0174 (SATT)PERMIT APPLICATION 1 `' L(� " 7 8I: U.
+ City of
La Ouinta
- _ Department of
Building,and Safety `
rj .,This permit becomes void if work not commenced within 180 days from date of issuance, OR, if work has been suspended or abandoned for a period of 180 days. -
'^
CERTIFICATE OF EXEMPTION FROM WORKERS' COAPENSATION INSURANCE: This section need not be completed if
LICENSED CONTRACTORS DECLARATION: 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 mann::rso as to become subject to the Workers' Compensation Laws of '
and effect. -
California.
License Class Lic: Number
Date Applica:it
Date , ,Contractor
NOTICE TO APPLICANT: If, after making this Certe'icate 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 must forthwith comply with such provisions or this permit shall
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to
be deemed revoked. r
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for '
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIf1CATION:
such permit to file a signed statement that tie is licensed pursuant to the provisions ofthe Contractor's License Law
0 hereby certify that no excavation five (5) or mae feet in depih imo which aperion 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 hermit 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 fora permit
demolition or dismantling thereof, will be more thzn thirty-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 (5500.):
_.C.A.C.)
O I. as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
O As owner -builder, I will^not employanyone 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
USE OF PERMIT.
8ing1,e Family Dwelling
through his own employees, provided that such improvements are not intended or offered for sale. If, however, the
❑ Division of Industrial Safety Permit No.
building orimprovemntissoldwithinoneyearofcompletion,theowner-builder will have the burdenofprovingthat
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
❑ I, as owner of the property, am ezculsively 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
ZONE ORD N
Contractor's License Law.).
Lender's Address '
a 1 am exempt under Sec. . B. 8 P.C. (Attached Certificate).
I certify'tfiat�l�have read thisapplication and statedhat the above information is correct. I agree to comply with all •
Date Owner _
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above=mentionec property for inspection purposes.
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.).
Signature of Applicant or Agent Date ~
Policy No. Company
n
jO��ertified copy is h�reby turn` shed. .r''�
-. ,
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that '
the.information given is correct„ Is agree to comply with all state laws and county ordinances relating to buidling
O Ceriifiedfcopy is filed with the City Building Inspection D p menl orr^Cityf-✓ Department.
construcpion end au�ho Sze a representative of We City of La Ouinta Department of _Building and Safety to enter _
the far'whic�i(I'Kav 7epplied for the i spectionst
r!9 et.�
Date APPlicanl �-
upon propert forth"p•ermit purpose ot,inaking
_ - / / V'/° "'f.�— f� 6 GF .
A Sig�na�tqut�eM1of Applicant ori, gent Date ri
Print Applicant/Agent Name
APPLICANT NAM (L, F, MI)
�a �?u�� xt I Joint Venture
ADDRESS p,'
P.,vn. Box 780 �+
CITY/COMMUNITY/STATE/ZIP ,ftp
ta# a 92253
:L a Qr,uinC
JOB SITE ADDRESS/SPACE -
49-981 Avenida Vista Bonita
CITY/COMMUNITY/STATE/ZIP
Tra. Quintal Ca 92253
-
BOK
PAG
PRC
C
TWN
RNG
SE •
S
TRACT
1.44961.
I LOT
134
Plan Check 'Fee
173,00
MOD
P�-?.
SB
Property, bev. Tee-
TRACT NAME, Santa.'Rosa coves
OWNER. NAME (L. F. MI) -
CONTRACTOR -FIRM NAME
Ancien Corporation
ADDRESS +� �q n -
P.O.ok ! QV ' ,
CITY/COMMUNITY/STATE/ZIP' -
La Quintal, Ca' 9.22.53
PHONE # -
619x5-431
LICNC
.333762
.,
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP - -
--
PHONE N -
LICNC N
"►
USE OF PERMIT.
8ing1,e Family Dwelling
'BL
ZON
FSB
SSB J.
SSB I
RSB'
OFC '
ZONE ORD N
r
,- LOT SZ
END
-SIDE'
Arrow Printing'250/1-83•••
APPL/PRMT �+ 2 0 174 DATE 4 �
Pc:rrait to construct Model P;.o2rA^ ,
DWelliIn1.p390
SqoiFt0
F
Garage
41.5 , Sq. x t.
PL'�.'tioCover. �
1.20. -.Sq. Pt..
V
Xech. Fee
$ 31.'' 0, t .
electric Fee
3l»25
Plumbing Fee -
..48050',
Plan Check 'Fee
173,00
Buil.diu4 Foe350-.94
Property, bev. Tee-
, 300- 00
EC
'®
M 2 0.1.983
F. ,ulnta
.,
y
TOTAL
FEE }
White: Finance Canary Assessor Pink Applica t ,Tag: Bldg'. Dept,
VALUATION ti .
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
/O
39
Appl. Clearance
7
Framing
PD ?
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 ADDITIONAL INFORMATION
NO.
I /
/r lG/Z//�� �g
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath %/ �� T -
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 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