001148 (SFD)+ PERMIT APPLICATION Q 1
Cityof•LaOumta -`•.
Department of Building,and Safety . �.„• Ct
This permit.becomes void if work not commenced within 180 days from date of issuance, OR, if work has been suspended.or abandon=d fora period of 180 da t
CERTIFICATE OF EXEMPTION FROM•WORKERS'COMPEN:ATIONINSURANCeed not be comp if,.LICENSED CONTRAC• .AS DECLARATION: I hereby affirm'that I am licensed: under, provisions of Chapter 9 �: +• the permit is for une hundred ($100) o. less. I certify th..t.in the performanpermit Is
'(commencing with eiction •7000) of Division 3 of the Business and Professions Code; and my license is in full force ~ issued; I shall not employ any.peison inany mannecso as to become subject to the Workers' Compensation laws of
and effect '” ' ; /� 's a California `
License Class - Lic: Number? �(' 'I'D ate ^ ! `� c / tri r 'Applicant,
•Date • Contractor + y .NOTICE TO-APPLICANT,11 ,after;making this Certificate of Exemption, you should become subject to the Workers'
' Compensali,in provisions of;te L
habor.Code, you must -orthwith comply with such provisions or this permit shall
OWNER' -BUILDER DECLARATIONr I hereby affirm that I am exempt from the Contiactor's License Law for the. - be deemed revoked._ 'I ._,�' r ' ' - - -
following reason (Sec 7031.5. Business and Professions Code: Any city or county which requires-a.permit to :a -
construct, alter, improve; demolish, or repair any struclure,•prior to its issuance, also requires the.applicant for DIVISION OF. INDUSTRIAL SAFETY PERMIT CERTIFICATION:. •�
,such permit tolileasignedstatemenithatheislicensedpursuanttotheprovisionsoft4eContracjor'sLicenseLaw rnK,01hereby certify that noexcavation five (5)ormore fee-ind"epthinto which aperson isrequired todescend. Will be
_(Chapter 9(commencing with section7000) of Division of the Business and Professions Code) or that tteisexempt ;.,.{ made in connection with work, authorized by this permits and that no building, structure. scaffoldings falsework, or r•
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant fora pet mit,r _t ' ; demolition ocdismantling thereof„will be more than thiry-six (36) feet high. (Chap 3.2, Grp Z Art 2, Sec341. TitleB,
-subjects the applicant to a civil penalty of not more than five hundred dollars ($500.): • .. A: `, ^,r . 'C.A.C.)Y. ” '•• + • .
- ❑ I. as owner.of.the property, or my -employees with wages as their sole compensation will do the work, and the r.:.
structure -is not intended or offered .for sale (Sec. 7044, Business and Professions Code: The Contractor's License ; Y � In As oat Safely, as; f will not employ anyone person
vara which would req h wo permit from the Division.oh
•; :; • 'Industrial Safety, as noted'above, unless such person ;as a peimit to do such_work-from that division._.
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 x �. O,Division ot. Industrial Safety Permit No.
• building orimprovemntissoldwithinoneyear.ofcompletion,theowner-builderwillhavetheburdenofprovingthaLr • / Date Applicant
he.did not build or improve for the purpose of sale.).
I.% ' '. CONSTRUCTION LENDING AGENCY: I hereby affirm that here is a construction lending agency for the performance
0 1. as owner of the property; am exculsively contracting with licensed contractors to construct the project (Sec:, v . • of -the work for which this permit is issued (Sec. 3097, :iv: C.). .
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 contractsPfor such projects with a contractor(s) licensed pursuant to the . `-Lender's Name
Contractor's License Law.). •� " Lender's Address
to 0 1 am' exempt under Sec: : B. & P.C. (Attached Certificate).,', I'certify.that I have read this application and state that fie above information is correct. I agree to comply with all
Date Owner, • : city and countyordinances and state laws ;elating to bu Iding construction, and hereby authorize representatives . +
of this county to enter upon the above4mentioned property forinspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, ora •~
' . certificate of Workers' Compensation Insurance , or a certified.copy thereof -(Sec. 3800. Lab. C.). •. Signature of Applicant or Agent Date
Policy No. ` Company CERTIFICATE OF COMPLIANCE AND AUTHORIZATION.OF ENTRY: I certify I have read this application and state that
O Certified copy is hereby furnished.>the inferm�tiong vVen is correct: I agree toreomply-with all state laws and county ordinances relating to buidling .
❑ Certified co is filed with the Cit Buildin Inspectio De artmen o Cit Department..construction, and�auihorize a' representative, of the Cit- of La Ouinta Department of Building and Safety to enter
PY Y 9 P Y/ �. r
y y C J= += 7 /,�,• ti'^ r' upon the property for which` I have applied for'this permit for the purpose of making inspections.
:Date Applicant
_ .V ! _
Signature,of Applicant or Agent } Date
Print Applicant/Agent Name
APPLICANT NAME (L, F. MI) } Tn den Corp
,Anden •
•�
ADDRESS • P w V • BOX ' ! 8 0 . .
CITY/COMMUNITY/STATE/ZIP -
La,Quinta, CA 92253
JOB SITE ADDRESS/SPACE 77-127 .Via Ruerto
'CIT Y/COMMUNITY/STATE/ZIPTa Quinta', CA
L 92253
BOK
PAG
PRC
C
also• a model.
TWN' •.
RNG 'ISE
J.
`.
I S'
TNT46A
�-2
L0T14
•15.50
'Plan Check' •Fee 29.12
M�OyD
SB
. Elect. Feel
•�
TRACT NAME Santa Rosa Cove •�
OWNER NAME (L, F. Mn - .. .. ..
CONTRACTOR -FIRM NAME -.
Appl.idaht ,
ADDRESS ' ' above .. .. .
CITY/CO MMUNITY/STATE/ZIP_.-
move `
PHONE 0, 564-1315
•.
`I°_333762
.'
.ARC/ENG FIRM NAME -
ADDRESS
CITY/COMMUNITY/STATE/ZIP -
PHONE N ..
-
LICNC N
-
USE OF PERMIT
S.F.D: T a•
SL
ZON
I.^FSB
SSB
�` J
SSB;.
RSB
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OFC
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"ZONE ORO. N .
-
LOT SZ ti
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t.. ENO 'e,
?IDE,.
APPL/PRMT "
1 2DATrE 0,•,44. •S • 1' a D,. . .
Permit to' construnt 'sq. ft.
'Of S.F.A. with attached garage,-,- `
This• .permA to replace perriiit
10420 642VMastich
as expired: This is - , °•
also• a model.
change from G.-3 to'
P-3�
`.
Mech. Fee
•15.50
'Plan Check' •Fee 29.12
Const. Fee
.224.00
. Elect. Feel
- 15.63 '
= Plumbing.Fee
26.26 k
Q � - r•`i....jrl
TOTAL
FEE
310.5 t?
J', L�. + ;_ VALUATION .. �Q�
y .:•Ft ' - , aux_ tx BLDG. DEPT,.. ..:
. _ . _ .Y
t. •
M
Ah.
Alk
"NO.
OPERATION ATE
INSPECTOR
NO.
OITKATION I DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
.v-
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
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
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