000982 (SATT)PERMIT APPLICATION
• City of La Og a •
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: .1 hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3of the Business and Professions Code, and my license is in full force
and effect.
-1
License Class Lic. Numb
t bo
Date • A!•• Z-1�4 'Contractor
v
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 w ith section 7000) of Division 3 of the Business and Professions Code) or that he is exempt
therefrom and -,(he 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 thanAive 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
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. Q.
Policy No. Company
O Certified copy is hereby furnished.. .. -
0 Certified copy is filed with the City Building Inspection Department or City Department.
Date - Applicant
APPLICANT NAME (L, -F. MI) -
per,.
ADDRESS P.O. Box 780
CITY/COMMUNITY/STATE/ZIP la ar` into, Cil 92253
JOB SITE ADDRESS/SPACE 77-160 AvenidaFernando
CITY/COMMUNITY/STATE/ZIP TA u+u/ C+ 92253
BOK
PAG
PRC
C
SMI Fee 7.39
TWN
FIND
SE
S
TRACT
1449643
LOT
55
MOD
G-3
SB
TRACT NAME Santa Ibisa' Cow -
OWNER NAME (L. F. MI)
Ajilftte
CONTRACTOR -FIRM NAME !9rkletl '
ADDRESS abwe
CITY/COMMUNITY/STATE/ZIP abme
PHONE •LICNC
564-131.5
333762
ARC/ENG FIRM NAME .w'
Barry Berk
ADDRESS
1531 Chapala Street
CITY/COMMUNITY/STATE/ZIP
Santa Barbara, CA 93101
PHONE .LICNC
805 963-801
.
USE OF PERMIT
Single FaaUy M ellinq
BL
ZON.
FSB
SSB
SSB
RSB
OFC,
ZONE ORD w
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•in 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 of the LaborCode, you must forthwith comply with such provisions or this permit shall
• be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
0 I 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 permit. -and that no building structure, scaffolding, lalsework, or
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2. Grp 2i Art 2. Sec341. Title 8,
C.A.C.)
0 As owner -builder, I will not employ anyone to do work which would.require a permit from the Division of
Induslrial-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. 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 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 given is co rte. I agree to comply with all state laws and county ordinances relating to buidling .
construction, and .auttiorize a'representative of the City of La Ouinta Department of Building and Safety to enter
uon th operty oi'hhave'applied for this permit for the purpose making inspections.
Signature of4p6licant or Agent Date
Print Applicant/Agent Name
APPL/PRMT "OnqRZDATE
10-19-84 S.F.D.
Pwdt to oanstruct 2,326 sq. ft. of
singlf a
emily dolling with attached
garage.
mechanical Fee 26.00
Plan Check.Fee 291.20
Const. Fee 8B 448.00
Elect. Fee. 36.90
SMI Fee 7.39
, Pluanbing Fee 73.00
Devel. Fee 450.00
RECEIVF-
7, .
Ell q;I'%lk(:'iL!' 901 Jf NT
TOTAL
FEE
1.332.4r
BLDG. DEPT.
VALUATION 10.5.P�7_'
NO.
OPERATION ATE INSPECTOR
NO.
OPe 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
a J _
36'
Inlets.& Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
39,
Appl: Clearance
7
Framing
a
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
NO.'
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
t3 Finish Grade
INSULATION Thick R
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 3 ��
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
P P/L
STREET. NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wihwg;
29A Grouridiriq,Vyire .;^!
29B Bonding '
30 Fiztures�-,' ; =
31 !e, ici
32 Phial'
s-