0421, 001149 (SFD)_
3 �
PERMIT
-
APPLICATIONMF
•..4 'o{.. � City of La Oumta. - ti ,+, y' Department of Building and Safety
r R ♦
• -This permit becomes void if work not commenced within 180 days'from date of
- 7
issuance. OR, if work'has been suspended or. abandoned fora period of 180 days.
'•:j- : -
-• CERTIFICATE OF EXEMPTION FROM WORKERS' COMPEN.-.41ON 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 ($100) o• less. I certify th it 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 infull force
issued. I shall not employ any person in any.manner so as to become subject to the Workers'Compensation Laws of ; 11
and effect. -
California.
License Class Lic. Number
Date -Applicant
j
Date "•' •" Contractor
NOTICE TO APPLICANT: If, after making this Certificateof.Exemption. you should become,subject.to the Workers', -r rrr
1.OWNER-6UILDER•-DECLARATf6N:-- I hereby affirm that I.am exempt from the Contractors License Law for the
.- Compensation provisions of the Labor Code, you must Forthwith comply with such provisions "or this -permit shall.-
hall-be deemed revoked.
be,•
• following reason (Sec. 7031.5; Business and Professions Code: Any city or county'which'requires a permit to
-- _ . •" a
construct, alter. improve, demolish, or repair any structure, prior to its issuance, also requires the applicant:for
. DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIF.ICAIlJN:
such permit to file a signed statement that heis,licensedpursuant totheprovisions oftheContractor'sLicense Law '.
- 01 hereby certify that no excavatidnfive(5)oimorefee! indepth into which Apersonisrequired todescend, will be ;
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) or that he is exempt .
made in connection with work'authoriied by this permit. and that no building structure, scaffolding,.falsework, or C
therefrom,and-the basis for the alleged exemption: Any.violation of, Section 7031.5 by any.applicant fora.permlt
demolition or dismantling thereof, will be more than thir.y-sik (36)ieet highi (Chap 3.2,:Grp 2, An 2, Sec 341, Title B.
'subjectstthe applicant to a civil penalty of not more than five hundred dollars ($500.): - - -
C:A.C.j _ _ '. '•^'c'i",� J {Sj
•• O Las owner of the property, or,my employees with wages as their sole compensation, will do the work, and the t
C) As owner -builder, Twill not employ anyone to do work which would require a'permit from the Division.of ' x
structure is, not intended or offered for sale (Sec, 7044, Business and Professions Code: The Contractor's License
himself
Industrial Safety,'as noted above, unless such person -ias a permit to do such'work from that division. '
'• ' ' r
Law does not apply to an owner of property who builds, or improves thereon; and who does such work or
' through his own employees, provided'that such improvements are not intended or offered for•sale: If:41owever„ the
-' .
Division, o1.Industrial,Safety Permit No.
building or improvenint is sold within one year of completion, the owner-.builde!_Will have the burden of proving that
Date Applicant - rj
• he did not build.or improve for -the purpose of sale,). ' . • . .f
CONSTRUCTION LENDING AGENCY .I hereby affirm that :here is a construction lending agency for the performance'
Cl- I. as owner of the property, am exculsively contracting with licensed contractorsto construct,the-project (Sec.::
• . of the Work for which this permit is•issued (Sec:!3097, Civ. C.)." ' , ' -
a.
7044, Business and Professions Code: --The Contractor's License Law does not apply to an ownerotproperty who
"
Lender's Name_
builds'or improves thereon, and'who contracts for such* projects with a contractor(s) licensed pursuant to.the'.
w
f
:Contractor's License Law.).'-..
Lender's Address
-0•1 am.exempt under' Sec. : B. & P.C:,(Attached Certificate). ' ,
'..I certify that I have. read this application and state that Atte above information is correct. I agree to comply.with all • "y
Date
roity and county.ordinances and state laws relating to building construction; and hereby authorize representatives 5
lof'this county'to enter upon the above-mentioned property for inspection purposes. '
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate'of consentto self -insure, ora "
certificate of Workers_ Compensation.lnsurance .-or a certified copy thereof (Sec. 3800. Lab: C.):' ^
Signature of Applicant or Agent " • Date
Rolicy No. „ Company _
,1
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OFENTRY. I certify I have read this application and stat0hat r 5
O Certified•copy is hereby. furnished- /�
the information given is correct. I agree to comply witt all state laws and county ordinances relating to buidlmg
'
r ^
19�CertilieE copy is filed with the City Building Inspection!IJepayrt�"ent-or City 1 Department.
•
construction, and authorize a re resentative of the City of La Ouinta De artment of Buildin y
P p g and Safety to'enter,
upon the for which I have applied for this pe omit for the purpose of making inspections.
Date Applicant. / t t.,/
-
property ,
r
Signature of Applicant or Agent Date '•
IY
APPLICANT7Sy�_te NAME (L, F. MI) - -
ciLiA.t� W
ADDRESS` O -- - '
P, D• B= 780
CITY/COMMUNITY/STATE/ZIP
La Quintar'CA 92253'
JOB SITE ADORESS/SPACE '
77-137 Via Hue to
CITY/COMMUNITY/STATE/ZIP • -
la Quinta,'. CA 92253
BON
PAG -
PRC
C.
_TWN
P gxrty Fez 450a�0 y
RNG
SE.,:
S
14496-2
LD15
T TAL ..
$ 1x332..49
m
sB .�
f1^ r.: •c'`�i�
TRACT NNA.�ME'D�.� T • ' = - �
Santa Rosa OWYG
OWNER NAME (L. F. MI)-
Sc-mACT09R-^IRM_NAME .. .. .. ... - - .
6'T ��
ADDRESSIEBSS•.
CITY/COMMUNITY/STATE/ZIP •.
PHONE
564-1315
LICNC
333762
ARC/ENG FIRM NAME n
ADDRESS ..
CITY/COMMUNITY/STATE/ZIP
PHONE
LICNC /
- - -
USE OF PERMIT -
S/F/D with Attached Gamm '
BL
ZON,
FSB
Sse SSB
'RSB
OFC
- - ZONE ORD 0 . -
LOT SZ •�♦
• END
^ SIDE
Print Applicant/Agent Name
APPL/PRMT � ;d [�'DATE
/
. �' � 1■11 f p . .
Pe=t to cimstmc t 2, 326. , Sq.. Ft.:of
S/F/D with Attached Garage
Y26;00
Platt. Mieck Fee 291,20.
Ciciristructian Fee 448400 r
Electzical. Fee 36:90 '
Sit Fee 7,39''
PUnbing Flee 73.00
P gxrty Fez 450a�0 y
R E
9 198
r
�r X101 .;yT#
J
yxi
T TAL ..
$ 1x332..49
'� ♦=�Gw �•� .Jti� .7 �.••`V „�a'��ia�.•�ai'", ft"f', S'�~ e •v�wE44 ! �l'f_•.W Yr.• -al ♦ J. . •ar -.. -• t (..
~ a f f Ufa.. ! r yT'. ;• ti'3 1'34g��r rti 4. '1 .•r .L.. Y�'..'f s �. T . "..", . _ �. I y.
i �•
v g
�r X101 .;yT#
J
yxi
VALUATION
:> 7.�J�iw �•"
=? '. c r1w �� r •.� y 4 :.BLDG'OEPT.4, 'R�
i+c � � ;r� K"a!, r....:
f1^ r.: •c'`�i�
..,rt s -�: sem, .u:� F+
i
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NO.
OPERATION ATE
INSPECTOR
NO.
OP RATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
o7 �g'
35
Furnace Compart.
3
Steel
j
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.
❑
OP'N
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
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 PA
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring -
29A Grounding Wire
29B Bonding
30 Fixtures
31- Service -
32 Final
„yF:
- PERMIT APPLICATION
CITY/COMMUNITY/STATE/ZIP T a Quinta, ' CA 92253
1717-137
• ,City of La Dug a
-Department of Building and Safety
'
BON
• " (�`*t' This -permit becomes void'if work not commenced within .180 days from date of issuance.
OR, it -work has been suspended or'abandoned 'for a period of 180 days. -
+' , . 2- :. `_ >*.`•.
hereby°affirm I licensed
CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION.INSURANCE: Thissectionneed hot becompleted if. +�,LI
thepermit.is for hundred less. I that in the of the for -which this is f.
- LICENSED CONTRACTORS DECLARATION: A that am under provisions of'Chapter.9.
• (commencing with Section 7000) of Division 3 of'the Bus'ness'and'Professions Code, and my license is in lull force ..
one ($100) o. certify performance work permit -f71
issued, 1 shall not employ any person in any manner so a; to become subject to the Workers'Compensation Laws of
and effect -
California. r
License Class - um� r ' '> 10 Y
_ - / i.�' 4. Iii. ,
Date Applicant
✓ '
Date-•=• Contractor +
NOTICE TO APPLICANT: If, after making this Certificate A Exemption, you should:become subject -to the Workers Ji„
` • � i d ..
OWNER -BUILDER DECLARATION: I hereby affirm that I: am exempt from the Contractor's License for the
-and
Compensation_ provisions of the Labor Code, you.must brthwith comply with Itch provisions or this permit shall fir;
be deemed revoked. '
'
following reason. (Sec: 7031.5, Business Professions' Code: Any•city or county which requires a permit.to
TRACT NAME ISanC.a Rosa Cove
t
'• construct, alter, improve, demolish; or repair any structure, prior to its issuance, -also requires the applicant for
DIVISION OF INDUSTRIAL.SAFETY PERMIT CERTIFICATI )N.
such,p6rmit to file a.signed statement that he is licensed pursuant to the,provisions of the Contractor's License Law
01 hereby certify thatdoexcavati0nfive(5)ormore fees indepthintowhichapersoItisrequiredtodescend, wiIIbe
:(Chapter -9 (commenciIt0 with section 7000) of Division 3 of the,Business and Professions Code) or that he is exempt.
made in connection with work authorized by thisand that no building structure, scaffolding, falsework, or '
' •therefrom,and the basis for the alleged exemption.• Any violation of Section,7031.5 by any applicant for a permit' ..'
,permit
demolition or dismantling thereof will be more than thiry-six (36) feeChigh' (Chap 32, Grp 2, Art 2, Sec341, Titleil, ��.a.3
• subjects'the applicant.to.a civil penalty of not more than five hundred dollars ($500):
ADDRESS ,
- '0 1: as owner of the property..or my employees with,wages asdheir sole compensation, will -do the work,•and the • -
`:0 'As owner. builder, I will not employ anyone to do vork which would require a permit from the Division of 1 • °,
•
• -structure is' notintended or offered for sale (Sec. 7044,' Business and Professions,Code:.The Contractor's License'
.
'Ind ustriaVSafety. as noted'above; unless such person.bas 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
USE OF PERMIT - S . "F. D . ,
through his own employees, provided thatsuch improvements are not intended or offered for sale. If, however, the '
0 Division of Industrial Safety Permit. No„
building orimprovemntissold within one year ofcompletion, theowner-builder will have the burden of proving that .
Date 'Applicant
he did not build or improve for the ur ose of:sale.). ; k;^;.
p D p
CONSTRUCTION LENDING AGENCY: I hereby affirm that here is a construction lending agency for the'performance
0 I, as owner of the property; am exculsivel .contractin with licensed,contractors to construct the project (Sec:
Y Y 9 I
' of the work for which this permif.iS issued (Sec; 3097. ;iv. 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
ZONE ORDr •-
Contractor's License Law.).
Lender's Address
D' I am exempt under Sec: ' B. & P.C. (Attached. Certificate),
•I certify that I have readdhis:application and state that tae above information is correct. I agree to comply with all
Date Owner `•I
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
-
of this county to enter upon the above-mentioned propertyfor inspection purposes.' '
WORKERS' COMPENSATION DECLARATION:' I hereby affirm that I have a certificate of consent to self -insure, ora
3.
certificate of Workers'.Compensation Iniiurance ; ora•certified -copy thereof (Sec. 3800. Lab. C.). ',+
• Signature of Applicant or Agent Date ..
• Policy No Company:CERTIFICATE
❑ Certified.copyis hereby furnished:
��
r
OFCOMPLIANCEANDAUTHORIZATIONOF":NTRY:Icertify lhaveread this application andstate that
'the,information giveArs correct. I agree'to comply with all state laws and county ordinances relating to buidling t.
O Certified copy ed with the City Building load tion Oepartment'or Cdy Department.. `-.
�
construction a d �u�,ict& a representative of the Citx of La Ouinta Department of Building +.
2,. P ,f P g and Safety enter
forwhich-I-have for for
fir_, �) ,GI . � i >• .�
Applicant
upon the prope)y applied this peroil the purpose. of.making,inspections.
`/�
•Rate '
: _ G ✓ .'
..
Signature of Applicant or Agent 'Date
+
Print Applicant/Agent Name
APPLICANT NAME (L. F: MI) Anders Corp.
ADDRESS P. O• BOX 7 U O
CITY/COMMUNITY/STATE/ZIP T a Quinta, ' CA 92253
1717-137
JOB SITE ADDRESS/SPACE'
Via .*Huetta -
CITY/COMMUNITY/STATE/ZIP Ta Qu intdl CA 92253'. '
BON
PAG
PRC
C�
#. � 0421
TWIN ••
.RNG
SE
S,
Tr-:
LOT
151
Mech.'
'V 3
so.
Const.
TRACT NAME ISanC.a Rosa Cove
t
OWNER NAME (L. F. Mn -
CONTRACTOR -FIRM NAME A'pp7 ,iC ani•
{•
ADDRESS .above .
CITY/COMMUNITY/STATE/ZIP • above -
564--131'5 =,"f9�J
PHONE •,
"�333
3 3 7 6
2 • -
ARC/ENG FIRM NAME
t �
ADDRESS ,
CITY/COMMUNITY/STATE/ZIP r "! •
PHONE II
'LICNC . -
. •"
USE OF PERMIT - S . "F. D . ,
BL
+ is •
ZON
a
"•FSB
.SSB
SSB
.RSB
`:;
OFC,;,
ZONE ORDr •-
1
.' LOT SZ
END
SIDEt '
. APPWRMT
i2A-E2O
Pert$it•
ti cnnstruct ' w sq. ft. of
..S.F.D.'
with attacked garage.
This peiniit.. t, reFlace permit .
#. � 0421
• which• -as ' expired:'. • This is -
also• a
model chance from 'Q-3 to
Mech.'
Fee 15.50.
Plan , Check . Fee -29.12` r" '
Const.
24.00`•.
Fee 224400-
-Elect.,
- Elect.
• Fee.' •15.63'
plumbing Fee 26.25
.. -
•v . 7. O
ftEc
.
'
t TOTAL
� FEE
•
3$0 50,
± , .►>: ~ TA
j 1
- tib o"`•,.y * �� * fi s"�,r.;,'!.� T'i3 ��#-• `,�.' 1
O :Z. w+1�
''wjj` i i �a +Y�' �'
• a
VALUATION
,
•, : -_r
+ is •
P. ` y i'i rr.,'f`' r ,
•.+ .. ft. ys . ;�
,1�+BLDG.DEPT 'S'' rr
a
....� •. , o.
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NO.
OPERATION DATE
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
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. ❑
OP'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
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