001012 (SATT)r
P.O. B= 780
• PERMIT APPLICATION
La Quints CA 92253
City of La Ouinta _ • .
r"=f + • Department of Building and Safety , + r • i
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'CITY/COMMUNITY/STATE/ZIP^.. . . -
La ouirota Com' 92253
8OK
This permit becomes void -if work not commenced within,180 days -from date of issuance, OR„ff:work has been suspended or abandoned.fcT.a period of 180 days.,
PRC
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CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This, section need not be completed'if
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-' LICENSED' CONTRACTORS' DECLARATION: I hereby affirm. that.fam-licensed under-provisions.of-Chapter 9' :.
;'the;permitis for one hundred ($100).o,.less.I certify.Mat.in the performance of the.work for which this permit is..
- LOT
(commencing with Section 7000) of. Division 3 oLthe Business, and Pro essioris-CEdeaand my license is in full force - =
issued; I shall not employ any person inany,manner.seas to become subject to the Workers'. Compensation Laws of, "y
and effect.' i
California.
al
License Class �Lic: N tuber / — — :.1.
.,Date °' --Applicant
20
.. %.� ; ", /1 1
_ 'Date • _ Contractor, •• /
- NOTICE TO APPLICANT: If, alter making this CerUficaL of Exemption, you should become subject to the Workers
y ✓
. OWNER -BUILDER DECLARATION: I hereby affirm that'f-`am exempt from,the Contractor's License Law for the •'
Compensation provisions of the Labor Code, you mus; forthwith comply with such provisions arthis permit shall,
�be -
'
following reason (Sec. 7031.5. Business 'and Professions Code: Any city orcounty which requires a -permit to
deemed revoked.
7. -
CONTRACTOR -FIRM NAME,., ,.
construcL alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICA-ION:
1
such permit to file asigned statement that he is licensed pursuant to.the provisions of the Contractor's License Law0'Ifierebycertifythat`doexcavationfive(5)ormorefeetindepthintowhichapersonisrequiredtodescend,willbe
PHONE N -
4„'131 `
LICNC N
• (Chapter 91commencing 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 perm -1, and that no building structure, scaffolding,,falsework, or
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therefrom and the basis for the,alleged exemption. -Any, vidlation of Section 7031.5 by.any applicant for a - permit .
demolition or dismantling thereof; will be more than th rty-six.(36) feet high: (Chap 3:2;Grp 2, Art 2, Sec 341, Title 8,
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' subjects the applicant to a civil penalty of not -more than five hundred dollars ($500.):
C.-A.C.) "
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. O I, asowner of the property, or; my employees with wages as their sole compensation, will do the work, and the
'0 As` owner- -builder, I will n6femploy anyone to do• work. whichwould 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'persor has a1 permit'to do: such work from that division.: 1
' Law does not apply to an owner of property who builds, or improves thereon, and who does such work himself or
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through his own employees, provided that such improvements are not intended or offered for sale. It, however, the ,,,
D Division of Induslrial,Safety Permit No.
rh
buildingorimprovemntissoldwithinoneyearofcompletion.theowner.builderwillhavetheburdenofprovingthat_;-. --
'. Date Applicant -
he.did not build or improve for the purpose of sale.).,;.
CONSTRUCTION LENDING -AGENCY: I hereby affirm tha; there is a constrdction lending agency forthe performance
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O. I; as,owner of the properly, am exculsively.contracting with licensed contractors to construct the project (Sec:
z --of the work for which this permit is issued.(Sec: 3097'Civ..CJ. _
. END
7044, Business and Professions Code: The Contractor's.License Law does not apply to an owner of property who
Lender's Name.,r
' builds or. improves thereon, and who-.contracts•for such projects with'a contractor(s)' licensed -pursuant to the"' ; - •,
. Contractor's License Law.). • . > ,
Lender's Address
O 1 am exempt under Sec.B: 8 P.C. (Attached Certificate):..-,
I certify that I have read this application and state that9he above information is,correct. I agree to comply with all
••,..A
y
Owner 3• .
Date.
-city and county ordinances and state laws relating to hailding.construction; and hereby authorize representatives
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of this county to enter upon the above'mentioned prooerty for inspection purposes. '-
WORKERS' COMPENSATION DECLARATION:. ].hereby affirm that I have a certificate of consent to self -insure. or a - - . -.•;
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certificate'of Workers' Compensation Insurance , or a certified copythereof (Sec. 3800. Lab.'C.).
i,
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Signature of Applicant or Agent` Date
Policy No. Company,
CERTIFICATE OF COMPLIANC A'ND AUTHORIZATION 08 ENTRY:.] certify I have read this application and state that
❑.Certified copy,is hereby furnished. - - r
the informatin given is correct. I agree to comply with all state.laws and county ordinances relating to buidlmg
' ❑ Certified copy is filed with the City Building Inspection Department or City Department.
construction, and aulhofize, a'representative of the Ciry of La Ouinta Department of Building and Safety to.enter
,
Date Applicant
�upowthe property rr_which'Lhave applied for this permit for the purpose of making inspections.
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Signature of App Want or Agent Date
Print Applicant/Agent Name
APPLICANT NAME'.(L„F, MITT)rxidn” ,.
ADDRESS' - -
P.O. B= 780
CITY/COMMUNITY/STATE/ZIP -
La Quints CA 92253
JOB SITE ADDRESS/SPACE -
49-312 Avexdda Vista Bonita
'CITY/COMMUNITY/STATE/ZIP^.. . . -
La ouirota Com' 92253
8OK
PAG
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RNG ;
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TRACT •
- LOT
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'354L-!7-8,
MOD
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14491C-.'
20
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TRACT NAME -
Yt{• C17t{Tfr±
OWNER NAME (L. F. MI) . -
And
CONTRACTOR -FIRM NAME,., ,.
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ADDRESS
CITY/COMMUNITY/STATE/ZIP •. .
PHONE N -
4„'131 `
LICNC N
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13762
e .
ARC/ENG FIRM NAME
Sia s Roar
ADDRESS -
1531 Cbapala Stxeet
CITY/COMMUNITY/STATE/ZIP
Santa Barbara, CA 93101
PHONE N •
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USE OF PERMIT
� ��, ^ ��}{'��
single
single famuly dmlljzw.
BL:
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FSB
SSB
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. END
SIDE ".
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1�A-E22-�4 $•F•�.•
:APPL/PRMT 1 n , 17
..4"
Permit to construct 2,758 sq. ft. of -
s le family tdrfaelling with attached
gars ThLS' V. _to _ i'?Pl'a- ce
0426 �`
mach. Fee 13.00
Plan . Fee 32.70 „
Const. Fee .251.50 .
Elect. Fee 21008
Plumbing Fee 36:+.50
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..•. - TOTAL
t FEE
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'354L-!7-8,
• • �: BLDG DEPT, fi
VALUATION,, p9,
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A&
NO.
OPERATION ATE INSPECTOR
NO.
OP ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVAL'S
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 WaII.
42
Commercial Hood
10
Fireplace P.L.
❑
43
Final
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)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb j
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
P;L _ P/I
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring'
29A Grounding Wire
29B Bonding
.30 Fixtures
31 Service
32 Final