0424 (SFD)�' : *•%-: .PENMIT APPLICATION
y, 1 '.'City of La Ouinta s- *' t
;. s% J• Department of Building and Safety �,•,
This permit becomes void it work not -commenced within 180 days from date of issuance, OR, if work has been suspended or abandoned for a period of 180 days.
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 the permit is.for.one hundred (SiOO) o, less. I certify th;t 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 anymannersoa: to become subject to the Workers'Compensation Laws of -
and effect. California.
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 section7000) of Division $ of the Business and Professions Code) or that he is exempt
s 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 1, 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 i mprovemnt 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 I.am exempt under Sec. ' - '• 8. 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 thereoV(Sec.•3800. Lab. -C.).
Policy No. Company
0 Certified copy is hereby furnished.
(kc is Tilyed with tjl mit Building Inspection Depa tmen(or C yt Department.,
q APPlicant
APPLICANT NELFAlI'
�.atIcIn
ADORE�• Box 780
WOMLI�Uy,NYI YX/�,S�TAT E/Z- rP� 92253
JOB SIJE ADORESS//SPACE
y .
1"36 Via flaer a
CITY/COMMLZNITY/STATE/ZIP
La Quinta, CA 92253
BOK
PAG
PRC
C
Plan Check Fee
TWN
RNG
SE
S
TRACT
14496r-2
LOT00
18
7.39
Plu :IdM Fee
73,00
SB
'
TRACT NAME
Santa Rasa CIDW P
OWNER NAME (L. F. MI) _
C`ON_ T�RACTOR-FIRM NA_ _ it - -
As me
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE4=1315
$1, 332.49
3 3162
ARC/ENG FIRM NAME ,
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE 0
LICNC N
01 r iD MI dth Attached Qwagie.
BL
ZON
FSB
SSB
SSB
RSB
OFC
ZONE ORD
LOT SZ
END
SIDE
Date Applicant
NOTICE TO APPLICANT: If,after.making this Certificate :)f Exemption, you should become subject to the Workers'
Compensation provisions.of the Labor Code, you must '7rthwith comply with such provisions or this permit shall
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY. PERMIT CERTIFICATION: d
0 I hereby certify that no excavation five (5) or more fee- in depth into which aperson 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 jhereof, will be more than Chir I -six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8,
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 nas a permit to do such work from that division.
0 Division of,lndustrial 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. C.). ? '
Lender's Name'
Lender's Address
I certify that I have read this application and state that me above information is correct. I agree to comply with all .
city and county ordinances and state laws relating to bLilding construction, and hereby authorize representatives.
of this county to enter- upon the above-mentioned proprty 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 buid ling
construction, and•authorize a'representative of the Citi of La Ouinta Department of Building and Safety to enter
upon the property for which I have applied for this pe mit. for the purpose of making inspections.
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPUPRMT 1DATE
-28-83
A
S/F/D
Fle at to crost=t 2,326 Sq. Ft. of S/F/D
with Attached C`z=ge
mica F@e .. $
26.00
Plan Check Fee
291,20
Construction Fee
448.00
Electrical Fee
36.90
SM Flee
7.39
Plu :IdM Fee
73,00
Property Development Fee 450,00
r
For) 1U)
y
6 . TOTAFEEL •
$1, 332.49
BLDG. DEPT.
VALUATION 1 $105,867.60
r-7
A&
NO.
OPERATION ATE
INSPECTOR
NO.
O ATION DATE INSPECTOR'
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
L
14
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.
.❑
NPON
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 oZ
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