001146 (SFD)r'F cif / -_ ..,. - S' � .• • . + , , .. :ti ,� • � . , � ,
PERMIT APPLICATION
City,of La Ouinta s s r s ; '
"3 4
Yl r�i r ,� �P f ent' a ts: •? , r;•� y r Department of Building and Safety , ,•€a' . �` yk z .• a1 ". j-, ;` s
ft
This permit becomes void if:work not commenced within 180 days from date of issuance: OR, if work has been suspended or abandoned for a 9eriod of 180 days.
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSCTION INSURANCE: This section need not -be completed if, r f }
LICENSED CONTRACTORS DECLARATION: I, hereby affirm that•I am licensed under provisions of Chapter 9 the permit is for one hundred ($100) o, less. I certify that:in the.performance of the work for which this permit is yn
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force, e.. issued; I shall not employ any person in any manner so as a become subject to the Workers' Compensation Laws of
and effect ,� �� �' j California. f
License Class- Lic. Number ) s % - Date_ - Applicant '
er''/+ a J,1,• �' f,���er• -.., '
•Date ' Contractor. NOTICE TO APPLICANT: If, after making this Certificate o. Exemption, you should become subject to the Workers _6
OWNER -BUILDER DECLARATION:; I hereby affirm that I a h exempt from the Contractor's License Law for the
Compensation provisions of the Labor Code, you must twthwith comply with such -provisions or this permit shall i of
be deemed revoked.
following reason (Sec. 7031.5. Business and Professions Code: Any, city or county which requires a permit to , , i i < ; •� 3
construct, alter, improve, demolisher repair any structure, prior.to its issuance, also requires the applicant for DIVISION OF. INDUSTRIAL SAFETY PERMIT, CERTIFICATION: „ • �,"t
such permit to file a signed statement that he is licensed pursuant to the provisionsoftheContractor's License Law. 01 hereby certify thafno.excavationfive (5)ormore feet iidepth into which aperson isrequired todescend, will be + '
(Chapter 9 (commencing with section 7000) of Division 3 o1 the Business and Professions Code) or that he is exempt .made in connection with work authorized by this permit, end that building Structure, scaffolding, falsework, or �' ";'
the'refiom.and the basis for the alleged exemptio",Any violation of Section 7031:5 by any applicant for a permit 'demolition or dismantling thereof, will be more than thirty-six (36yfeet high. (Chap 3.2, Grp 2, Art 2, Sec341, Title8.
subjects the applicant to a civil penalty of nol.more;than five hundred dollars ($500.): C.A.C.) a y
D. Las owner;ofthe property, or my employees with wages as their sole compensation; will do the work, and the '.:. 0 A owner -builder; I will not etfiploy anyone:to do. w,>rk which would require a.permit from the Division of,.. +.
structure is not intended.or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Industrial. Safety, as, noted above; unless such person h.ls a permit 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,employeesr provided that such improvements are not intended or offered forsale..lf, however, the ❑ Division of Industrial Safety. Permit No. 4
buitIfingoI.iInprovemntissotowiIhinoneyea rofcompletiontheown er•builderwitIhavethe burdenofprovingIhat rDate Applicant S s
r_ J,. e did, not build or improve for the purpose.of, sale.). ,^;. • _
„:.c . • . . , CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance p jJ
' ❑ ..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. 3097', Gv: C.).
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
❑.I am exempt under Sec:
B. 8 P.C. (Attached Certificate), I certify that I have read,this application and state that the above information is.correct.I agree to comply with all x,
Date
x city and county ordinances and state lawsrelating to bui ding construction, and hereby authorize representatives ,
Owner
of this county to enter upon the above-mentioned property for inspection purposes.
WORKERS` COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self•insure, or. a -
certificateof Workers' Compensation Insurance ,.or a certified copy thereo� : 3800. Lab. C.). I Signature of Applicant or Agent "' Date ' *:
Policy. No Company v CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
❑ Certified copy is hereby furnished. i the information given Is_corr'ect. I agree to comply with; 11 state laws and.county ordinances relating to buidhng 7
❑•Certified copy is filed with the Clty Building Inspectio D arlm"e� or Cdy ��~ Department construcilon,.and athonie, a representative,of the City of La Ouinta Department of Building, and Safety to enter, ,
��-�/✓� r�- - .. �_.� / ! > ' upon the proper for•whichthave applied for this.pernit for the purpose of making Ippections...
Date Applicant / / - Lc f r
Signature of Applicant or Agent Date
APPLICANT NAME'(L. F. MI) Anden Cotporatinn '
ADDRESS -"' ' • '
PX. Box 780 .
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253'-
JOB SITE ADDRESS/SPACE 77-144 via F$uerta
CITY/COMMUNITY/STATE/ZIP "La�'`"Qu rita, CA, 92253
BOK .
PAG
PRC
to replace
existing'permit
TWN
PING'
SE'
S
T1A4496- Z
LOT
Fee
13.00
MOD G 1
se
Const.
TRACT NAME Santa• 8osa Cove -
OWNER NAME (L. F. MI) .. ,. ..
CONTRACTOR -FIRM NAME
Applicant'
ADDRESS..•' - -
above
CITY/COMMUNITY/STATE/ZIP
above -
PHONE•564-1h'5
..<
333762
.
ARC/ENG FIRM NAME
ADDRESS '
CITY/COMMUNITY/STATE/ZIP
PHONE . +
LICNC
USE OF PERMIT S • F'o D •
BL
'4
ZON
FSB
SSB;
•. Sse
.RSB.
OFC.'
r „ • ZONE ORD•- "•
LOT SZ •
3�'4 • q rr7 8':.r
..LEND •-
SIDE .
< Print Applicant/Agent Name
APPL/PRMT ,
. i fl ll 4 4
1 G TE2 0/ O S F D
- Pernhit
to'construct 2,758 sq. It. of
S.F.D.
with attached garage. ..This
permit
to replace
existing'permit
which
has expired.- See' # 0423 - 12/83
Mech.
Fee
13.00
Plan Check'
8'2.70
Const.
fee.*'
251.50
E1'ect.
Fee,
21008''
"Piumbing Fee
36.50
•
'4
::TOTAL
• •
FEE..354.'78'
3�'4 • q rr7 8':.r
BLDG: DEPT. .
c��
VALUATION r0— �. •. - '
Ah'
NO.
OPERATION TE INSPECTOR
NO.
DPW. 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
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 7
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 PyI
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final