0871 (SFD)PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
5`i- `6(-a I✓
' 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.
he did not build or improve for the purpose of sale.). ,
O 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.).
O 1 am exempt under Sec. . B. & P.C. (Attached Certificate).
' Date Owner'
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 Certified copy is hereby furnished. . a .
�-O Certified copy is filed with the City Building Inspection Department or City •" - Department.
Date %.r/. / I� Applicant�-
APPLICANT NAME (L. F. MI)
Rick Johnsm
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
LICENSED CONTRACTORS DECLARATION: I hereby. affirm that I. am licensed under provisions of Chapter 9
the permit.is for one hundred ($100) o. less.,) certify that in the performance of the work for which this permit is
(commencing with Section 7000) of Division 3 d 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. — _> IC.
i'' — >/�' l
California.
License Class Lic. Number > Date Applicant
Date �S .�/ i� -Contractor .� y t� — — r . .,..... NOTICE TO APPLICANT: If, after making this Certificate 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 . `r,
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which -requires a permit to .
be deemed revoked.
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:, .
such permitto file asigned statement that he.is licensed pursuant to the provisions of the Contractor's License Law .'
•01 hereby certify that no excavation five (5) or more fiet 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 Code) 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;,, -
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, An 2, Sec341; TilleB:
subjects the applicant to a civil penalty of not more than five hundred'dollars ($500.): .t J,; a .
C.A.C.)
O I, as owner of,the property, or my employees with wages as their sole compensation, wjjl do the work, and the - -
O As owner -builder,`] will not employ anyone to 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 -
Industrial 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 ori
+ w
through his own employees, provided that such improvements are not intended or offered for sale. If, however, the
O Division of Industrial Safety Permit No.
building or improvernm is sold within one year of completion, the owner -builder will have the burden of proving that
Date Applicant
he did not build or improve for the purpose of sale.). ,
O 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.).
O 1 am exempt under Sec. . B. & P.C. (Attached Certificate).
' Date Owner'
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 Certified copy is hereby furnished. . a .
�-O Certified copy is filed with the City Building Inspection Department or City •" - Department.
Date %.r/. / I� Applicant�-
APPLICANT NAME (L. F. MI)
Rick Johnsm
ADDRESS 53-740 Avenida Raddrez
CITY/COMMUNITr/ST,A� T�EIZI,P,.� -
ta, CA
�Aveni&
(_•�
}9�2�2�53
JOB SITE ADORESS/SPiCiC=8660 Diaz
CITY/COMMUNITY/STATE/ZIP
QQ . Sta, .CA 92253 "
774
PAG
Lit
PRC
Y/V6BOK
CC
TWN
RNG
SE
S
TRACT
LOT
Plan ds. Fee 244.40
MOD
Sla
'
TRACT NAME -
OWNER NAME (L. F. 11• jOyUI^(D„•t1
A
CONTRACTOR -FIRM A�1•,-ME_ �- J h, ro Omstraction
ADDRESS abo
CITY/COMMUNITY/STATE/ZIP
PHONE . I I
I
LICNC
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE •
LICNC 8
'
USE OF PERMIT Single family ctlalelling "
BL
ZON
FSB
SSB
SSB
RSB
OFC-,
ZONE ORD a
LOT SZ'
END
SIDE
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.).
r
Lender's Name ! (,'-'n,! 4-� In%✓=. L rC_
Lender's Address a^' �" ✓ r
i
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 to building construction, and herebyauthorize representatives
of this county to enter upon the above-mentioned property for inspection purposes. "
Signature of Applicant or Agent Date
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 property for,which'I have applied for this permit for the purpose of making inspections. ••
Signature.of Applicant or Agent / • Date '
f
Print Applicant/Agent Name
APPL/PRMT DATE
17424-84
permit to co�nstnact 1592 sq.
ft. of
single-family dwelling and 91
sq. ft.
of porch and 430 sq. ft. of
garage as per appznvled plan.
Mesh. Fee 22.00
Plan ds. Fee 244.40
Omst. Fee 376.00
Elect. Fee 43.13
SMI Fee 5.64
Plumbing Fee 50.50
Prop. revel. -Fee 450.00
1,191.67
451
TOTAL
FEE
✓,� 6 7
BLDG. DEPT. VALUATION 1 80,628.80
26 Power Pole (J
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32_ Final
STREET NAME
{
NO.
OPERATION DATE INSPECTOR
NO.
OPERATION DATE INSPECTOR" "
BUILDING'APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System _. F
2
Ftgs & Frms
i
34
Plenums & Ducts j
2A
Slab Grade
35
Furnace,Compart.
3 ..
Steel
36
Inlets &Outlets r
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor r
6
Roof Deck
I
39
APpl. Clearance
7
Framing
40
Fire Damper•
8 -
Vents'.
41
Smoke Detection Device J '
9
Garage Fire Wall'
42
Commercial Hood -
10 •.'
Fireplace P. L.
❑
43
Final
10A •
fireplace T.O.
❑
NON
ADDLTIONAL.INFORMATION'
� �I
/�11V
SEWAGE.SYSTEM'SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
j 12A Drywall ..
13 Finish Grade
INSULATION Thick R"
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPRQ ALS
" 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
25 Final
Tank Pit L. Line
ELECTRIC APPFIOV,ALS
REAR OF PROPERTY LINE
26 Power Pole (J
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32_ Final
STREET NAME