001020 (SATT)PERMIT APPLICATION
• City of La Dg a •
r.-- Department of Building and Safety
4 .
This permit becomes void if work not commenced within 180 days from date of issuance. OR, if work has been suspended or abandoned fc r a period of 180 days.:
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code :.and my license is in full force
and effect. /r
License Class Lic. Number }
Date �1 • Contractor -
/1
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to
construct, 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 Contractor's License Law
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) or that he is exempt
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
O I. as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
structure is not intended or offered for sale (Sec. 7044. Business and Professions Code: The Contractor's License
Law does not apply to an owner of property who builds, or, improves thereon, and who does such work himself or
through his own employees. provided that such improvements are not intended or offered for sale. If, however, the
building or improvemnt is sold within one year of completion, the owner -builder will have the burden otproving that
he did not build or improve for the purpose of sale.). V.
O I, as 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
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
O 1 am exempt under Sec. B. 8 P.C. (Attached Certificate).
Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.).
Policy No. _ Company .
O Certified copy is hereby furnished. ,
O Certified copy is filed with the City Building Inspection Department or City M1 Department..
Date Applicant
APPLICANT NAME (L, F. MI7T) nN&w
ADDRESS
P.O. Box 780
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
JOB SITE ADDRESS/SPACE
49-486 Avenida Vista Bonita
CITY/COMMUNITY/STATE/ZIP
La ouinta CA 92253
BOK
PAG
PRC
C
TWN
RNG
SE
S
TRACTLOT
14496-1
12 1
321.07
MOD
6-3
SB
TRACT NAME - yy.��..''�^ {yme
Santa i�7bm
OWNER NAME (L. F. MI) T��� • ,
ATxlen
CONTRACTOR -FIRM NAME -
ATAgn
ADDRESS __�MM -
abme
CITY/COMMUNITY/STATE/ZIP "
above
PHONE a
Q-175
LICNC 0
333762
ARC/ENG FIRM NAME nn^^ PA�w_
rry
ADDRESS d
531 ChRnala Street
CITY/COMMUNITY/STATE/ZIP
ntA BnXbM. CA 9ft 93101
PHONE M
LICNC I
.
USE OF PERMIT siMle fainly ,�„-M,lnq
•iC
BL
- ZON
FSB
SSBSB�llR13•
SSB�AN�RSSB•
OFC
ZONE ORD 6
LOT SZ
FEND
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPEJSATION INSURANCE: This section need not be completed if
the permit is for one hundred ($100) o, less. l certify -hat in the performance of the work for which this permit is
issued, I shall.not employ any person in any manner sc-as to, become subject to the Workers' Compensation Laws of
California.
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 s ,
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY, PERMIT CERTIFICATION:
O 1 hereby certify 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 pernit. and that no building structure, scaffolding, falsework, or
demolition or dismantling thereof, will be more than tiirty-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 its 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. Y
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. 309►, Civ: C.).
Lender's Name
Lender's Address
I certify that I have read this application and state tha the above information is correct.I agree to comply with all
city and county ordinances and state laws relating to wilding construction, and hereby authorize representatives
of this county to enleT upon the above-mentioned pnperty for inspection purposes.
Signature of Applicant or Agent Date.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
the infogptiomgiv`e, i'; correct. 1 agree to comply wih all state laws and county ordinances relating to buidling
cons�cuc on, and authorize a'representative of the Gly of La Ouinta Department of Building and Safety to enter
upo the property f"or•whicfi I have applied for this permit for the purpose of making inspections.
`Signe of Applicant or Agent Date
Print Applicant/Agent Name
APPL/PRMT n■ A l n 7.n 1DATE
0-22-84 • S _F.D.
rorvni 4-n rwvm 2_12s; sari- ft- of
single family daelliM with attached
qaraqe. This pemirt to replace # 0418
EXPI .
mech. Fee 13.00
Plan Cbeck Fee 29.12
Czarist. Fee 4.00
Elect. Fee 18.45
Plumbim Fee 36.50
0 F
TOTAL
321.07
BLDG. DEPT.
VALUATION —0—
Ah
Ah Ar,
NO.
OPERATION I IMTE
INSPECTOR
NO.
OP TION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
e? gs
34
Plenums & Ducts
2A
Slab GradeJ
'
35
Furnace Compart.
3
Steel
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
ZL
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.
❑
NO.
ADDITIONAL INFORMATION
SEWAGE SYSTEM -SIZE & LOCATION
11 .. Exterior Lath
12 Internal Lath
12A Drywall p2
13 Finish Grade `
INSULATION Thick "R
Value
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 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