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0168 (SFD)PERMIT APPLICATION / 5D � U SA U'6' City of La Duinta Department of Building and Safety 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. 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 Lic. Number )ate Contractor 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.): 0 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, 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 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.). 0 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.). 0 1 am exempt under Sec. Date Owner B. d 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 O ertified copy is hereby furnished. 0 Certifiedtco�py is find with,I a C' y Building Inspection Depart entor City Department. Date i+1 fy V Applicant 6"s ••' f I ori { /k/. APPLICANT NAME (L. F. MI) La Q uinta 3oint Vonture ADDRESS P.O. Box 780 °T;a°Qi ir��Gap Ca 92253 JOB 5U-»0525�Avenida Vista Bonita CITY/COMMUNITY/STATE/ZIP I,a �uinta, Ca 92253 BOK PAG PRC C TWN RNG SE S TRACT 144 LOT 120 Plan Check Fee 173,00 MOD P-2 SB nroperty Dev. Fce TRACT NAME .:mntatoaa Cove OWNER NAME (L, F. MI) CONTRACTOR -FIRM NAME Anden c.orporatic�n ADDR P,En. nox 780 °La ° �)_uin.ta/,P Ca 92253 P619�-564-13 .5 `331762 TTL ARC/ENG FIRM NAME ADDRESS CITY/COMMUNITY/STATE/ZIP PHONE N LICNC N USE OF PERMIT Si.ngla Family Dwelling BL ZON FSB SSB SSB RSB OFC ZONE ORD N LOT SZ END SIDE CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed it the permit is for one hundred ($100) o. less. I certfy that in the performance of the work for which this permit is issued, I shall not employ any person in any mannEr so as to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certiicate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you nust forthwith comply with such provisions or this permit shall be deemed revoked. DIVISION OF INDUSTRIAL SAFETY PERMIT CERTISCATION: 0 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this Germit and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more tha-i thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2. Sec341, Title 8, C.A.C.) 0 As owner -builder, I will not employ anyone t•, 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. 0 Division of Industrial Safety Permit No. Applicant CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's Address I certify that I have read this application and stateRhat the above information is correct. l agree to comply with all 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. Signature of Applicant or Agent Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATIdN OF ENTRY: I certify I have read this application and state that the information given is correct -1 agree to compl- with all state laws and county ordinances relating to buidling construction and authorize a�,;rejres�tative of Ill a City of La Ouinta Department of Building and Safety to enter upon the poperty 1 �((�h,hh�ave applied fo{�tr s permit for the purpose oMaking" n';pections�f S'gnatGre of Applicant or Agent Date 'r L -V ry . Print Applicant/Agent Name Y APPUPRMT % Permit to conatruct Model P 2* -A myelling 1,390 Sq. Ft. Garage 415 Sq. Ft. Patio Cover 120 SQ, Ft,. Ue ;h, Fee $ 31600 Electric Fee 31,25 Plumbing Fee 48„50 Plan Check Fee 173,00 Building Fee 350,94. nroperty Dev. Fce 300.00 IVED CRY of 0 TTL $934.FEE G9 VALUATION 170,00i5.510 Arrow Printing 250/1-83 White: Finance Canary: Assessor Pink: Applicant Tag: Bldg. Dept. 11 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 0171, 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. ❑ OP'N ADDITIONAL INFORMATION NO. 4 ` ^n ^� S�A� � -¢6L- K'�� g• �`�� SEWAGE SYSTEM SIZE & LOCATION 11 Exterior Lath ��J r• p/- 12 Internal Lath 12A Drywall 13 Finish Grade INSULATION Thick Value 7A Walls (Batts) 12B Ceiling (Batts) 0 12C Ceiling (Blown) 14 Final PLUMBING APPROVALS 15 Ground Plumb 16 Water Piping '117 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 J 32 Final