001147 (SFD)MI) APPL/PRMT 0� TEyO
nd6�4 F
An' Corp .
ADDRESS P.O. BOX 780' ••
PERMIT APPLICATION '' .9
City of La Ouinta
�`-.�` f• . Department of Building and Safety
. `►. wr
BOK
. PAG `
PRC
This permit becomes void if work not commenced within 180 days from date
of issuance, OR, if work has been suspended or'abandoned for. period of 180 days." '
TNN
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENS.TION INSURANCE: -This section need not be completed if p
' LICENSED CONTRACTORS DECL'ARATION:' I hereby: affirm .that I am licensed.under provisions 'of Chapter 9"
the permit is for one'hundred ($100) o, less. I certify tha. in the performance of the work for which this permit is
(commencing with Section -7000) of Division 3 of the Business and Profe sion's in y license is in full force
sued. I shall not employ any person in any mannersoa=_to become subject to the•Workers'Compensation Laws of ;
and effect. - _` nd
California. .;
.a
License Class Lic. Numbeo- ? �;
/ �• t `� r�l'r3 r °
Date ' %' ' Applicant ;;
Date' � Contractor —�^� ..
NOTICE TO APPLICANT: If; after making this Certificate . I Exem tion, you should become subject to the Workers
g p y I j.e
OWNER -BUILDER(DECLARATION:+I hereby affirm that I am exempt from the Contractor's License Law fo'r the
x Compensation provisions of the Labor Code, you must I irthwith comply with such provisions or this permit shall -
be deemed rivoked. ' z
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
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATIHN " Z
" such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law'
,. b -1 here6yceriify that no 6kcavalionfive (5) or more feetih depth into w"hich' a -person is required to descend, will'be i
(Chapter 9(commencing with section 7000) of Division 3 of the Business and Professions Code) orthat he is exempt'
made imconnection with'work authorized by this permit and thatno building structure; scaffolding, falsework, or
'therefrom. and, the basis for the alleged exemption. Any violation of Section 7031:5 by any applicant for a perm t ,
,
demolition or dismantling thereof, will be moire than thirty-six (36) feet high. (Chap 3.2; Grp 2, Art 2, Sec341, Title8,
subjects•the applicant to a civil penalty of not more than five hundred dollars ($500:): : "; 7,.,.
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 wouldrequire' a permit from the Division Of -N,
structure is not intended oroffered for.sale (Sec. 7044, Business and Professions Code:,The Contractor's License , :.
Industrial ety, as noted above, unless such person rasa 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
.Saf
. . • .. ' .
through his awn employees, provided that such improvements, are not intended or offered for sale.1f, however, the
0 Division of -Industrial Safety Permit No.
building or improventrit is sold within one year of completion, the owner -builder will have the burden of proving that
Date' r .Applicant
he did not build or improve for the purpose of sale:).: ,a ; •
CONSTRUCTION'LENDING AGENCY: I herebyaffirm that (here is a construction lending agencyfor Iheperformance
0 1, as owner of the property, am exculsively contracting Nith'liceAsed contractors to construct.the project (Sec. • -'
of the work'for which 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 -^
L.ender'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
0 I am exempt. under Sec. • B. 8 P.C. (Atiached,Certificate).
I certify that I have read this application and state that the above information is correct. I agree to comply with all ;Z
' 1
Date - �' �' "Dwnlir'
:r city and county ordinances and state laws relating to b6lding construction, and hereby authorize representatives - `
•
- WORKERS' COMPENSATION DECLARATION::I hereby atfir'm that I have a certificate of consent to self -insure, ora
of this county to enter upon the above-mentioned prolerty for inspection -purposes. „
a,
}
" certificate of Workers'%.Compensation Insurance.,'or a' certified copyAhereof:(Sec. 3800. Lab. C.)'"
Signature of Applicant or Agent Date
.Policy No - - Company' �•�
:O Certified copy is.hereby furnished.
-
e that'
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read thisapplicatidnand stat '
the information givgn is.correct l agree to comply will all state laws and county. ordinances relating to buidling • ay
�/y�-
O '" Department::
J.' construction, and authorize a representative of the Ci,yof La Ouinta Department of Building and Safety to enter
Certified,cop ed the City Building Inspectlon.Deepartme'li t•'or City
• •��/ _ / [/� •/. v/g
Applicant.
,
upon the pro 1410 which•I•have applied for.thispermit for the purpose of making inspections. + • •y
Date
4
Signature of'Applicant or Agent Date > .'
r . •
Print Applicant/Agent Name } • +�
i 4
t
APPLICANT NAME L. F.
nr
MI) APPL/PRMT 0� TEyO
nd6�4 F
An' Corp .
ADDRESS P.O. BOX 780' ••
CITY/COMMUNITY/STATE/ZIP' La Quint&, CA• 92.253
JOB SITE ADDRESS/SPACE -
•77-147 Via'Huerta
CITY/COMMUNITY/STATE/ZIP LA Quint&, CA 92253
BOK
. PAG `
PRC
C
..
TNN
RNG r
SE -'
, S ..
T14T496--
LOT
16
Elect. Fee
G 1
SB
'
TRACT NAME " Santa Rosa Cove
OWNER NAME (L. F, MI), '
CONTRACTOR -FIRM NAME •• Appla.cant�
ADDRESS -
above
CITY/COMMUNITY/STATE/ZIP
above
PNDNE'54
61315+'
`I°1 762
.3
ARC/ENG FIRM NAME -
ADDRESS _
CITY/COMMUNITY/STATE/ZIP
PNONE'1
LICNC , •
-
USE OF PERMIT _
S.F.D:
BL
- ZON
FSB
SSB
SSB
RSB
OFC '
ZONE ORD M.
, LOT, SZ
END
SIDE
9
�--4• ►7 ..L.:•
Permit to construct,2,758 sq. ft.' of
s . f . d. withattached gara4e . ' , ,
This •perinit to replace existing-
ap rmit' y� ith has
(expired: 0922 '.
dated 12-28-83
Mech. Fee
13:00',"
Plan Check Fee .'
32.70 -
•Const.- Fee
251:504
Elect. Fee
21.08 -
Plumbing Fee
36.50
NP
..
>
' TOTAL...�.,.
FEE,,
r'=.%
• 354'..78,
.41
Y4 A-
.+(t'�;+',�.-.nQ'..yn �'� "`�•.. X n ' .,►� Gi•+a ..4 r.`1r.. fe %-�c •` `• l
as•: tai r�^ #�` { ww.%i, j'""3' 'kid.3yd• aJ+�?,*`7
�• try k xr" 1Y�' t IF + i �' VAL'UATION
':>��"�"3'�`,::I »r BLDG. DEPT: ''t`�i:
NO.
OPERATION ATE
INSPECTOR
NO.
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
3
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
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 S
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