0432 (SATT)PERMIT APPLICATION
City Of La Og a
Department of Building and Safely
ADDRESS
. B= 780 .. . .
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
This permit becomes void if work not commenced within 160 days from date of issuance, OR, if work has been suspended or abandoned for a period of 180 days.
CITY/COMMUNITY/STATE/ZIP
La Qzinta, CA 92253
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
LICENSED CONTRACTORS DECLARATION: 1• hereby affirm that •I am - licensed under provisions of Chapter 9
the permit is for one hundred ($100) o, less. I certfy 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 so 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 Certi Rcate 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 nust forthwith_comply with such provisions or this permit shall
be deemed revoke.6.
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires.a permit to
SB
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 asigned statement that he is licensed pursuant to the provisions of the Contractor's License Law
0 hereby certify that no excavation five (5) or more feel,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 Cade) 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. basis for the alleged exemption. Any violation of Section 7031:5 by any applicant for a permit
demolitioh:ordismantling thereof, will be more thEwthirty-six (36) feet high. (Chap 3.2, Grp 2 Art2, Sec341, Title8.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
C.A.C:)'I
O 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 t', 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
Andustrial 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
LICNC
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 year of completion, the owner -builder will havetheburden ofproving that
Date Applicait
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. 3097, 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.
OFC
Contractor's License Law.).
Lender's Address
0 1 am exempt under'Sec. .8. 8 P.C. (Attached Certificate).. .
I certify that I have read this application 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 building construction, and hereby authorize representatives
END
of this county to enter upon the above-mentioneo 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
CERTIFICATE OF COMPLIANCE AND AUTHORIZATIrN OF ENTRY: I certify I have read this application and state that
0 Certified copy is hereby furnished. ,
ri ° �
the information given is correct:.tagree to compl.- with all state laws.and county ordinances relating to buidling
t
f'E3.Certilieo copy is)filed wn t>e City Building.lnspecti n Department or Clty 1 •-' Department.
f [ �t P f s o1 I ��
construction, and authorize a' representative of the City of La Ouinta Department of Building and Safety to enter
upon the property for which I have applied for tY s permit for the purpose of making inspections.
%Date � Applicant. r
,
-
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPLICANT NA}�M_ E(L, F, MUI � 1
ADDRESS
. B= 780 .. . .
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
JOB SITE 50-031 RESS/SPAC1E. _ Vista Bcnil'
{f•�
CITY/COMMUNITY/STATE/ZIP
La Qzinta, CA 92253
BOK
PAG
PRC
C
Pian Check Fee
TWIN
RNG
SE
S
TRACT
14496-1
LOT.
125
7.39
Plu*ming Fee
MOO
P,-3
SB
TRACT NAME '
Rfi#li Santa RDsa Cave
OWNER NAME (L. F. MI) ,
CONTRACTOR -FIRM NAME
Sam AsLT7ii•ArJrYwrC..
ADDRESS
CITY/COMMUNITY/STATE/ZIP -
PHONE r
564-1315
II
1.135
333?62
'
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP ,
PHONE •
LICNC
% OF PERMIT
wiith Attached Garage
BL
ZON
FSB
SSB
SSB
.RSB
OFC
ZONE ORD
' LOT' SZ
END
,SIDE
APPUPRMT 0437,12DATE
228-•s3
S/F/D
P=&t to construct -4,F326 Sq. Ft. of S/FVD
vrith Attached Garam-
m:c�' Fee $
31.00
Pian Check Fee
291.20
Construction Fee
448.00
Elec ri,cal Fee
31.25
SMI Fee
7.39
Plu*ming Fee
' 52.50
Property Development Flee 450.00 •
R very Fr +C E u r% f_rra
vLV
'TFEEL
$ 1,311.34
BLDG. DEPT. VALUATION $105,699.40
Ah
Adk
NO.
OPERATION ATE INSPECTOR
NO. OPM ATION 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
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
/
�
lll4� 1 i
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb 46-
16
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
PSL 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