0036 (SFD)PERMIT APPLICATIONILI Q �� /
City of La Ouinta ( (
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 elfect.
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's License 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 applicant for 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 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.).
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 , or a certified copy thereof (Sec. 3800. Lab. C.).
Policy No. Company
O C,rtified copy is hereby furnished. r^^ti /�.�
0 Certified copy is filed with tthhq City Building Inspection hDepa tme/ntlor,Cititty�,r � Department.
Date ✓ —�/� " -� — Applicant
APPLICANT NAME (L. F. MI)
AXldmi DOM10PMeft 0=0M CIII
ADDRESS
P. O. B= 780
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
JOB SITE ADDRESS/SPACE
49-961 Calle Estrella
CITY/COMMUNITY/STATE/ZIP
La ouinta, Ch 92253
BOK
PAG
PRC
C
Malch. Fee
TWN
SING
SE
S
TRACT
14496•-1
LOT
99
179.00
B Alding Fee
MOD
F-2
SB
5.22
TRACT NAME
Banta Pose Ck)w
OWNER NAME (L. F. MI)
CONTRACTOR -FIRM NAME
Ar&n Deml t C=.
ADDRESS
P, O. Box 780
C-_ ITV/COMMON TY/STATE/ZI w53
G�
564-1315
JIS762
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE N
LICNC a
USE OF PESin N rwaly .
BL
ZONFSB
SSB
SSB
RSB
OFC
ZONE ORD N
LOT SZ
END
SIDE
ff
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: 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:
0 I 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.)
0 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.
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. Q.
Lender's Name
Lender's AddrE
I certify 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 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 comply with all state laws and county ordinances relating to buidling
constrgction, and auihogi a'representative of the City of La Ouinta Department of Building and:.afety to enter
upohe pro rty for;wl�ich� have applied.forAhis,permit for the purpose of maRing i0ypectiLs.
Signaturelof Applicant or Agent Date
riri cant /Agent Name
Lr`
APPL/PRMTi 3� 003 �
�r ��
PexMit o ccWtXuatMo&a P -2-A
a4duing
1,390 Sq.Ft.
Garage
422 Sq.Ft.
Malch. Fee
$ 31.00
Electric Fee
31.25
Plumbing Fee
48.50
Plan Check Fee
179.00
B Alding Fee
358.00
S.Mli.P.
5.22
Property Dett. Fee
300.00
R V
eft Of j
TOTAL
T L
��2.97'to
VALUATION
Arrow Printing 250/1-83 White: Finance Canary: Assessor. Pink: Applicant Tag: Bldg. Dept.
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
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
j39
Appl. Clearance
7
Framing
40
Fire Damper
8
Vents
41
Smoke Detection Device XV
9
Garage Fire Wall
l
42
Commercial Hood
10
Fireplace P.L.
❑
43
Final
21
10A
fireplace T.O.
❑
NOADDITIONAL INF MATION
-
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 AP ROVALS
15 Ground Plumb g �✓�
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 4A 9 7
25 FinallS ;
Tank Pit
L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY
PSL
STREET NAME
LINE
P/1
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B BondingZoe
30 Fixtur"es
31 Service
32 Final