0425 (SFD)PERMIT APPLICATION t
City of La Ouinta fir
i • Department of Building and Safety • y'
This permit becomes void If work not commenced within 180 days from date of
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed'under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code;'and my license is in full force
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 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 section 7000) of Division 3of 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 not more than five hundred dollars ($500.):
❑ I. as owner 91 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, Y
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-improvemnt 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.).
❑ 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 projectswith a contractor(s) licensed pursuant to the
Contractor's License -Law.).
❑ 1 am exempt under Sec. '.,B. 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 thereof (Sec. 3800..Lab. C.).
Policy No. Company
❑ Certified copy is hereby furnished. �q
❑uCertified Tpy is filed with th}e Citty Building Inspection'Department or Cityj>' i)• - Department.
/ e /i / APPlicant % 1 V �y --
.Date
APPLICANT NAME (L. F. MI)
CPL�IC=Moraoca}m
ADDRESS
P. O. Boat 780
CITY/COMMUNITY/STATE/ZIP
la Quinta, CA 92253
JOB SITE AODRESS/SPACE -
77-•128 Via iaerta
CITY/COMMUNITY/STATE/ZIP -
La Quinta. CA 92253
BOK PAG
PRC.
C
26.00
TWN
RNG
SE
S
TRACT -
14496.2
LOT
19
SU Fee
7,39
MOD
c ��
SB
Property Development Fie
TRACT NAME /d
Santa RDsa Clave
OWNER NAME (L. F. MI)
CONTRACTOR -FIRM NAME
Surae As Above
ADDRESS -
CITY/COMMUNITY/STATE/ZIP -
PHONE •
564-1315
LICNC /
333762
A It in,
tax U
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP '
PHONE M
LICNC •
= j
UgS,Ori PI) l dth At� C�a.
! '
SL
ZON
FSO
SSB
SSB '
RSB
OFC
ZONE ORD • '.
LOT SZ
END
SIDE
ssuance, OR. If work has been suspended or abandoned to a period of 180 days
CERTIFICATE OF EXEMPTION FROM WORKERS: COMPENSATION INSURANCE: This section need not be completed if
the permit is for one hundred. ($100) o, less. I certify t0at in the.performance of the work for which this permit is
issued, I shall not employ any person in any manner so -Is to become subject to the Workers' Compensation Laws of
California.
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you.should become subject to the Workers'
Compensation provisions of the Labor Code, you mustforthwith comply with such provisions or -this, permit shall
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 hereby certify that no excavation five (5) or more feet i6 depth into Which a person is required to descend, will be
made in connection with work authorized by this permi:,'and that no building structure, scaffolding, falsework, or
demolition or dismantling thereof, will be more than thi ty-six (36) feet high: -(Chap 3.2, Grp 2, Art 2, Sec 341, Title 8,
C.A:C.) '
❑ As owner -builder, -'l will not employ anyone to do work'which would require a permit from the Division of
Industrial Safety; as noted above, unless such person has a permit to do such work from that division.
❑ Division of 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 permit is issued (Sec. 309T Civ. C.).
Lender's Name
Lender's Address
certify that I have read this application and state that -:he above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to ehter upon the above-mentioned pro rerty for inspection purposes.
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read thisapplicatiodand state that .
the information given is correct. I agree to comply will all state laws and county ordinances relating to buidling
construction, and authorize a'representative of the Ci'y of La Ouinta Department of Building and Safety to enter,
upon the property for which I have applied for this permit for the purpose of making inspections.
Signature of Applicant or Agent
Print Applicant/Agent Name
Date
t 2DATE
APPL/PRMTn 4 -/ S 12-28-83
n 28 83
G/ F. D . .
Permit to cionstruct 2,326 Sq. Ft. of S/F/D
with Attached Garage
teGh3nical Fee. $
26.00
Plan Check Fee
2911.20
Construction Fee
448.00
Electrical Fee
36.90
SU Fee
7,39
Plumbing Fee
73,00
Property Development Fie
450.00
UEC
City CEJ U IQi In'. a
A It in,
tax U
TFEE`
$ 1,332.49
BLDG. DEPT. VALUATION $105,u67.5G
JNO.
OPERATION MATE �5.,'' o?+ '"fNSRECTOR>'tia
!
iVO: N ' `++ t `,�`: OP .,ATION DATE INSPECTOR
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
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.
❑
NO.
NO.
—ADDITIONAL INFORMATION
s -
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)
12CT Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer R6 T
21 Water-Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
r'.r
P/L P/I
STREET NAME
26 Power Pole
27 Conduit '
28 Service Entrance
29 Wiring �>
29A Grounding Wire
29B Bonding i
30 Fixtures
31 Service
32 Final.