0359 (SATT)PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
ThWpermit becomes void it work not commenced within 180 days from date of issuance,-O&1f work has been suspended or abandoned for aperiod of 180 days.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that •1 am licensed under provisions of. Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my lioense is in tulltorce
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 requiresis permit to
construct, alter, improve, demolish, or repair any structure, prior Io'its issuance, also requires the applicant for
such permit to file a signed statement thathe is. kcensed pursuant to the provisions of the Contiactor'st-iceose Law
(Chapteug (commencing with section 7000) oLDivision 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 noUmore than five.hundred dollars ($500.):
0J. as owner of the property, or -my employees with wages as their sole compensation; will do the work, and the -
�•
structure is not imended.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 hiaown employees, provided thatsuc h improvements are not intended or offered for sale. Whowever; the
building orimprovemntissold within one year ofcompletion. the owner -builder will have the burden oiproving that _•
he did not build or improve for the, purpose of sale.).
0 1, as ownevof 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 whMcontracts --tor such projecte`with a contractor(s) licensed pursuant to the
Contractor's License Law:j.
01 am exempt under Sec. 8: 8'P.C. (Attached Certificate).
D2tQ ° j . l.: • -t Y'` •S . . . Owner . l�, �..�. •V_., ! i '�.-..(" -
WORKERS' COMPENSATION DECLARATION: I hereby affirmAhat 1 have a certificate of consent to self -insure, or a
certificate of Workers' Compensation'Insurance , or a certified copy thereof (Sec. 3800. Lab. C.). "
Poticy.No. Company
0 Certified'copy is hereby furnished. t
0 Certified copy is filed with ihe.City Building Inspection Departmeni drCity Department.
Date Applicant
1 k. �
ve AEP�1� q
P. o. Fcoc 704
Quin, 92253
a91131111 MACE Drive
MTr tpelTY/sr, CA 92253 ATE/ZIP
3
acs
PU65
018
0
-
rawr1No
250.25
sE
s
TRACT
LOT
SMI Fez
5.85
MOD
SO
”
TRACT NAME .
OWNER NAME (L. F. eel),
ADDRESS
CITY/COeWWiITY/STATE21P - - -
3455
LICNC e
140V 9. 3 W3
c4y of Ed 9011ft
ARC/ENG FIRM NAME •- '
ADDRESS -
CITY/COMMUNITY/STATE/ZIP -
PHONE /
$ 1 255047
LICNC #
BL
ZON
FSB
'-SSB
SSB.'
RSB
OFC
ZONE ORD a
LOT SZ
END-
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be Completed if
me permit is forone hundred ($100) o, less; l certify that In performance,oi the work for which this permit is
issued. l 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.Certificati of Exemptton,.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 thereby certify that no exravationfive (5) or more feet in depth into which aperson is required to descand.will be
madetn connection with work' authorized by this permit, and that no building structure„scaffolding, falsework, or
demolition or dismantling thereof; will be more than thirty -sl' f3fh feet high. (Chap 32 Grp Z Art 2: Sec341; Title8,
C.A.CJ r
O As owner -builder, l willofiotemploy anyone'to do work which would require a permit from the DNision'of
Industrial Safety, as noted above, unless'such person has a permit to do such work from.thatdivision.
sa Divisioncaf, 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 permitts issued (Sec. 3097, Civ: C.).
Lender's Address
1 certify that [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 herebyauthorize representatives
of this county to enter upowthe above-mentioned property for inspection purposes.
Signature of Applieantor Ageiil 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
construction, and authorize a represemative:of the City of La Ouinta Department -of -Building and Safety to enter
upon the propertyfor which.l have applied; for this. permit for.,the:purpose of making Inspections.
Signature of Applicant or Agent. Date
Prim Applicant/Agent Name
APPL/PRMT a n_ - l.PA'%3 .
apt
Permit -to oanstruct 1, 750 Sq. Ft.
of Duplex
Nlacii. Fee $
36.00
Plan Chec1c Fee
250.25
Construckim Fee
385.00
Electrical Fee
34.87
SMI Fez
5.85
Plumbing Fee
93.50
Property Df mlopw nt Fee
450.00
rR E&u C E i [T EWil
140V 9. 3 W3
c4y of Ed 9011ft
FAL-
U
$ 1 255047
BLDG. DEPT.
VALUATION' $83,930000
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 L:E]77'-'1171
35 Furnace Comport.
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 o23
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 S
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 001_ Pi
�l
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME