001246 (SFD)t7
APPLICANT NAME (C.' F, MO Rick.
pJo^h,.nson
ADDRESS P.O. B= 2288,
} PERMIT APPLICATION ,
City of La Ouinta
- , Department of Building and Safety •• r
_This permit becomes void if work not commenced within- 180 days from date of
ays.,
issuance: OR,if work has been suspended or abandoned for a period of 180 days.,-
_ Y •. : 3 - -
'7
.- CERTIFICATE OF. EXEMPTION FROM WORKERS' COMPENSATION INSURANCE-: This section need not be completed it -
LICENSED CONTRACTORS; DECLARATION:,I hereby affirm that P am,.licensed.under provisions oftChapter 9x ' '
the permit'is for:one hundred ($100) o. less. I certify that in the•performance of the work -for which this permit is ;
(co mmencing.with .Section:7000) of.Division Sof the Business and Professions Code; and my license is in full force.'.
issued, I shall not employ,anyperson.inany mannerso as to become subject lothe Workers'Compensation Laws of
and effect. ?
California. 1
License Class Lic..WQer�'
Date -' Applicant
Date ---.Contractor
•'
NOTICE TO APPLICANT: If, after. making this Certificate,of Exemption, you should become subject to the,Workers,',.,
!'hereby • • `- -'' / - ' -
OWNER -BUILDER DECLARATION:- affirm that I am exempt,lrcm the Contractor's License. Law for -the .�
'requires
.r Compensation provisions of the or Code, you must forthwith comply with such provisions or this permit shall ,.
• •.
. be deemed'revo - ,.
following reason (Sec. 7031.5, Business and Professions Code: Any city or. county which a permit to- ,`.
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 bf,the Contractor's License Law '
❑sl hereby certify that no excavatibritNe (5) or more feet in depth into which a pJrson is required to descend, will be"'
-(Chapter 9 (commencing with section X000) of Division 3 of the Business and Professions Codejor that he is exempt .,., _
- m4de in corthection with work authorized by this permit, and that no building structure; scaffolding, talsework, or
therefrom and the oasls.f(rgghe alleged exemption. Any violation of Section 7031.5 by any applicant for, a permit
-ofnot
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap`3.2. Grp 2. Art 2, Sec341;?Title8.
subjects the applicant to -a civil penalty more than live hundred dollars ($500):..
CA:C 1 _ • . - , i r- •- r ,r _,a, .
O I, as owner.of the property, or my employees with wages as their sole compensation, will do the work, and the -
,'p As owner -builder, I will not employ anyone to do work which would requirea permit from the Division of
structure is notintended 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 wfio does such work himself or.
ti • . +-
Division of.lndustrial Safety Permit,'No.
through his own employees. provided that such improvements are not intended or offered for,sale.11, however, the , .
•, , .0
building orimprovemntissold within oneyearofcompletion. theowner-builder will have the burdenofproving that.
Date Applicant
he did not.build or improve for the purpose of sale.), -• „'1
CONSTRUCTION LENDING AGENCY.,- I hereby affirmthatdhere is a construction lending agency for the performance
O 1, 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.)..
7044. Business and Professions Code:.The Contractor's License Law does not,applyto an owner of property who. •
Lender's Name
builds or improves thereon; and who contracts:forsuch projects with a contractor(s) licensed pursuant to the . ..
OFC ,
Contractor's License Law.). �, -.
Lender's Address
❑ 1 am'exemptunder Sec.; - B. 8 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 .
END ,.
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.):'^, a
1 . , Signature IiNpplicantor' Agent 1' - Date
Policy No. Company,~ +-
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that A
'• ❑ 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 co Is filed with the Cit Buildin 'Ins ection De artment or Cit De artment:-- 1
DY Y 9 P P y' P
construction,^and authorize a *representative ot,the City of La Ouinta Department of Building and Safety to enter
r
upon the.propertyaor=whic fl -have applied for this permit for the purpose of making inspections.,
_
Date Applicant
r •.
f1, ... / .
„
Signatu`e of Applicant or Agent Date +
Print Applicant/Agent Name r ,
t7
APPLICANT NAME (C.' F, MO Rick.
pJo^h,.nson
ADDRESS P.O. B= 2288,
CITY/COMMUNITY/STATF/ZIP JL�Ii.1io, CA. -92201-
JOB SITE ADDRESS/SPACE 51-935 Avenida Villa
CITY/COMMUNITY/STATE/ZIP •, Qu nta,- CA 92253
sz����•�
B0I l3
"N2
V213
.0
9arage',.as Per approlved Plass. ,
TWN
RNG.
SE ,
S .
TRACT
LOT
Plan Ck. Fee
MOD
so
Mech. Fee • ' •- '
TRACT NAME . None
•�•y�"
yy,,,�,.,�
.OWNER NAME (L. F. MIj Ma Johnsm Ocnst. -
CONTRACTOR -FIRM NAME - Applicant ... _ .
��.•.L.....,•+
ADDRESS , .. .
CiWVC
CITY/COMMUNITY/STATE/ZIP 1 .... .
6L
3.t 7„ 77 7 11
PHONE . '347-7171
1 /.L
68.75 •
LICNC F
SMi Fee '
ARC/ENG FIRM NAME .
ADDRESS -
CITY/COMMUNITY/STATE/ZIP , •' '
PHONE N
LICNC II
450.00
USE OF PERMIT
ng a f,•; Wi •1 y , &elling
Single
BL
ZON
FSB
• SSB
SSSLLBti/
RSB
-
OFC ,
ZONE ORD .;
. i ?.
LOT SZ
END ,.
" • SIDE '
APPL/PRMT '�,. (� p'�:
'3�0•'Aj�E05
A7.F. De
Permit to.construct 1592 sq. ft. of house
-'277 sq. -ft. of, porch, `and 430 sq.
ft. 'of
9arage',.as Per approlved Plass. ,
N,
Plan Ck. Fee
326.58
Mech. Fee • ' •- '
40.00 .
-
Oonst: Flee . '
388.00
Elec. Fere
68.75 •
-
SMi Fee '
50-95,..
Pluming Fee
89.00
Prop. Devel. Fee
450.00
.:TOTAL
FEE
s , A 039,0
BLDG. DEPT.,
..
'VALUATION 134, 248.!)0:
Akk
Ah
NO.
OPERATION I WR rE INSPECTOR
NO.
OP TION - 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.
❑
NON
_ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
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-
isposal__-20
20Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
------------
25 Final
Tank Pit L. Line
ELECTRICAPPROVALSREAR
V
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