0426 (SATT)PERMIT APPLICATION
• City of La Og a •
Department of Building and, Safety
This permit becomes void if work not commenced within .180 days from date ot.issuance, OR, if work has been suspended or abandoned for r period of 180 days.
APPLICANTxI,NAME (L, F, MI) tat.Crt
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not.be completed it
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am. licensed under provisions .of Chapter 9 •
the permit is for one hundred ($100) o, less. I certify thFt,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 mylicense is in full force
issued, I shall not employ any person in -any manner so at to become subject tothe Workers'Compensation Laws of
and effect.
California.
License Class Lic. Number
Date Applicant
Date Contractor,
NOTICE TO APPLICANT: It, after making this Certificate if Exemption, you should become subject to the Workers:
OWNER -BUILDER DECLARATION: I hereby affirm that Tam exempt -from 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 a permit to
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20
construct: alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for.
DIVISION OF INDUSTRIAL SAFETY. PERMIT CERTIFICATWN:
such permit to file,asigned statement that he is licensed.pursuant to the provisions of the Contractor's License Law
01 hereby certifyth'atooexcavation five (5)ormore feet It depth into -which aperson isrequired todescend, will be.
(ChaDter9 (commencing with section 7000) of Division 3.of the Business and Piofessions Code)ordhat he is exempt
made in connection with'work'authorized by this permit.;and that no building structure, scaffolding, falkwork; or
,therefrom and the basis for. the alleged exemption. Any.vialation of Section 7031.5 by any applicant for a permit ..
demolition or dismantling thereof, Will be more thandhirtv-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec341; TitleB,
subjects the applicant to a civil penalty of nobmore than five hundred dollars ($500.):
C.A'.C.)--- -
0 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
0 A owner -builder; I will notleinploy anyone to do vwrk 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 Las 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
ADDRESS
through his own employees, provided that such improvements are not intended or offered for sale. If, however, the
0 Division od Industrial Safety. Permit No.
building orimprovemntissold within one year ofcompletion, theowner-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 here is a construction lending agency for the performance
0 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, :iv. 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 contraclor(s) licensed pursuant to the
SSB -
Contractor's License. Law.).
Lender's Address
0 I -am exempt under Sec. B. & P.C. (Attached Certificate).
I certify that I have read this application and state that tl a above information is correct. I agree to comply with all
DateOwner
city and county ordinances and state laws relating to bu [ding 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 of consent to self -insure, ora
-
certificate'of Workers' Compensation Insurance , ora certified copy thereof (Sec. 3800,,Lab. C.).-
• . --
Signature of Applicant or Agent" 'Date
Policy No. Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF 1 NTRY: I certify I have read this application and state that
O Certified copy is he�eby tu�nished. / (� a
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 and Safety to enter
Certilied copy is filed ith thff Gily Building Inspection Departm- entlor'Cdy' X11 Department.
� V l./rt ~ �----
upon the property for which I have applied for this per nit for the purpose•of making inspections.
Applicant /~
t L`
APPLICANTxI,NAME (L, F, MI) tat.Crt
ADDRESS -
P. 8. B= 780
CITY/COMMUNITY/STATE/ZIP
la Qiin7:ga,, 922253
SCA
` S T,Ey yDDRESS/SPACE
� }�
CI.Yri1i a Vista Boni a -
Bonita
•JiOMMUGf'IITY/STATE/ZIP
CITY//CC
La Quinta, CA 92253
BON
PAG
PRC
C
Plan . Check Fee 3 �1 _'7c)
TWN'
RNG
SE
[S
14496-2
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20
8.93
Plunbi m Fee 310- 5 o
MCrl
SB
X450.00
TRACT NAME � 0ow
OWNER NAME (L. F. MI) ,
CONTRACTOR -FIRM NAME
AS��1
ADDRESS _
CITY/COMMUNITY/STATE/ZIP '
PHONE N
564-1315
LICNC N
333762
TOTAL
ARC/ENG FIRM NAME ....
ADDRESS
CITY/COMMUNITY/STATE/ZIP ,
PHONE N
LICN�C N
,
USE OF
iICrme
+/Dwiyh Attached
SL 'I
ZON
FSB
SSB -
SSB .
RSB
OFC
ZONE ORD N
LOT SZ
END
SIDE
Signature of Applicant or Agent
Print Applicant/Agent Name
Date
APPL/PRMT 0 4 2 6 1DATE
2-•28-83
S/F/D
Penni t to construct 2,758 Sq. Ft. of S/F/D]
with Attached C>e
Mc hlanical Fee 00$
26.00
Plan . Check Fee 3 �1 _'7c)
326.95
Caastxuctim Fee asljso
503.00
Electrical Fee 9/.03
42.16
SMI Fee
8.93
Plunbi m Fee 310- 5 o
73.00
Property Dev'eloment Fee
X450.00
Rvp
In
a
TOTAL
$ 1,430.04'
BLDG. DEPT. VALUATION $127,658.80
Ah
NO.
OPERATION ATE INSPECTOR
NO.
OP ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS -
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34 •
Plenums & Ducts
2A
Slab Grade
35
Furnace Com part.
`3
Steel
36
Inlets'& Outlets
4
Grout Blocks
37 ,
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
9
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.
ElNON
ADDITIONAL INFORMATION
SEWAGE SYSTEM -SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R"
Value 1
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 1 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
Tank Pit L. Line
ELECTRIC APPROVALS
..
REAR OF PROPERTY LINE
P/L PiI
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring .
29A Grounding Wire <'
29B Bonding
30 Fixtures
31 Service
32 Final