0521 (SATT)AP ANF
,.,.
AJ
* I�CT NAME,( -g=
ADD N.
.1E
TN. 'TW; Mieriud Suitmf, 231
CITX1COMMUN2STATF/ZIPj%'
owl %,92205
5 08� AOORESS/SPACIE JJCpal
-PERMIT APPLICATION
BOK'**'
City of La Quinta
Department of Building and Safety
PRC
r
.
1.10,04
This permit becomes void it work not commenced within 180 days from daCe'of issuance.
OR, if:work has been suspended or abandoned fora piriod of 180 da;s.
S
44..
--CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE: This section need not be 6ompletbd it.
LICENSED
CONTRACTORS OECLARATION:'l hereby affirm'that I am licensed under provisions of -Chapter -g-
the permit is for.one hundred ($100) o, less. I certify that in the performance of the work for which this permit is
(commencing
with Section 7000) of Division 301 the Business and Professions Code, and my license is in full force ' ,
issued: I shall not employ any person in any manner so as to become subjectto the Workers'Compensation Laws of
and effect. •
California.
Class Lic. N umber
Date Applicant
Contractor
NOTICE TO APPLICANT:- If, 'after making this Certificate'of Exemption,you,should become subject to the.Workers"
• OWNER -BUILDER DECLARATION: I hereby affirm that I am*e'xempt*from the. 6ointrarclor's, License Law.for the
Compensation provisions of the Labor Code; you must forthwith comply with such provisions or this permit shall
be deemed revoked. AT
'
following reason.(Sec. 7031.5. Business and Professions Code Any city or county which. requ ires*a permit to
ADDRESS,
construct, cf. alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:'.,
suckpermit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's. License Law
0 1 herebycertify that'rI6 exiaLation fiJe (5) or more feet in depth into which a person is required to deicend, will be
(Chapter g(com mencing with s - ection 7000) of Division Sof the Business and Professions Code)or!hat he is exempt
'made in connection with .work authorized by this permit, and that ho buildihg structure, scaffolding; falsework, or
therefrom and the basis tot theAleged exemption. Any viol.ation.of Section 7031.5 by any applicant for a permit-
demolition ordiimantling thereof, will be more than thirty-six (36) feM Nigh. (Chap 3.2. Grp Z Art 27Sec 341, Titlefl,
subjects the applicant to a civil penalty of not.more than five hundred dollars ($500.):
C.A.C.)'
01. as owner of the property, or my employees withyages as their sole compensation, will.do,,Ihe work, and the
-0 As owner -builder,- I will not .employ anyone to do work 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.
Ind6strial 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, and who does such work himself or
a.
through his own employees, provided that such improvements are not intehtledoi-fifered for sale. If, however, the
O.Div.ision ofAndustrial.Safety, Permit No.
building,or improvemnt is sold within, one year of completion, the owner. -builder wil I have the burden of prov ing 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 p;rformance .
0 1, as owner of the property, am exculsively contracting with licensed,contractors to construct the project (Sec.N
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
d I -s' Nam
Len Lender's
builds or improves thereon, and who contracts for such projects with: a contractor(s) licensed pursuant to the
• Contractor's License Law.)..
Aender's Address
.0, [am exempt under. Sec. r8. & 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
- Owner
- city and'county ordinances and state laws relating to building construction, and hereby authorize representatives
of this'county to enter Upon the above4entioned property for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm.that'l have a certificate of,consent to'self-insure, or a•
cert ilicate*of Workers'. Cbmitensation Insurance, or a certified copy. thereof. (Sec., 3800. Lab` C�)�
V . I I I
.. .-Signatureof Applicant or Agent -Date
Policy No. CoTpany
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:' I certily'l have read thisapplicalion and state that
0 Certified -copy is hereby furnished.,,
the information given is.correct. I agree to comply with allstate laws and'county ordinances relating to buidling
b IJ11rIifiedIc;*py is filed With the City Building Inspecl[ion.DepCa:et:i:n:enit:,or.City�' �.�Department...,
dap
construction, and authorize a 'representative of the City of La Ouinta Department of, Building and Safety to enter
upon the property for -which 'i have applied for thispermit for-the'purpbse of making inspections.**
u
Datel el
Applicant
Signature of Applicant or Agent Date
Print Applicant/Agent Name
AP ANF
,.,.
AJ
* I�CT NAME,( -g=
ADD N.
.1E
TN. 'TW; Mieriud Suitmf, 231
CITX1COMMUN2STATF/ZIPj%'
owl %,92205
5 08� AOORESS/SPACIE JJCpal
CITY1CQ=MM1,/STATE/ZIP .7
QuZA 92253
BOK'**'
PAG
PRC
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.
1.10,04
FIND
SE
S
T1!SCP- -3
U0
LOT7,
II Fee
SEI
TRACT.NAmEA De'l
-a Paz,'Ltd,
OWNER &ME& F.&UM'
CONTRACTOR -FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE
66
L!CNC
TOTAL •
ARC/ENG FIRM NAME
i
ADDRESS,
CITY/COMMUNITY/STATE/ZIP
PHONE 6 •
LICNC 0
U 6
SEniU.M) .
27RMIT(CCjndad
ZON
'FSB
sse
SSB'RSB
I
OFC
ZONE ORD 0
LOT �SZEND
-SIDE,
7
W-84
APPUPRMT1-2A nS
'J -
Cmdo
Permit to construct 1,973 Sq.
Ft, of S/F/D
with 400 Sq. Ft. of Garage pet
Fee
"00
Plan Check Fee-
-Paid,."
ClonstructUm Fee-
455,50 .
Flectri,cal Fee,35;66
II Fee
Pluftibing FeLi
property makrdlogi t -Fee
.450.i0T`.
RECEIVED
City ;J ZIA i irM.
TOTAL •
11$10022
BLDG. DEPT.
• VALUATION 819,A0
L,
NO.
OPERATION ATE
INSPECTOR
NO.
- OP rtATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
/ — -yu
` �,
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.
❑
OWN
NO.
•ADDITIONAL INFORMATION
,
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade •
AV
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
n
14 Final�-
PLUMBING APPROVALS
15 Ground Plumb C,
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
i
P/L P/I
STREET NAME
26 Power Pole Arm
27 Conduit •
28 Service Entrance
29 Wiring
29A Grounding Wire — _ • ( G .
29B Bonding
30 Fixtures
31 Service
32 Final —1(�