0431 (SFD)PERMIT APPLICATION
ADDRESS Baas 780
i
' City of
+Department of
La Ouinta
Building'and Safety
BOK
PAG
This permit becomes void if work -not commenced within 180 days from date of.issuance, OR, if work has been'suspended or abandonee for a period of 180 days., a
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CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This "section need not be completed it". _ 1
"LICENSED CONTRACTORS, DECLARATION" I. hereby affirm that I am licensed under' provisions ot:Chapter 9'
the permit -is for one hundred ($100) o: less.I certif7 that in the performance of the work for which this permit is,
_ (commencing with Section 7000).of Division 3 of the Business and Professions Code, and my license is in full force
issued; I shall not employ any person in anymanner.3o as to become subject to the Workers'Compensation Laws of
and effect.
California.
.License Class Lic. Number
Date Applicanti
Date ContractorNOTICE
TLicu:•
TO APPLICANT: It, after making -this Certifi,:ateof Exemption, you should become subject to the Workers' + '
r,^ • c
OWNER -BUILDER DECLARATION: I hereby affirm that I am'exempt from the Contractor's ense Law for.the
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 bi county which'requires a°permil,to
be deemed revoked.
'construct, alter, improve, demolish, or repair any structure, prior twits issuance; also requires the applicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFNATION: .'
such permit -to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
.;01hereby 'certifythatnoexcavationlive(5)ormoref"dridepth into which apersonisrequired to'descend,willbe
,,. (Chapter 9 (commencing with section 7000).oI Division,3 of.the Business and Professions Code) or that he is exeinpt - .
_made in connection with work authorized by this peTmit; and that no building structure, scaffolding, falsework,or . •f
therefrom andahe'basis torIhe alleged exemption. Any:violation;of Section 7031.5 by, any applicant for a permit -...
• :. r, demolition or dismantling thereof, will be more thanthirtysiz (36) feet high.. (Chap 3:2, Grp 2, Art,2, Sec 341, Title 8,-
' `subjects the applicant to a civil penalty of not more than five hundred dollars ($500t)i.
- CACQ)
I; as owner of the property; or.my employees with wages as their sole compensation, will do the _work, and the
0 As owner -builder; I'witl not'empfoy anyone to-do work which would require a• permit from tfie Division of.
.structure is not intended or offered for sale (Sec. 7044. Business and•Professions Code: The Contractor's LicenseIndustrial
Safety, as noted above, unless such.peron has a permit to do such work from that division: '
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: - 0 Division,,of.lndustrial Safety Permit No.
building orimprovemntissold within one year ofcompletion. the owner -builder will have the burden of proving that
Date Applicant. 3
he did not build, or improve for the purpose of sale.).
A , '
CONSTRUCTION LENDING AGENCY: I hereby affirm °hatthere is a construction lending agency for the performance :9 • ' '
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. 3D97, Civ:.C.). -' ' . • • r+
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
.+
' Contractor's License Law.):
Lender's Address
• .0'1 am exempt under Sec. " B. 8 P.C. (Attached Certificate).
I certify that I have read this application.and state fiat the'above information is correct.1 agree to comply with all
' Date Owner"
city and county ordinances and state laws relating o building construction, and hereby authorize representatives,
of this county to enter upon the above-mentioned iroperty for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm'that I have a certificate'of consent to self -insure, or a .
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' certificate'ot Workers' Compensation Insurance•; or. a certified copy thereof (Sec. 3800. Lab. -C.).;.
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Signature of Applicant or Agent °`' Date
Policy No. . • Company' _. t
t
" CERTIFICATE OF COMPLIANCE AND AUTHORIZATIOU OF ENTRY: I certify I have read thisapplicationand state that
-0 Certified copy is hereby:furnis-�hed.
' �fJ/Certified is tiled(,gi the_ ity Building Inspection Dep rtment tlr Cuy Department;,
the information given is correct. lagree to comply with all state laws and county ordinances relating to btiidling
construction, and. authorize a'representative of th. City of La Ouinta.Department of Building and Safety to enter.
_
copy
• f -L I-'�• 4 -t� /. + ' u�
upon the property for which I have applied for thi: permit for the purpose`ol making inspections.
\L\
Date Applicant.'
Signature of Applicant or Agent Date
APPLICANT NAME (L. F. MI) - • .•
Arden. Cal rporaticin
ADDRESS Baas 780
GITr,;//cGM�MUN�I�ta,TE/Z�(P'i92253
4-98yySJ�f A�DppDRESSSOS.�,P�A.,C.E.�1 Quintana •• `
I I ° •�7 ' camim Quintana
CITY/COMMUNITY/STATE/ZIP • - "
La QLunta, CA 92253
BOK
PAG
PRC
:C
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TNM .
RNG'
SE' ..
S
TRACT
LOT.
7.39
Plumbing Fee
MOD
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�1v,4��4,86•-p2�M.� ry��2,5
ta Rc �1 Cove •. • ' ,.
•7iAttCT NAME
OWNER NAME (L. F. Ml) '• ... ., ... .
`CONTRACTOR_FIRM NAME
Sww As •Ab we
ADDRESS .. .
CITY/COMMUNITY/STATE/ZIP ,
564-1315
333762`
ARC/ENG FIRM NAME
ADDRESS -
CITY/COMMUNITY/STATE/ZIP '
PHONE 9
.
LICNCUSEO
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IT
ai'rF/ 9.J Min th Attached Garage
BL
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END
. SIDE
Print Applicant/Agent Name
APPL/P.RMT - A■�■n■■■111.AT_k8 83
U431.Q
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Permit to construct 2e.326 Sq. Ft. of S/F/D
with Attached Garage
Kcal Fee $
'26,00
Platt Check Fee.'
291.;20 '
Oonstr1aet4ic h tee
448.00
F.ls6tr'3.eal Fee
. '36, 90 '
SMI Fee
7.39
Plumbing Fee
73.00
Praperty Dwelapnezit Ilie •
450,00
J.
RE
.,. U
I
m
,. _.... �: TOTAL W X332:49
.11
$ 1'
bd
t. VALUATION $1E35'>$!?f IVY .tt
t
,. ,�,. •, y t.` . t�:. _ - BLDG. DEPT...
Ah
Ah
NO.
OPERATION ATE INSPECTOR
NO.
OP TION DATE ll\IiHSTOR
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
a
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
t2 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
126 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
PSL P/1
STREET NAME
26 Power Polq
27 Conduit.. .
28 Service Ent}'ence"
29 -Wiring ,a'•=
294 Grounding Wire:
29B Bonding.
30 Fixtures
31 Service' - +
32 Final