0170 (SFD)PERMIT APPLICATION
City of La Duinta
Department of Building and Safety
This permit becomes void it work not commenced within 180 days from date o1 issuance, OR, if work has been suspended or abandonec for a period of 180 days.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
and effect.
License Class
Contractor
Lic. Number
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for
such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) or that he is exempt
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
O I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License
Law does not apply to an owner of property who builds, or improves thereon, avid who does such work himself or
through his own employees, provided that such improvements are not intended or offered for sale. If, however, the
building or improvemnt is sold within one year of completion, the owner -builder will have the burden of proving that
he did not build or improve for the purpose of sale.).
❑ I, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec.
7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
❑ 1 am exempt under Sec.
Date Owner
B. 8 P.C. (Attached Certificate).
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.).
Policy No. Company
; [D Certified copy is hereby furnished.
❑ Certified co y is filedizwith the City Building Inspection De mentor 11 Department.
Date i VAPPlicant /! �.!/Z
r
APPLICANT NAME (L. F, MI)
T,:1 'g1a nt a .1n nf- tent-t,Irn
ADDRESS
P.O. Box 780
CITY/COMMUNITY/STATE/ZIP
La (:,uinta, Ca 92253
JOB SITE ADDRESS/SPACE
0--032 iWcnida Uinta Bonita
CITY/COMM UN I TY/STATE/zl P
Iia ?uinta, Ca 92253
BOK PAG
PRC
C
1.12 Sol. Ft.
TWN
RNG
SE
S
TRACTLOT
14996-1.
122
Plumbing roe
48.50
MOD
p--1
se
Building r'e a
TRACT NAME '
Santa 1�osa Cove
OWNER NAME (L. F. MI)
CONTRACTOR -FIRM NAME
Anden Corporation
ADDRESS
P.O. Dox 780
CITY/COMMUNITY/STATE/ZIP
Y/COMQM, u Ii /nST�ATaE/ZIPCa 9 2253
PHONE MLICNC
619--564-1315
N
333762
1111 fl
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE M 1
$1,107.54
1 LICNC N
USE OF PERMIT
6 ingle Family feel ling
BL
I
I ZONFSB
SSB
SSB
RSB
OFC
ZONE ORD N
LOT SZ
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COM'ENSATION INSURANCE: This section need not be completed if
the permit is for one hundred ($100) o, less. I certiti that in the performance of the work for which this permit is
issued, I shall not employ any person in any mannerso as to become subject to the Workers' Compensation Laws of
California.
Date
Applicant
NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFI;ATION:
❑ 1 hereby certify that no excavation five (5) or mor :feet in depth into which a person is required to descend, will be
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
demolition or dismantling thereof, will be more that- thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec341, Title B.
C.A.C.)
O As owner -builder, I will not employ anyone to do work which would require a permit from the Division of
Industrial Safety, as noted above, unless such person has a permit to do such work from that division.
❑ Division of Industrial Safety Permit No.
Applican-
CONSTRUCTION LENDING AGENCY: I hereby affirm :hat there is a construction lending agency for the performance
of the work for which this permit is issued (Sec. Z)97, Civ. C.).
Lender's Name
Lender's Address
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating :o building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for inspection purposes.
Signature of Applicant or Agent
Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATIOW OF ENTRY: I certify I have read this application and state that
the information given is correct. I agree to complywith all state laws and county ordinances relating to buidling
construction; anduauthorize a -representative of the City of La Ouinta Department of Building and Safety to enter
upon ytliVropertyf//fo wjhlch have°applied for-forfor the purpose of ing ins' pections.,,
Signature of Applicahhor Agent Date
l!
Print Applicant/Agent Name
APPL/PRMT J 7 11 f�
'tilt d id
DATgE
�."i6"'83
Parmit to construct
e' odel P -1--L
Dwelling 1,481 Sq. rt.
Garage
41:23 Jig. Ft.
<-Oatio Cover
1.12 Sol. Ft.
:•tech. Fee
$ 31.00
%lactr ical Fee
31.25
Plumbing roe
48.50
Plan Check Foe
160.50
Building r'e a
366.29
Property Dev. Fee
1550.00
t F. C F� I V r- i=.Ir /A\
jUN20198
1111 fl
city of La uinta
TOTAL
$1,107.54
VALUATION y 75, 024.00
Arrow Printing 250/1-83 White: Finance Canary: Assessor Pink: Applicant Tag: Bldg. Dept.
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
�'� �9
�f7r
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.
❑
NO. ADDITIONAL INFORMATION
NO.
/ �% (1] OAC
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath �0 7
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
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 f�
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
P/L p/1
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures 'y
31 Service
32 Final ^