0180 (SATT). ra PERMIT APPLICATION t u T o7 I. V �` • t
City of La 0uinta' I ,
-. Department of Building
and Safety
CITY/COMMUNITY/STATE/ZIP
Era QUinta„ Ga 97253 '
-JOB-SITE ADDRESS/SPACE•
49.-9,21 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 fcr a period of 180 days.
1
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 (5100) o, less. I certify tilt 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 lull force
issued, I shall not employ any person inany manner sons to became subject to the Workers'Compensation laws of
and effect.
California. . . - . ' , '
License Class Lic. Number
Date Applicant
I
Date Contractor
•
NOTICE TO APPLICANT: If, after making this Certifica-E of Exemption, you should become subject to the Workers'
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from,the Contractor's License Law for the
Compensation provisions of the Labor Code, you mum forthwith comply with such provisions or lhis,permitshall ,
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to -
be deemed revoked. ,
construct, alter, improve, demolish, or repair any structure; prior to its issuance; also, requires the applicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: • s ,•
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 five (5) or more feet in depth int6 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 perriit, 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 thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec341, Title B, .. r
subjects the applicant to a civil penalty of not more than five hundred dollars (S500.):
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 As owner -builder, I will not employ anyone to de 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
«
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 orimprovemntissold within one year ofcompletion. 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: I hereby affirm that there 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. 309F, Civ. C.). r
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
• ZONE ORO a';
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 Misapplication and state that the above information is correct: I agree to comply with all
Date Owner
city and county ordinances and state laws relating to wilding construction, and hereby authorize representatives ,
of this county to enter upon the above-mentioned pnperty for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
�• • t •' +
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.).
Signature of Applicant & Agent Date • `
Policy No. Company
�e -
4k.
CERTIFICATE OF. COMPLIANCE AND AUTHORIZATION nF ENTRY: I certify I have read thisappficationand state that
0 Certified copy is hereby furnished.
the. information given is correct. I agree to comply win all state laws and county ordinances relating to buidling
' O Certified copy is�filed with tris City Building InspectionlUepar�ment or'City Department
(p ` Cd0' J , ( �4 M� ,�b� w +
constructiornndd Vhorize zr ep resentative of the Oily of La Ouinta Departmenl,of Building and Safety to enter
upon the. proArty•for Wbich°I hate applied for this lermit for the purpose of making inspections
Date Applicant
�% .✓ / 6 - "•.w.:n,...••., —! tG+ CJ j
f
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPLICANT NAME (L. F. MI)
La Qu�.'nta Joint 'Venture
?,
QDDAk§S-W$FVKXXNjil' X=XXNKX=to
P.O. Boni 780
CITY/COMMUNITY/STATE/ZIP
Era QUinta„ Ga 97253 '
-JOB-SITE ADDRESS/SPACE•
49.-9,21 Avenida vista ;Bonita .
CITY/COMMUNITY/STATE/ZIP
Era Quinti, Ga 92253
BOK
PAG
PRC
C
TWN -
RNG
SE
S
TRACT
14496- L
LOTMOD
140
+Plumbing
1." lan 'Check•..Pew
/52,5
- 209:m 00`
P 3
SB
Property Dev. P'ee - 450.001',7 s
TRACT NAME .
Santa.Rosa Cove
OWNER NAME -(L. F, MI)
CONTRACTOR -FIRM NAME
, nden Corpo.rat .on
ADDRESS
P.0. 13ox 780
C��I••TY/COM(fM�UNIyyTYy/yS.T�AA.TE/ZIP
lat Ca 92253
PHONE a " -
619''564-1315
'
LICNC
33J762
.ARC/ENG FIRM NAME
L,
ADDRESS --
CITY/COMMUNITY/STATE/ZIP - ..
r .
PHONE a
-
LICNC a
USEOF PERMIT -
Single
BL
- .ZION
•w
FSB
, SSB: -:
, SSB_
RSB . -
OFC
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• ZONE ORO a';
LOT SZ
END.
- SIDE
APPUPRMT ¢ 1 &A. DATEr s "
Permit to cofistruct"Mode-A :?-3:'A:
Dwelling
Lj$16 Sqo Ftw "
Guest IRPOTa
377 Sq. Ft,
e
�(
-Garage
433 sq. Vto.
Patio cover
140 Sq".
Piech. Fee,
3. 00.
Electric ' kde
31625 '
Fee
.
'
+Plumbing
1." lan 'Check•..Pew
/52,5
- 209:m 00`
Building Fee
424,.62
Property Dev. P'ee - 450.001',7 s
DELAN
I I
City ®f La uon
TOTAL`S
FEE.
• , � - .. ~.+ •c � . , r »... ,, w•• , :• � :+• ^,r'.+• t ��.. '� � +5 r VALUATION �'v�9� p Ups, 7
Arrow Printing 250/1-83 White; Finance Canary. Assessor -.Pink: App Tag. EId§."Dept:
•s.'',r
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
3
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.
❑
NPN ADDITIONAL INFORMATION
,�/ �1^7A
W D`1 3
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
Walls (Batts) ,3
126 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
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding ,
30 Fixtures
31 Service ^ .:-•
.32 Final