0245 (SFD)APPLICANT NAME (L. F. MI).
F.ca f^rtti d n9- 'fnd vti 1'7rmt-tt m
PERMIT APPLICATION
City of La Ouinta,,
Department of Building
and Safety -
JOB SITE ADDRESS/SPACE '
49 -685 -Avenida Vista Bonita
This permit becomes void if work not commenced within 180 days from date of issuance,
OR, if work has been suspended or abandoned fDr a period of 180 days. -
'
•, CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if.
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 that 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 my license is in full force
issued, I shall not employ any person in any manner s+as to become subject to the Workers' Compensation Laws of
and effect
California.
License Class Lic. Number
Date Applicant
Date - Contractor
NOTICE TO APPLICANT: If, after making this Certificateof Exemption, you should become subject to the Workers'
OWNER -BUILDER DECLARATION:. 1 hereby affirm that I am 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 ,
following reason (Sec. 7031.5, Business and Processions Code: Any city or county which requires a permit to
be deemed revoked. t '
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICrTION:
such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
01 hereby certify that no excavation liv; 15) or more f, -et in depth into which a person is required to discend, 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 pernit, and that no building structure, scaffolding, falsework, or
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
demolition or dismantling thereof, will be more than dirty -six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec341, Title B,
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
C.A.C.)
O I, as owner o1 the property, or my employees with wages as their sole compensation, will do the work, and the
O As owner -builder, I will not,employ anyone to do work 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 has 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
Tag Bldg: Dept` ' '
through his own employees, provided that such improvements are not intended or offered for sale. If, however, the
0 Division of Industrial Safety Permit No.
building or improvemnt is sold within one yearof completion, the owner -builder will havethe burden of provingthat
Date Applicant
he did not build or improve for the purpose of. sale.).
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
17 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, Civ. 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 contractor(s) licensed pursuant to the
CITY/COMMUNITY/STATE/ZIP - -
Contractor's License Law.).
Lender's Address
01 am exempt under Sec. B. 8 P.C. (Attached Certificate).
I certify that I have read this application and state thrt the above information is correct. I agree to comply with all -
Date Owner
city and county ordinances and state laws relating tdbuilding 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 codsent to self -insure, or a
r
certificate of Workers' Compensation Insurance , or a certified copy`there_of (Sec. 3800. Lab. C.).
SSB
RSB
Signature of Applicant or Agent Date
Policy No. Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION DF ENTRY: I certify I have read this application and state that
17 Certified copy is hereby furnished. a
the information given is correct. I agree to comply voth all state laws and county ordinances relating to buidling
' copy is fileewith Iti Building Inspection Depa tf metilt , ily Department.
construction!•and�authorize a?epresentalive of the :ity of La Ouinta Department of Building and Safety to enter
„certified jity
A•_ ? (� 4/ -Or }- t..✓
Date •r d .8 Applicant
upon the property for wlilc d ha•ie applied for this.rermit for the purpose of making i spections.(
(�JyJ¢ . ^,..^ 4! C7 t
A `
• � j7 ^ -
° Signature of Applicant or Agent r. Date
» ZONE ORD M
Print Applicant/Agent Name r -•
APPLICANT NAME (L. F. MI).
F.ca f^rtti d n9- 'fnd vti 1'7rmt-tt m
ADDRESS"r. .- .. _ .
R.
P.®e Box /�y SCJ
CITY/COMMUNITY/STATE/ZIP ,
-La Guinta,.Ca 92253
JOB SITE ADDRESS/SPACE '
49 -685 -Avenida Vista Bonita
CITY/COMMUNITY/STATE/ZIP '
La Quints, Ca 92253
END
BOK
PAG
PRC
C
TOTAL
TWIN
RNG
SE,
S
f
TRACT
LOT
MOD
SB
`
#144 96
2 58
+ Y a Or
G -I
P Ink Applicant
Tag Bldg: Dept` ' '
TRACT NAME - - • - - -
Santa Rosea Cove •n. i
OWNER NAME (L. F. MI)
CONTRACTOR -FIR NAME -
anaen �:orporation
ADDRESS %
Box 780•. ..
YP.�U.
CL.�aO �uIi:. ta,YP Ca 92253 S y
PUO -564-1315
-'
LI�3C316j
ARC/ENG FIRM NAME + -
ADDRESS
CITY/COMMUNITY/STATE/ZIP - -
PHONE p
LICNC N
USE -QF PER IT '
S angle Family , Dwelling
BLZON
FSB
SSB
SSB
RSB
OFC,`.'
» ZONE ORD M
LOT SZ
_
Arrow W
Printing 250/1-83 hite:'Finance
0
APPL/PRMT Fi.. +e' DS•
, - ATE
./;t'1f . .,
� `gym „s' j 'y V" 83
Permit .to construct Model- G -'1-A
Dwelling 2, 296
,Garage- 462' Sq,
Patio cover 178-Sq;'Ft
Mech. I-ee r 23.00' `
Flan �kaeck Fee °-305,83
Consturctionl Fee 470 50 '"
Electrical. Pec • -.42;1,6✓' J
SMI Fee `8.02 .
Plumbing'.Fee 71.50
Property Uev. gee 450.00.
• ,.
7` qt
? A
END
-SIDE
4f
-��'•
i
,�1'hQuOn�' _.r.
TOTAL
Y��3�Ie�l..
f
APPL/PRMT Fi.. +e' DS•
, - ATE
./;t'1f . .,
� `gym „s' j 'y V" 83
Permit .to construct Model- G -'1-A
Dwelling 2, 296
,Garage- 462' Sq,
Patio cover 178-Sq;'Ft
Mech. I-ee r 23.00' `
Flan �kaeck Fee °-305,83
Consturctionl Fee 470 50 '"
Electrical. Pec • -.42;1,6✓' J
SMI Fee `8.02 .
Plumbing'.Fee 71.50
Property Uev. gee 450.00.
• ,.
7` qt
? A
END
-SIDE
4f
-��'•
i
,�1'hQuOn�' _.r.
TOTAL
Y��3�Ie�l..
f
5L
`
A
VL D ATION
+ Y a Or
Cana Assesso r
ry:,
P Ink Applicant
Tag Bldg: Dept` ' '
1. U
t
,
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL 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
�Q g
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.
❑
OP'N
NO.
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall /oi 7zw/
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 ��/ r( 7-1 .
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
PSL P/L
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final