0807 (SATT)PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
This permit becomes void it work not commenced within 180 days from dale o1 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 ellect.
License Class
Contractor
Lic- Number
OWNER -BUILDER DECLARATION: I hereby affirm that I at 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 Thal 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 (S500.):
❑ 1, 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 properly 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 havethe burden of proving that
he did not build or improve for the purpose of sale.),
❑ I, as owner of the properly, 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 contraclor(s) licensed pursuant to the
Contractor's License Law,)-
❑ 1 am exempt under Sec:
Date
Owner
B. & 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-
• Certilied copy is hereby furnished-
❑ Certified copy is filed with the City Building Inspection Department or City Department.
Date_ Applicant
APPLICANT NAME (L. F. MI) 1LLL\ i CORP •
UV
ADDRESS ./ 1 1000
CITY/COMMUNITY/STATE/ZIP CC
Su Otiilr'`- , r-1 2253
JOB SITE ADDRESS/SPACE
I
CITY/COMMUNITY/STATE/ZIP
BOK
PAG
PRC
C
TWN
RNG
SE
S
TRACT �r�
LOT
MOD
SB
Unit 2a—
V V
TR�AyCT NAME /� ��yy��
Ai•.. T,fja �-L'Qta rmae 1 •-
OWNER NAME (L. F. MI)
1.7.1-at Corp.
CONTRACTOR -FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP /�+� g
92" 53
PHONE N +} (�
LICNC N
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE N
LICNC N
USE OF PERMIT
"Y.e •t. 111rTrb. Build
BL
ZON
FSB
SSB
SSB
RSB
OFC
ZONE ORD N
I
LOT SZ
I I
I END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE: This section need not be completed if
the permit is for one hundred (S100) o, less. I certify 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.
Dale Applicant
NOTICE TO APPLICANT: 11, alter 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 CERTIFICATION:
❑ 1 hereby certify that no excavation live (5) or more 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 than thirty-six (36) feet high (Chap 32, Grp 2, Art 2, Sec341, Title&
C.A.C:)
❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of
Industrial Safely, as noted above, unless such person has a permit to do such work from that division.
❑ Division of Industrial Safety Permit No.
we. Applicant
CONSTRUCTION LENDING AGENCY: I hereby alfirm 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 certily that I have read this application and stale that the above information is correct. I 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 -mentioned property for inspection purposes.
Signature of Applicant or Agent Dale
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
the information given is correct, I agree to comply with all state laws and county ordinances relating to buidling
construction, and authorize a representative of the City of La Ouinta Department of Building and Safety to enter
upon the properly for which I have applied for this permit for the purpose of making inspeclioons.
Signature of Applicant or Agent Dale
Print Applicant/Agent Name
APPL/PRMT
6 2T5-84
comb.
f ermit to Build
2349 Sq. Ft.
~ Condom1.2iuim
Mech. fee
28.00
Plan Check Fee
284.7U
35.54
S.iT Fee
7.11
-'limb. Fee
55.50
Prop. Devl Fee
450 0G
Al
g r
TOTAL
FEE
VALUATION
BLDG. DEPT.
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
1
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
%�
�f{
35
Furnace Compart.
3
Steel
S
G
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
1
38
Compressor
6
Roof Deck
a
39
Appl. Clearance
7
Framing
40
Fire Damper
8
Vents
41
Smoke Detection Device
9
Garage Fire Wall
1
42
Commercial Hood
10
Fireplace P.L. ❑
43
Final
10A
fireplace T.O. ❑
NON ADDITIONAL INFORMATION
1
1
SEWAGE SYSTEM SIZE & LOCATION
11
Exterior Lath
( /
�TT
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
p
16
Water Piping
17
Rough Plumb
�Q
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
PjL PII
STREET NAME
26
Power Pole
27
Conduit
28
Service Entrance
29
Wiring
29A
Grounding Wire
29B
Bonding
30
Fixtures
31
Service
32
Final