0418 (SATT)PERMIT APPLICATION
City of La Ouinta
- rg
,,1' • 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 fc- 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.
License Class Lic. Number
Date Contractor
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt fronmthe Coritractor'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 violationofSection 7031.5 by any applicant fora permit ;.
subjects the applicant to a civil penalty of not more thanfive hundred dollars ($500.):
❑ I, as owner of the properly. 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 i mprovemnt 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.). ,
❑ I, as owner of,the propertytam•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 contractors) licensed pursuant to the '
Contractor's License Law.).
❑ 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 t
❑ Certified copy is hereby furnished. �• / , s » ,
p\Certified copy is ed w h f city Building Inspection Dep�r meat or Department.
Date_ Applicant X
APPLICANT NAME (L.
k41ADDR�.GiV.iJlAl
SS
P, U, Hoop 780
la - Y,�it 9,22253
,2
u� 00ADDREAv W da Vista Bonita
CITY/COMMUNITY./STATE/ZIP
1a itA, CA 92253
BOK I
PAG
PRC
C
Plan Check'Fee
TWN
RNG
SE
S
TRACT
4Y96—Z
LD,T, 2
7.39
PlunbjM Fee
m,, 3
`T-•
SB
-
TjiACT NAE � ��
OWNER NAME (L. F. MI) •-
CONTRACTOR -FIRM NAME
��:atllon
'
ADDRESS s Abme
CITY/COMMUNITY/STATE/ZIP
564.4315
3J.3762
ARC/ENG FIRM NAME
ADDRESS '
CITY/COMMUNITY/STATE/ZIP
PHONE N
' } III, FEE
LICNC P
&JP/) with Attached Garage
BL
1
1 ZON
FSB
SSB
SSB
RSB
OFC
ZONE ORD #...,,
LOT SZ
•
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if.
the permit is for one hundred ($100) o, less. I certify that in the performance of the.work for which this permit is
issued. I shall not employ any person i n any manner soxas to become subject to the Workers' Compensation Laws of,
California.
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificat: of Exemption, you should become subject to the Workers
Compensation provisions of the Labor Code, you mus: forthwith comply with such provisions or this permit shall
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 permit, and that rib building structure, scaffolding, falsework, or
,demolition or dismantling thereof, will be more than th rty-six (36) feet high. (Chap 3.2, Grp 2. Art 2, See 341, Title 8.
C.A.C.)
❑ As owner -builder, I will not employ anyone fb do work which would require a permit from the Division of
IndustrialSafety, as noted above, unless such persoe has a permit to do such work from that division.
❑ 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. 309x, 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 7uilding construction• and hereby authorize representatives
of this county to enter upon the above-mentioned pnperty for inspection purposes..
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION IF ENTRY: I certify I have read this application and state that
the information given incorrect. I agree to comply.w lh 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
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 n a 1 R 1DATE
2;;28-8L7L
`/D
Permit to constrwct 20326 Sq. Ft. of S/F/D
with Attached Garde
Mecha iical. Fee $
26.00
Plan Check'Fee
291.20
doatstracti+on Fee
448.00
'Electrical Fee
36.90
SMI Fee
7.39
PlunbjM Fee
73.00
Property Develapnent Fee
450.00
P
UEL Z 9 1983
' } III, FEE
$ 1,►332.49
BLDG. DEPT. VALUATION $105,867.60
Ah
r1
NO.
OPERATION 15ATE 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 1 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.
❑
NON. 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
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/� . ' P/I
+,;? �C;
STREET NAME
26 Power Pole '
27 Conduit
28 Service Entrance
29 Wiring ..
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final