0518 (SATT)PPL CIN,T NA,MjE(C
"°; ;�N. Ttastan Averrize,' Suite 231-
G, G. LAM Z 92705
Jos SIT CAo6Rusisp'U Nrar a -• ✓'. -' ,
K ' PERMIT APPLICATION t
BOK'.
City of La Ouinta 1
PRC,
Department of Building
aid Safety
Plan Check Fee
FIND
SE '
f a .. 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 period of 180 days.'. - -
L02
r.,
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed it., •.!;
'• .'LICENSED
CONTRACTORS• DECLARATION: d .hereby 7affirm that l'.am licensed :under provisions of'Chapter,.9' , - :; '.
.;.the permit is for.one•hundred ($100),o, less. I certify that in the performance of the workfor which this permit is
f (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force, '. s
issued; I,shall not employ any person in any manner soasto become subject to the Workers'Compensation Laws of.'
Land effect.
_ _
California.,
1 LicenYse
Class ' Lic. Number '' "
Date Applicant
f•{ Date A
Contractor -' r-
NOTICE TO 4PPLICANT:4f, after making this Certificate of Exemption, you should become subject to the Workers'e
OWNER
-BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the
'Compensation provisions of the Labor Cade, you must forthwith comply with such provisions or this permit shall r
I following
reason (Sec. 7031.5.' Business and Professions Code:,Any city or county which requires a permit to .•.'
be deemed revoked.', ;
i construct, alter, improve. demolish. or repair any structure, prior to its issuance, also.requires the applicant for, '';.... •.
. DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
such permit -to file a signed statement that.he is licensed pursuant to the provisions of the Contractor's License.Law.'.01herebycertifythatnoexcavationfive(5)ormorefeelindepthintowhichapersonisrequiredtodescend,willbe
FSB-
• . (Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code)or-that he is exempt •.
'made in connection with work authorized by this permit, anddhat no building structure; scaffolding, falsework, or
.therefrom and the basis for, the alleged exemption.-Apy violation of Section 7031.5 by any applicant fora permit
..demofition'oidismantling thereof, will be more than thirty -'six (36) -feet high, (Chap 3.2, Grp 2, Art 2, Sec341, Title8,
subjects the applicant to a civil penalty. ol notmore than five hundred dollars'($SOOJ:..
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 'r•, :.
- 0 As owner -builder; I wilh not employ -anyone to do work which ,would require a -permit from the Division
• 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 has a permit to do such work from that division. ,
Law,does not apply to an owner of property who builds, or improves thereon, add who does such work himself or.
•71
-
O Djvisipn Industrial Safety Permit No.
' through his own employees, provided that such improvementsare not intended or offered for sale. If, however; the
of
building orimprovemntissold within one year ofcompletion the owner -builder will have the burden of proving that
:.Date Applicant' .-
he did not build or improve for the purpose of sale.)._ ,
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is'a construction lending agency for the performance
, a 0 ,'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, Civ. C.).'•
• 70441 Business and Professions Code: The Contractors License Law does not apply to an owner of property who
builds or improves thereon, and. who contracts for such projects with a'contraclor(s) licensed pursuant to the. ' =
_ Lender's Name '
Contractor's License law.).
Lender's Address
•0 dam exempt under Sec. B. 8 P.C:•(Attached Certificate).
I certify.that.l have read this application and state that the above information is correct. I agree.to comply with all
Dater Owner -' —
city.and county ordinances and state laws relating to building:construction; and hereby authorize representatives,
of this county to enter upon the above'mentioned property for inspection purposes. .•
WORKERS` COMPENSATION DECLARATION: I hereby affirm that have a certificate of consent to self -insure, ora .
' r certificate of Workers' Compensation Insurance ; or. a certified copy,thereoi (Sec.3800.'Lab. C.).
i . .
Signature of Applicant or Agent Date'
Policy No. Company.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY; I certify l have read this application and state that
% 0 C`rtified.copy is hereby furnished... ; i : •- •-
the information given is correct: I agree to comply with all state laws and county ordinances relating to buidling . �.
0 Certified copy is filed 'with the City Building Inspection_Departn eht or City Department
construction, and authorize a' representative of the City of. La Ouinta Department of Building and Safety to enter
pr e.,, . J•.•
upon'the propeiiy for.which.l have applied for this permit for the purpose of making inspections.
Date
Applicant ,
Signature of Applicant'or Agent , Date,
Print Applicant/Agent Name
PPL CIN,T NA,MjE(C
"°; ;�N. Ttastan Averrize,' Suite 231-
G, G. LAM Z 92705
Jos SIT CAo6Rusisp'U Nrar a -• ✓'. -' ,
CI Ct u�N'•1{T�Y//+rST�A;E/ZI }1 92253 _ ..
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PAG
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Plan Check Fee
FIND
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+, S
TiAa�40-3 `
L02
SMI Free
,(M'°�cD
V
So.
ProperLv Devaopmfent Fee
n'A uiia De - La . Paz, Ltd,
OWEELR&VMW F.MI___ly=y�. .. . .
CONTRACTOR -FIRM NAME ,. , • ... ,_ . -
ADDRESS .. _ •Y
CITY/COMMUNITY/STATE/ZIP - -
ri 5EA j `55$ 3766
LI�N� .
TOTS
• FEE
ARC/ENG FIRM NAME ... w
ADDRESS -
CITY/COMMUNITY/STATE/ZIP
PHONE M. - •
LICNC r
SAU \
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.. ZONE ORD
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;END'
-.' SIDE '
APPUPRMT ,. -1-8 Er$4, ✓ � .' J,,
,.
Pennit to construct .1,,704
Sq. Ft,-, Of S/F/D
and -400 Sq. •Ft. of Garacre as per -approved,
plans
15,00 .,
Plan Check Fee
—Paid
d
cmxstrtactian F'ee
415.00
''Fee
-30.
SMI Free
FlimbiFie
ng
56,00
ProperLv Devaopmfent Fee
r •450,00-' .
r
. - : •
♦ City
V .
vi• Lz W. ♦L4� • ,
TOTS
• FEE
$' "980 a 9Z
♦BLDG. DEPT.
VALUATIONIs 94,670.40...
9
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NO.
OPERATION DATE
INSPECTOR %
NO.
OPE 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
9E:
Garage Fire Wall
42
Commercial Hood
10
Fireplace P.L.
❑
43
Final
10A
Fireplace T.O.❑
NO: OP'N
ADDITIONAL INFORMATION
,
SEWAGE SYSTEM SIZE & LOCATION
kc
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick al 7
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final C-/ —ITT-
$gPLUMBING
PLUMBINGAPPROVALS-
PPROVALS•-15
15Ground Plumb
16 Water Piping
17 Rough Plumb \
18 Vents IL_
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
P/L P/I
r -
STREET NAME
26 Power Pole,
27 Conduit
28 Service Entrance"
29 Wiring
29A Grounding Wire.
... e
29B Bonding
30 Fixtures
31 Service
32 Final Cj - 4 5 -S3`