0031 (SATT)PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
4QAQ25 EStre•L(..
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 lull force
and effect.
License Class
Lic. Number
)ate 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's License Law
(Chapter 9(commencing with section 7000) of Division 3 of the Business and Professions Code) or that he isexempt
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 (5500.):
O 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, avid 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 improvemnt 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 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
builps or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
O 1 am exempt under Sec.
Owner
B. 8 P.C. (Attached Certificate).
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 )
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.
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 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 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, Sec341, Title8,
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 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
I certify that I have read Misapplication 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 herebyauthorize representatives
of this county to enter upon the above-mentioned property for inspection purposes.
Signature of Applicant or Agent Date
Policy No. Company
r i+ CERTIFICATE':OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and slate that
O Certified copy is hereby furnished. the information given is correct.) agree to comply with all state laws and county ordinances relating to buidling
O Certified ca is�.11li:d wd the Oity Building Ins ection:0e artment or Cit . ��De artment. construction'a`nd "authorize iFrep�esentalive of the City of La Ouinta Department of Building and Safety to enter
PY s 9 0 P Y r x r
41 r / V P-- upon the propect 'for which 0 ave apphedsfor this,permit for the purpose of andkingM1in_ss ect�ns.
Date Applicant / f„I" ^^�' el ,,�
Signaaturree of Applicant or Agent Date
PV rinrApplicant /Agent Name
APPLICANT NAME E�i(L JF. _ ib
ADDRESS
7..V• B= 780
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LOT 94
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aoSa 1dVYC"r
OWNER NAME (L. F. MI)
HM
CONTTRAC1O NAM y
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le. .ADDRESS U. B= 780
C4 1 Y/CONY � IM,U
CITY/COMMUNITY/STAT TEd 92253
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S64-1315
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ARC/ENG
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE N
LICNC N
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END
SIDE
Arrow Printing 250/1-83 White: Finance Canary: Assessor
APPL/PRMT 4• 2 I 3031
{ L31 2wTE��
POVMit tO 0011 t M311A P-1-B.'
Doewairg
1,481 rlq.Ft.
Garage
422 Dg.F't.
Mach. Fe
a 31.00
Ir lect—ric Fe
31.25
Pluib ng Fee
48.50
Plan Check Fee 179.00
Bttiu3.' m Flee
358.00
SAOI.P.
5.22
F=Pexty Derv.
Fee ' 300.00
FFWA
TFEE`
$952.97
VALUATION $74,396.30
Pink: Applicant Tag: Bldg. Dept.
ELECTRIC APPROVALS
26
Power Pole
27
Conduit
28
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION DATE INSPECTOR
29B
Bonding
BUILDING APPROVALS
Fixtures
31
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.
EJNON"
ADDITIONAL INFORMATION
...-e .
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior, Lath
12 Internal Lath
12A Drywall
�.3 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
ELECTRIC APPROVALS
26
Power Pole
27
Conduit
28
Service Entrance
29
Wiring
29A
Grounding Wire
29B
Bonding
30
Fixtures
31
Service
32
Final
Tank
L. Line
REAR OF PROPERTY LINk
P/L Pi
STREET NAME