
TWN•
RNG
SE'
S
TRACT -
', LOT
MOD '
SB
'
TRACT NAME
OWNER NAME (L. F. Ulf' • `-
CMRM of ST. FRAYS of •ASStST
CONTRACTOR•FIRM NAMEy,.,,.u"
Gott
ction
ADDRESS
1656 Vkest 9th
CITY/COMMUNITY/STATE/ZIP • . ' '
UpLa nd P CA 1917R&
BH71:4N) 982-8951
B L279688
Ekect.' Fee
-FIRME
ARC/ENG M NA
Robe irniavrii "
ADDRESS '
• 73-70o, &* 111 '
CITY/COMMUNITY/STATE/ZIP
Palm Deme eA Q7o?gn
PHONE N ' * '
. LICNC N
.
Prop. Dev. Fee
750.00
USE OF PERMIT - -
- PAMSH -HAM AMITIO!N
BL
ZON
FSB
SSB
SSB.
RSB
OFC
i 'ZONE ORD N -•
LOT SZ
=TOTAL,..:.
END' •
SIDE",
•
-APPL/PRMT �.i ■• .•.: � 0j 4_84 LLL4JV•
Penni t to build
4860 sq ft of CW=h
`garish Hall and
363 lineal: feat of
wall as per approved plans.
b -
Fee
22.00 �.
C�. Plan Qs. Fee
Cont. Fee
474.83
,730.50
Ekect.' Fee
63.75
SMI Fes .
15.30
Plumbing Fee
.57.00
Prop. Dev. Fee
750.00
2,113.38.
=TOTAL,..:.
• .' VALUATION 218,055.00
BLDG. DEPT. - _ ,
NO.
OPERATION DATE INSPECTOR,
'NO. OPERATION DATE JNSPECTOR
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
39Appl. Clearance
7
Framing (,�/ALLS /�
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
o /
SEWAGE SYSTEM SIZE & LOCATION
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
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/I
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring.
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final