000981 (SATT)PERMIT APPLICATION' '
City lit 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. g',
License Class ♦ �'"-LTe> u be
Date 42 i�rl 't�/+ Contractor 's
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. B. & P.C. (Attached Certificate).
Date Owner v 4 '
WORKERS' COMPENSATION*DECLARATION: I hereby affirm that I have a certificate of consentito self -insure, or a
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. IC.� A
Policy No. I Company
O Certified copy is hereby furnished.
0 Certified copy is filed with the City Building Inspection Department or City I Department.
Date Applicant
APPLICANT NAME (L. F. MIt,__ �___ WkP
�Box
ADDRESS P.O.
TonoV
.CITY/COMMUNITY/STATE/ZIP
La Qui nta, CA 92253
JOB SITE ADDRESS/SPACE
77-140 Avenida Fernando
CITY/COMMUNITY/STATE/ZIP
,a (mix)l'ta w CA 92253
BOK
PAG
PRC
C
TWIN
RNG
SE
S
•�;
TRiA, C`�T496-3
LDT53
Elect. Fee
36.90
MEP-3
SB
. .
TRACT NAME
Detrol res
OWNER NAME (L. F. MI) -•
� P,ra
CONTRACTOR -FIRM NAME t
Arxi
ADDRESS
e :
CITY/COMMUNITY/STATE/ZIP '
above
PHONE •
LICNC
564-1315
333762
ARC/ENG FIRM NAME Der1'fYA
uu iS
ADDRESS
1531 Qzapatla Street
CITY/COMMUNITY/STATE/ZIP
Santa Barbara, CA 93101
PHONEM
805 963-890
LICNC .
1
USE OF PERMIT '
Single FMm y Dwellim
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 if
the permit is for one hundred.($100) o. less. I certify that in the performance of the work for which this permit is
issued, I shall not employ any person i n any manner so as to become subject to the Workers' Compensation Laws of
California.
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'
Compensation provisions ofd the Labor Code, you must forthwith comply with such provisions or this permit shall
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
0 (hereby certify that n o 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 permit, and that no building structure, scaffolding, falsework, or
demolition or dismantling thereof; will be more than thirty-six (36) feet hidh. (Chap 3.2, Grp 2. Art 2, Sec 341, Title 8.
C.A.C.) . :,a % n,.
0 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.
0 Division of Industrial Safety Permit No.
Date -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. Q.
Lender's Name
Lender's Address
certify that I have readlhis appliaation and state that the above information is correct. I agree to comply with all
city and county ordinances andstate 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 Date "
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
the information giveni's•correctrl agree to comply with all state:laws and county ordinances relating to buidling
construction, and a thorize a representative of the City of La Duinta Department of Building and Safety to enter
•upon the property for -which l havve`applied for this permit for the purpose of making inspections..
Signature of�Appt ant or Agent Date
Print Applicant/Agent Name .
APPUPRMT
]Fo�rmit �o�c22aa tyyi=t, 2.326yy{�s�a . ft. Of
'~'TR!</Ca1_p familm (P#teUina with attach .
t�AlTt"�ir� �
rr
Mechanical Foe
26.00
Plan Check Free
291.20
Const. Fee
448.00
Elect. Fee
36.90
CW
7.399
Detrol res
450.,010
MSS
I�
P LArr;IrJT
e :
TOTAL '
FEE
T.331 AG
VALUATION 105,867.60
'e.
r 1
NO.
OPERATION I '—'TA' TE
INSPECTOR
NO.
OP 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.
❑
NO
ADDITIONAL INFORMATION
a��q"
SEWAGE SYSTEM SIZE &LOCATION •
11 Exterior.Lath Joi
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick RI
.
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 ,7
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
------------
25 Final
-
Tank Pit v L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
P/.L P/L
STREET NAME
26 Power Pole.
27Conduit
28 Seivics.}ivance,
29 Wiring
296 Bondirig.,:
30 '."'%Aures
31 Service .
32 Final