001151 (SFD)A +� x • ''
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rpc + a PERMIT APPLICATION
City of
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La Duinta
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r• „ t This permit becomes void it work not commenced within 180 days from date of
issuance, OR, if work has been suspended oc abandoned'for. a'period of 180 days..,
.! • ' ' l n .' , ry r '' " "}: CERTIFICATE OF EXEMPTION FROM WORKERS'LOMPEP13A710N INSURANCE:.This section need not be completed it
LICENSED'CONTRACTORS DECLARATION: I .hereby, affirm that I am licensed under provisionsrol Chapter 9
.the permit.is.for one.hundred ($100) o,less. I'certify ft -at in the performance of the work for which this.permd is , w
(commencing with Section 7000),of Division 3 of the Business and Professions -Codi, -in; my license is in full force
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issued, I shall not employ any person in any manner so: sto become subject to the Workers'Compensation Laws of,
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and effect.' - • _ ,i%
California. • , ,a�+A,
• License Class Lic. Number (J -f / �'
�✓ ' J 1 f,.l ^'h•'�'
Date' Contractor, - •.
Date Applicant
=NOTICE TO APPLICANT: IL atter making this Certilicateof Exemption, you should become subject to the Workers'
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OWNER -BUILDER DECLARATION:' I hereby-alfirm-that I am exempt from the Contractor's' license Law'.fbr the
Compensation provisions of the Labor Code, you must:iorthwith comply with such•provisions.or this permit shall
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' following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to
be deemed revoked..,
' construct, alter, iinprove,'demolish, or repair any structure, prior to its issuance, also requires the applicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATi ON:
'such per initto, fileasignedstateinentIhat IteisIicensedpursuanttothe provision softhe Cont ractoI!sLicense Law
Olhereby certify thainoexcavationfive (5)ormorefeetindepthintawhichapersonisrequiredYooescend,willbe��
(Chapter9 (commencing with section 7000) of Division 3 of the Business and Professions Code) or that he is exempt
made in connection with work'authoiized.bythis permi' , andlhat no building structure, scaffolding, lalsework, or .i•
' therefrom and the basis.fotthe alleged exemption. Any violation of Section.7031.5.by any applicant for a permit
demolition or dismantling thereof, will be more than thi ity=six:(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 ($500.)., H';+. S'
C.A.C.)
�'. 0 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 will not employ -anyone to do .work which would require a permit from the Division of �
structure is not intended or -offered for -sate (Sec: 7044, Business and Professions Code: The Contractor's License
Industrial Safety, as noted above; unless such personlhas 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 ,
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through his own employees, provided that such improvementswe not intended or offered for sale. If, however, the'-
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0. Division of Industrial SatetX Permit No. _ .w
building or improventrit is sold within one year of completion, the owner -builder will have the burden of proving that
Dale Applicant-` ,�„,
he did not build or improve for the purpose of sale.):s.
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' 0 -of the licensed to construct the
CONSTRUCTION LENDING AGENCY "I hereby affirm thadthere is a construction lending agency for the performance :4 ^ "•:
Lias owner property�am exculsively contracting with contractors project (Sec:
of the work torwhich this permit is issued (Sec. 3097- Civ. C.).
7044, Business and Professions Code:. The Contractor's License Law does not apply to an owner of property who
J Lender's Name
builds or improves thereon, and who contracts for suchprojects with acontractor(s) licensed pursuant .to the
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Contractor's License Law.). v •
Lender's Address
END
0 1 am exempt under Sec.' B. & P.C..(Attached Certificate).
I certify that I have read this application'and state that :he above information is correct. I agree to comply with ally .. .
' Date tl' Owner
city and county ordinances and state laws relating to b eilding construction, and hereby authorize representatives
of this county to enter upon the above-mentioned pro�.erty for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, ora
certiticate'oVWorkers' Compensation Insurance', or a certified copy thereof (Sec.3800'Lab. C.).' -
Signature of Applicant or Agents - Date t { 1
Policy No. Company _
CERTIFICATEOFCOMPLIANCEAND AUTHORIZATION OF.ENTRY:Icertifylhavereadthis application and state that :y
' Certified is. hereby furnished..
.0 copy ,-
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0 Cerlilied copy is filedwith•the City Building Inspection Depart City Department
the information given•is co7fect. I agree to comply with•all state laws and county ordinances relating to buidlmg .•,”
construction, na authorize a representative.of the City of La Ouinta.Department of Building and Safety to enter . •"
ent,or n .
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`upon,tl�e pro, rty or which-I•have applied for this pe mit for the purpose of making.inspec loner
Date APPiicant
l°G' d.�-Y,�:
j Signatureof Applicant or Agent Date ,
Print Applicant/Agent Name + ?
APPLICANT NAME (L: F, MI) Anden Corp • '
'ADDRESS' - P.O.. DOx 780' r .• .
CITY/COMMUNITY/STATE2IP La Quinta, CA 92253
JOB SITE ADDRESS/SPACE 77-3.36 Via ' Huerta '
CITY/COMMUNITY/STATE/ZIP La ,Quinta, CA 92253 '
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TRACT NAME
Santa=Rosa Cove,
OWNER NAME (L. F. MI) •-
CONTRACTOR -FIRM NAME -..
Applicant
ADDRESS '
above
CITY/COMMUNITY/STATE/ZIP. , ..
above
PHONE • 564-1315
LICK 33762
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ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP •. -
PHONE •
LICNC r
USE OF PERMIT ^ • F •'T' '
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SSB
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' ZONE ORD a'
- LOT SZ
END
SIDE
APPL/PRMT
—20-8L..
Perm` it to construct 2,326 sq. ft.
of 'S.F.D: ' with attached garage.
This,. peXTit',,to replace existing
permit- # 0424 whit -h has ikpired
and this is also ,a model change
from G -3 --to P=3
Mech. Fee' 15.50
Plan Cheeh Fee' 29.12
Const. Fee 224.'00
Elect. Fee 15.63 4
Plumbing Fee 26.25
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+
TOTAL""', -1
FEE '
.VALUATION —0—. '
BLDG. DEPT. `
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NO.
OPERATION I ATE
INSPECTOR
NO.
OPRATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
5
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)
126 Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb 8S
16 Water Piping
17 Rough Plumb
18 "Vents
19 Sewage Disposal
20 Sewer Z2d A _
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