0523 (SATT)PERMIT APPLICATION
• City of La Dg a •
Department of Building and Safety
" 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.'
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 - - the permit is for one hundred:($100).o, less. l certify that 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 in full force issued, I shall not employ any person in any mannerso as to become subject to the Workers'CompensationLaws of
and erfect. California.
Licen.e Class Lic. Number
Date " Contractor
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor'sliconse Law for the
follo'+ing reason (Sec. 7031.5.' Business and Professions Code: Any city or county which requires a permit to -
cons.ruct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for
such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractors License Law
(Cha ter 9(commencing with section 7000) of Division 3 of the Business and Professions Code)or that he is exempt'
thererom and•the basis for the alleged exemption. Any violation of Section 7031.5 by y1 -by for a permit,
subjectsthe applicant to a civil penalty of not more than five hundred dollars ($500:):
• O I. is owner of the property, or my employees with wages as their sole compensation, will do the work, and the
strueure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License'
Law Boes not apply to an owner of property who builds, or improves thereon, and who does such work himself or
throLgh his own employees, provided that such improvements are not intended or offered for sale. If; however; the
buildng or improverrint is sold within one year of completion, the owner -builder will have the burden of proving that '
he did not build or improve for the purpose of sale.).
O I, Its owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec.
7044. Business and Professions Code: The Contractor's License.Law does not apply to an owner of property who
buil¢ or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
Cont actor's License Law.).
O 1 an exempt under Sec. B.8 P.C. (Attached Certificate). -
"Date Owner
WOR:ERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
certircate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.).
Polio No. Company
O Certified copy is hereby furnished.
❑ CE t_ified copy is filed with the City Building Inspeclion•D parg tmepl�C W_ Department. .
Date. Applicant �~ s- •�•
flat l.L.JN M�(L FSMI -
"JDRS N. Tustin Ammer Slllte '231
CICOM�MLUN`I•T�•Y,YS�TAvTE/: 92705
8.., �D P Neal
G° xE`Z , 9Ii#2253
BOK
PAG .
PRC
C
Plan Check Fee
TWN
PING
SE
S
TR.r.y�i40-3
`°9
6.48
Plumbing Fee
58,50
SB
450900
TRACT NAME De La Paz, Ltd.
O,iRNAM, F., MII
CONTRACTOR -FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP -
JLICNI
Pi 4N) 558-3766
T T
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE @
LICNC s
USE' F/,PERMITnMa��) .
I `ZOUN•Ai'••i.
BL
FSB
SSB,
SSB
RSB
OFC' '
ZONE ORD ,;
LOT SZ
ENO
SIDE'
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forthwith comply with such. provisions or this permit shall
be'deemed revoked. '
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
0 1 hereby cbriify that no excavation five (5) or more feet in depth into which a person is required to descend, will be '•
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2. Art 2, Sec 341, Title 8,
C.A.C.)
O'As.owner-builder. I will not employ anyone to do work which would require a permit from the Division of.
Industrial Safety, as noted above, unless such person has a permit to do such work from that division. -
O Division of Industrial Safety Permit No.
Date Applicant •
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
I.cerlify that I have read this application and state that the above information is correct. I agree to comply with.all
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 inspectiod purposes.
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and statethat
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
construction, and authorize a.' representative of the City of La Ouinta Department of Building andSafety to enter
upon the property for which I have applied for -this permit for the purpose of making inspections.
Signature of Applicant or Agent
Print Applicant/Agent Name
Date
APPL/PRMT RA i1 J lDATE-
�C..�•��4
Cando
Pennit to aarMtruct 1 f 662 Sq. Ft. of S/I' /D
-with 400 Sq. Ft. of Garage Per appzwed
plans
Meoisanical Fire $ 18.00
Plan Check Fee
Paid
Constructicin Fee
412000
Electrical Fee
31„77
1 -Fee
6.48
Plumbing Fee
58,50
Ply Development Fee
450900
• ' G+a,
R E tz r ..
EB 519183
T T
$ 976,75
VALUATION $ 921461.20
BLDG. DEPT.
Ah
NO.
OPERATION ATE
INSPECTOR
NO.
OPRATION
DATE. INSPECTOR
BUILDING APPROVALS
MECHANICAL
PPROVALS
1
Set Back
33
Ventilation System
Al
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.
❑
OPEN
NO..
ADDITIONAL INFORMATION
'
SEWAGE SYSTEM SIZE &LOCATION
11 Exterior Lath
12 Internal Lath L Will,
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts) IV
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 — t _-
Tank Pit
L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY
P/L
`
STREET NAME
LINE
P)1
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire $L( <
29B Bonding
30 Fixtures
31 Service
32 Final