0415 (SATT)C fq
APPLICANT NAME(L, F; MI) . '. 111.-
Ander ibrporation
ADDRESS
P. O. Box -780
-'PERMIT APPLICATION
.• ti • •, City of
La Uuinta;' y'
- - , Department of Building and Safety '
•
CITY/COMMUNITY/STATE/ZIP
la cluinta, to 92253
BOK
.This permit becomes void it work not•commenced within 180 days from date of
issuance; OR, if work has been suspended or abandoned b.r a period of 180 days. -
•
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be'completed it -..
: LICENSED CONTRACTORS `DECLARATION: d hereby. affirm- hat•I am licensed under: provisions of Chapter.'9: -" .'
'- thepermitisforonehundred ($100)o, lessitcertify that inthe performance of the work for, which -this 'permitis.: ,
(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 mannersc as to become subject to the Workers' Compensation Laws of
and effect. - {
California. -
• License.Class' Lic. Number
Date Applicant ;.
'Date Contractor'
= . NOT,ICE.TO APPLICANT: If, after making this Certificate of Exemption, you should.become subject to the Workers'
•
OWNER -BUILDER DECLARATION: I hereby affirm that'I am exempt Irom.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 '
- - - -
construct, alter: improver demolish: or repair any structure, prior to its issuance, also requires the applicant for .••
DIVISION OF.INDUSTRIAL SAFETY PERMIT CERTIFICATION:.
such permit, to file a signed statement that he is licensed pursuant to the. provisions.of the Contractors License La*.
0 l hereby certify'tfiat no eRcavation five (5)`or more Iaet in depth into which a person is required to descend; will be
'(Chapter 9 (commencing 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 permit, and that no building structure, scaffolding, falsework, or
therefrom and the basisfor the alleged exemption..Any violation of Section 7031.5 by anyapplicant for a permit
,_N demolition or dismantling thereof, will be more`than thirty-six (36) tedthigh. (Chap 3.2, Grp 2, Art 2, Sec341,.Title8: ••
subjects the applicant to a civihpenalty of not more than five hundred' dollars ($500.):
%'X.?xC.A'.C.)
' O I, as'owner of the properly;or my employees with wages as their sole,compensation; will do the work; and the
O'As,owner-builder, l will:root employ anyone.to do work which would require a permit from the Division of -
structure is: not intended.orotfereddorsale (Sec: 7044,.Business and. Professions Code: The Contractor's License .•., •
IAdustrial Safety; as noted above; unless such persm has a permit to do such Work -from that division' :7� r
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'thatsuch improvements are not intended or offered for sale. If, however, the.
0 Division of Industrial Safety Permit No.
' R
''building or improvemnt is sold within one year of completion, the owner -builder will have the burden of proving that,
Date - Applicant
• he.did not build or improve.for the purpose, of sale.):
CONSTRUCTION'LENDING AGENCY: Ihereby affirm Ont there is a construction lending agencyforthe performance' .'
0 I, as.owner of.the property, am exculsively contracting with licensed contractors to constructthe.project,(Sec:.. , ..
, of the work for which this permit is issued'(Sec..30',7, Civ. C.): `- '• k.
7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who: ,-
- , .' - * * - - I ' '
Lender's Name..
builgs or improves thereon: and who contracts for,such projects with a contractor(s) licensed pursuant'to.the.
LOT'SZ.
Contractor's License Law:).
Lender's Address ,
0 1 am'exempt under Sec: B: 8. P.C. (Attached Certificate)..: .
, I certify that I have read this application and state that the above informatiomis correct. I agree to comply with all
Dale Owner' " ' -
city and county ordinances and state laws relating tc building construction, and hereby authorize representatives o .q
of this county to enter upon the above-mentioned property for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that Ihave acertificate of consent to self -insure, or a. ..
_ - -• `' .
certificate of Workers' Compensation Insurance•, or a certified copy thereof (Sec. 3800. Lab. C.);
'
Signature of Applicant'orAgent Date
,.• Policy No � Company !+
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:'I certify I have read this application and state that
0 Certified copy is hereby furnished. { .: _
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidlingI. I
' Certibed copy isade Iwuh-theiCity.Building_Inspection Depart nt or'City " i1 Department.
construction, and authorize a'representative of the City of La Ouinta Department of Building and Safety to enter
G-�' �-/J 7 (I� L
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upon the property forwhich I have applied for. this permit for the purpose of making inspections.
Date Applicant
Y
Signature of Applicant or Agent Date '+
'J
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APPLICANT NAME(L, F; MI) . '. 111.-
Ander ibrporation
ADDRESS
P. O. Box -780
CITY/COMMUNITY/STATE/ZIP
La Quanta, CA 92253 :
49= 52U AiferUda Vista Bomita
CITY/COMMUNITY/STATE/ZIP
la cluinta, to 92253
BOK
PAG
PRC
C-
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TWN
RNC
SE
S
TRACT.
14496-2
LOT
9
'
73e00
Property Develognent ree `
MOD
G-3
SB
- ..
TRACT NAME '
Santa Rosa, Owe
O♦�MM�EYR�,NAME AsL. F. MI .... .. ...
.�ocr[a.y2 L].7 �
R•FM NAME
CONTRAIR
en, - ;, ,' - ... ..... ...
ADDRESS' '+ P. 0, Box 780
CITY/COMMUNITY/STATE/ZIP,
la Quina, CA .92253 .
PHONE M -• +
564-1315
.
"LICNC N
333762
S:� 1,332.49 v
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP:
PHONE N
LICNC N
+• •- .-.
e
USE -OF PERMIT -
SIEPID• with Al-tached Garage .
BL.'
ZON
FSB
SSB •
SSB
RSB
OFC "
t, ZONE'ORON
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LOT'SZ.
- -
1END1 t'
•'SIDE
Print Applicant/Agent Name
APPL/PRMT
nA
lzGTE -a!8-s3.
-
,S/V/D
Permit t bolns6mct 2,.326 Sq. Ft of S/F/D
with Attached Garage
N>Fee.. $
-2 :6
26 00
Plan! C heck Fe€ '
291020
Canstructim Ftp
448; 00
Electrical••Fee r
36090 ,
SaF
,'7:39
4
PlumbiM Fee
'
73e00
Property Develognent ree `
450.00
- L LI `✓ E1 7L4W
AT utu 9963
c96 ' 6f
La
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y
I- • TOTfu` •
FEE •'
S:� 1,332.49 v
-*.. �;.,• `` t� r. 'BLDG. DEPT.,
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VALUATION
i3— "ate
.r - - i - • r
r-1
Adk
NO.
OPERATION MTE
INSPECTOR
NO.
OP TION DATE ZPECTOR
BUILDING APPROVALS
e
MECHANICA L -APPROVALS
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 Wall
42
Commercial Hood
10
Fireplace P. L. • ❑
43
Final
10A
Fireplace T.O. ❑
NPON
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/L PyI
STREET NAME
6 -"Power Pole
27 Conduit '
28 Service Entrance
'29 Wiring
29A Grounding Wire .;
296 Bonding
30 .'mixtures
31 Service
32 Final