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0433 (SFD)APPLICANT NAME (L. -F: M1) ..,y, Corporatillon ADDREUSS r* 9 I Box 780 CITY/COMMUNITY/STATF:/ZIP La %JWnta-,,.CA 92253 PERMIT APPLICATION CITY/CCMMUNITY/STATE/ZIP La Quintap,CA 92253 - • City of La Quinta Department of Building and Safely r. PRC C Plan Check Fee This.permit becomes void if. work not commenced within' 180 days from dale of issuance, OR, it work has*been.suspen;ed ocabandored for a period of 180 days. - SE. - S. CERTIFICATE OF EXEMPTION FROM WORKERS' CCIMPENSATION INSURANCE: This section need not be completed if LOT 126 :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.ce;tifythat in the performance of. the work for which this -permit is MOD P-2 .;(commencing -with Section 7000) of Division 3 of the Business and Professions.Code, and my license is in full.force- - v. issued. I shall not employ any person in any manner so as to become subject to the Workers"Compensation Laws of TRACT NAME Santa Rosa Cam and effect. California. ADDRESS License Class Lic. Number Date Applicznt t,:77 Ott t 9 Date actor,' NOTICE TO APPLICANT:. lf,.after making this Cer-ificate.ot-Exemption..ydu.should become subject to the,Workers' ARC/ENG FIRM NAME OWNER -BUILDER DECLARATION: I her6by affirm that I'am exempt froth the Contractor's License Law for the Compensation provisions of the Labor Code, yoL must,forthwith'comply with such provisions or this permit shall be deemed revoked. PHONE 0 following reason (Sec. 7031.5. Business and Professions Code: Any city or county which'requires a permit to - LICNC construct, alter; improve, 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 theprovisions ofthe Contractor's License Law 0 1 hire . by certify'that - no excavation five (5) or m3r-efeet in depth intb whichSperson is required to descend,will be r-vt (Chapter 9 (commencing with section 71100) of Division 3 of the Business and Professions Code) or that he is exempt. made de in'coirinection "with work authorized by thispermit, and that no building structure, scaffolding, falsework 'or 4 therefrom and the basis,for the alleged exemption. Any violation of Section 7031.5 by anyapplicantfor a permit8, :�six (36) feet high. (Chap 3.2, Grp Z Art 2, S6c 341, TitlTitledemolition or dismantling thereof , 'will be more Wan thirty subjects the applicant to a civil penalty of not more than five hundred dollars (5500.): C.A.C.). 'LOT SZ' I. 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 do, work which would require a permit from the Division of 'I structure is not intended or offered for sale (Sec. 7044, Business and Professions. Code: The Contractor's License Industrial Safely, a"s.noted above. Unless such 1 erson 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 . ... ' " _, I . P .. 4 - . I through his own employees, provided that such improvements are not intended or offered for sale: It, however: the .0 Division of Industrial Safely Permit No. building or improverrint is sold within one year of completion. the owner-bluilde.r will have the burden of proving thati- Date _-Applic,nV-- he did not build or. improve for the purpose of sale:)!;, CONSTRUCTION LENDING AGENCY: I hereby alliin that.there is i'constiuction lending agency for the performance' 4 0A.'as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec.,- of th6 work for which this permit is issued (Ser- 3097, Civ.'C.). 7044. Business and Professions Code: The Contractor's License Law does not apply 16 an owner of property who Lender's Name d* -builds or improves thereon, anwho contracts for such projects with a contractor(s) licensed pursuant to the:. Contractor's License Law.):. Lender's Address 0 1 amexempt undei Sec.: B. & P.C. (Attached Certificate): I certify that) have read this application and stae that the above information is correct. I agree to comply with all Date Own . er city and county ordinances and state laws relating to building construction, and hereby authorize representatives • or this county to'ehter upon the above-mentiorf!d property for inspection purposes.- WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a -• . . . . . —, . :. .1. 1 -, . . . . I.. . . . .certificate of Workers' Compensation Insurance -,*or a certified'copy thereof (Sec., 38004ab.X.). 'Signature of Applicant or Agent Date Poli(iy.No,. Company, CERTIFICATE OF *COMPLIANCE AND AUTHORIZA111ON OF ENTRY:A certify I have read this appli6ation and statethat 0 Certified copy is hereby furnished, the information given.is correct. I agree to comply,with all state laws and county'ordinances relating to buidling - ittrthe'City Ouil'ding,lnspectio 00epaftm I irtifield-copy-is filed w r 'eht,or Cityy ;Q — Department. 01-K construction, and authorize a 'representative of fthe City of La Ouinta Department.of Building and Safety to enter - 16 - L/ - — - — - - — — upon the,property for which 1,have applied for [his permit for the purpose of making inspections. - Date.: Applicant Signature of Applicant or Agent Date APPLICANT NAME (L. -F: M1) ..,y, Corporatillon ADDREUSS r* 9 I Box 780 CITY/COMMUNITY/STATF:/ZIP La %JWnta-,,.CA 92253 JOB SITE ADDRESSfSPACE 50-021 Avenida Vista Badta- CITY/CCMMUNITY/STATE/ZIP La Quintap,CA 92253 BOK. - PAG PRC C Plan Check Fee TWN• FIND. SE. - S. TRACT 144961 LOT 126 5.75 Pluabing Fee MOD P-2 SB 30000 TRACT NAME Santa Rosa Cam OWNER NAME (L. F. Mi) CONTRACTOR -FIRM NAME Se -m As m ADDRESS CITY/COMMUNITY/STATE/ZIP'. PHONE 0 -564-1315 t,:77 Ott t 9 LICNC 0 333762 city MN'Z ARC/ENG FIRM NAME ADDRESS CITY/COMMUNITY/STATE/ZIP PHONE 0 Fs, -1,r-61.17". LICNC USE.OF PERMIT S/F/D with Attached Cage BIL 'ZON FSB SSB '0 _SSB RSB OFC ZONE ORD# 'LOT SZ' END i SIDE Print Applicant/Agent Name APPUPRMT11. 3 1L: 41 2--.748-83 Pe=;Lt to cmstn=t 1,0812 Sq. Ft. of, S/P/D with Attached Garage Ndrhani cal .1 Me $ 31,00 Plan Check Fee 242A5 Cmv�t�m Fee ectricaI Fee 31.o25. SM1 Fee 5.75 Pluabing Fee `48.510 Property Development Fee 30000 t,:77 Ott t 9 city MN'Z TOTAL yr FEE - : Fs, -1,r-61.17". _,tot �Zo 0:. q to BLDG. DEPT' •tA: VALUATION_ $, 79,103.2'. Ah F-1 NO. OPERATION I v TE INSPECTOR NO. OP TION DATE INSPECTOR BUILDING APPROVALS I 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 % 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 % �0 25 Final Tank Pit L. Line ELECTRIC APPROVALS REAR OF PROPERTY LINE P I L PyI STREET NAME 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service 32 N Final