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• PERMIT APPLICATION . ;..r,_. -. f.•
CITY./COMMUNI Y/STATE/ZIP -
aalcYtira t` Wp U4 92705 .
City of La Ouinta ,
Department of Building and, Safety
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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."..-
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CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
,
LICENSED
CONTRACTORS: DECLARATION: I hereby affirm that I am -licensed under provisions of .Chapter 9:'-.; . • `
,.4he 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 3 o1 the Business and Professions Code, and my license is in full force'..
: issued) shall not employ any person in any manner so as to become subject to,the-Workers'Compensation Laws.of • `•
and effect. . •
California. . • r
'
Lice se Class Lic.,Number 1 .^
Date Applicant
Date Y„. ' Contractor;.- •
NOTICE TO APPLICANT: If,.after making this Certificate'of Exemption, you should become subject.to the Workers v .^
:,De,
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••, OWNER -BUILDER DECLARATION': I her eby,affum'Ihaf7 am exemptfro.in the Contractor'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.
` following reason (Sec. 7031.5. Business and Professions Code: 'Any -city or county which requires permit to
^. •' •', ,
^ construct, alter, improve; demolish, or repair any structure, prior to its issuance, also requires the applicant for
DIVISION OF.INDUSTRIAL SAFETY. PERMIT CERTIFICATION:
su c6 permit to,file a signed.statement that he is licensed pursuant to the provisions of the Contractor's License Law.. '.•
0 1 hereby certify'lhat no excavation five (5) or moie feet indepth into which a person is requiied to descend, will be:
• L (Chapter 9(commencing with section 7000) of Division 3 of the Business and Professions Code)orthat he is exempt ,
made in connection with work authorized by this permit, and, that no building structure, scaffolding, falsework, or. a
therefrom and the, basis for the alleged•ezemption. Any.violation of Section 7031.5 by any applicant fora permit
'demolition or dismantling thereof: will be more thanthirty-six (36) feet high, (Chap 3.2; Grp 2; Art 2, Sec 341, Title 8,
.subjects the applicant to a•civifpenslty of -not more than five hundred dollars ($500.): _
C.A-.C.) "l`”
'..i, 0.I,1as owner of the property, or my employees with wages as their sole compensation, will do the work, and the. , .;
O 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 _
'.Industrial Safety; as noted above, unless such person has a permit to do;such work from that division.
i Law does not apply town owner of property who -builds, or improves thereon, and who does such work himself or
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No.
' through'his own,employees, provided that such improvements are not intended or offered for sale'. If, however, the, :
,•r4P Division of Industrial Safety Permit
.1 building orimprovemntissold within one year ofcompletion. the owner -builder will have the burden of pro_Kingthat
Date L Applicant M
he.dYd not build or improve for the purpose of sale.).••
CONSTRUCTION LENDING AGENCY: I hereby affirm that thereis a construction lending agency for•the performance. •
- O I.,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.):.
' 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 - •"
r,•
Contractor's License. Law.).
Lender's Address +
' O I am exempt under. Sec.: •.: B. & P.C. (Attached Certificate).
I certify that I have read this application and state that the above, information incorrect: I agree to comply with all
1 1 ^ '
Date 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 I have a certificate.ol consent to self -insure, ora.
certificate of Workers Compensation•Insurance,; or a certified copy thereof (Sec.•3800. Lab: C.): '
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'' "• ' Signature of Applictant or Agent Date +
Policy No. Company
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CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
• O Certified copy is hereby furnished. ;<v.: "
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the information given is correct. I agree to comply with all state laws and count ordinances relating to buidlin
9 P Y Y 9 9•
` O Certified copy is filed with the City Building Inspeecction,Department• r.City, M ' • Department:
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construction; and authorize a'representative of the City of La Ouinta Department,of Building and Safety to enter.'
upon ttie property for which Lhave applied for"this permit for the purpose of making inspections.:,
,.
Date-' Applicant
_
Signature of Applicant or Agent + Date
CZT NAM
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ivu SN.. Tustin Auenue, '- Suite 231
CITY./COMMUNI Y/STATE/ZIP -
aalcYtira t` Wp U4 92705 .
JOBr, •ADDRESS/SPACE,., *y,p.,�!} .•' ^' • 1./']
• .L•.V V.tSc.Gt LLIIGG i`n+1rca+ • `I ' C;J.r) t••,1 `•� • .
-CITY/COMMUNITY/STATE/ZIP - .. -
CL t.u.t�t•sil, CA 92253
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..' 61.00 ; }•+_
TlWih, De La Paz, Ltd;
OWOME (L: FEMI -
CONTRACTOR -FIRM NAME , • - '-,,'. - - .
ADDRESS - .., r ,...
CITY/COMMUNITY/STATE/ZIP,
'"t i.IA) 558-3766 '
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ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP _ •^ ..
PHONE N , '' r•
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ITE�QFePEdRMI1d CIVSA.I LIIIt�.
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Pennit o cl struct 10894-S- . -Ft of S/F/D _
with 400 - S4g. ' Ft. , of . Garage as • per approved'
plans_.
P�eGhdcal 'Fea
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Print Applicant/Agent Name
APPUPRMT'^ .• ,-1—`U-84
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Pennit o cl struct 10894-S- . -Ft of S/F/D _
with 400 - S4g. ' Ft. , of . Garage as • per approved'
plans_.
P�eGhdcal 'Fea
$ : 18:00:
Plata Check' Fee
Paid • :.
Cbnstruction Fee
.445.50
Electrical F ,` -
34.6V. • 4-"
SMI Fee
ry . 7.32' _
Pltunbang Eee' t ' �.
..' 61.00 ; }•+_
Pzomrty Dlsvel*mient . Flee-,
' ': 450.00`•
RE ail
• i983
C4 4f''adA ixEeesti
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BLDG DEPT:'. `
TFEfE • $ "1.016:49
VALUATION $104;664.40•"
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NO.
OPERATION IIATE
INSPECTOR
NO.
ORWATION 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
dw
42
43
Commercial Hood
Final _
10 Fireplace_ P.L. ❑
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)
126 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 Cj
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY:LINE
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire ' (_ r art '7 -G -
29B Bonding
30 Fixtures
31 Service
32 Final
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