000987 (SATT),. . r,. r. s•..• ... ... � - , i r ... t.`r^.4 ,'�' =sw•.' 1'�i•��.°.y,��s'7.
.
PERMIT APPLICATION . • *'b ;.'•�•
i�
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 �Cfc�}Nu ber /
Date
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 fill signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
(Chapter 9(commencing with section 7000) of Division 30 the Businessand 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.): a '
O I. as owner o1 the property, or my employees with wages as their sole compensation, will clothe 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•• .
l did,not build or improve for the purpose of sale.).
o 1. 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 contractors) 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 .
❑ Certified copy is hereby furnished.
O Certified copy is filed with the City Building Inspection Department or City •- Department.
Date Applicant
APPLICANT NAME (L. F. MI) C,�
l
ADDRESS '
P.O. Boot 780
CITY/COMMUNITY/STATE/ZIP '•
La Quintal CA 92253
JOB SITE ADDRESS/SPACE '
77-180 Avenida Ferns j
CITY/COMMUNITY/STATE/ZIP
La Ouint.a CA 92253
BOK
PAG
PRC
C TWN--
FIND
SE
S'
TRACT
14496-3
LOTMOD
57 l
36.90
G-3
SB.
01 hereby Certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be
TRACT NAME "
Santa. r4l cbv+e
OWNER NAME (L. F. MI)
Anden
CONTRACTOR -FIRM NAME ,
Anda
ADDRESS
Axxp_ l scant
CITY/COMMUNITY/STATE/ZIP '
AnnUant
PHONE "564-1315 V'�
:s 762
❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of
ARC/ENG FIRM NAME
Barry Bexkus
ADDRESS
1531 Chapala Street
CITY/COMMUNITY/STATE/ZIP -
Santa Barbara, CA 93101
PHONELICNC .
805 963-8901
TOTAL
FEE
USE OF PERMIT
Simla family dwei l itix>r
BL
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
ZON
of the worl for which this permit is issued (Sec. 3097, Civ. Ca.
FSB SSB SSB
RSB
OFC
`
ZONE ORD /
LOT SZ
of this county to enter upon the above-mentioned property for inspection purposes.
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed it
10DA
-x.9-84 S.F.D.
the permit.is for one hundred ($100) o, less. I certify that in the performance of the.work for which this permit is
stele fa—Aly, &telling with attached
issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of'
California.
Date Applicant
26.00
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'
291.20
Compensation provisions of the Labor Code, yowmust forthwith Comply with such provisions or this permit shall'
448.00
be deemed revoked.
36.90
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
Y
01 hereby Certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be
73,00
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework'or
•.
demolition or dismantling thereof. will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341. Title B,
C.A.C.)
r.
❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of
...�$��
Industrial Safety; as noted above, unless such person has a permit to do'such work from that division.
BUILDI GF EPA TLA M NT
Division of Industrial Safety Permit No.
TOTAL
FEE
.. Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
y
of the worl for which this permit is issued (Sec. 3097, Civ. Ca.
ti
Lender's Name
Lender's Address
`
. I certify that I have read this application and state that the above information is correct.) 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 g Ven -is cdrtect. I agree to comply with all state laws and county ordinances relating to buidling
construction, an;,aul'hl' ze a'reprresentative of the City of La Duinta Department of Building and Safety to enter.
(Upon e pIrope`. y for which I have applied for this permit for the purpose of making inspections.
?:.ice •.�i�
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPL/PRMT n fl ■
10DA
-x.9-84 S.F.D.
Permit to construct 2,326 sq. ft. of
stele fa—Aly, &telling with attached
garage •
Meeh. Fee
26.00
Plan Check Fee
291.20
Const. Fee
448.00
Elect. Flee
36.90
SMI Fee
7.89
Plumbing Fee
73,00
Prop. Devfel. Fee
450.00.
...�$��
BUILDI GF EPA TLA M NT
"
TOTAL
FEE
1.332.49
VALUATION 105,867.60
BLDG. DEPT.
NO. OPERATIONATE INSPECTOR NO. OP ATION DATE INSPECTOR A
BUILDING APPROVALS MECHANICAL APPROVALS
1 Set -Back 33 Ventilation System
2 Ftgs & Frms 34 Plenums & Ducts ~
2A Slab Grade 35 Furnace Compart. u
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. ❑ NON ADDITIONAL INFORMATION
11 Exterior Lath
12 Internal Lath
12A. Drywall
13 Finish Grade
INSULATION Thick R„
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final I_
l�tAp
PLUMBING APPROVALS
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 nvn��w• �wwt�wu
ELECTRIC APPROVALS
26 Power Pole,
27 Conduit:
28 Service Entrance,:
29 i Wiring
29A Ground'ng�Wif;'j',(
29B Bonding
30 Fixtures',:,'.
31 Service
32 Final
Tank Pit- L. Line
REAR OF PROPERTY LINE
STREET NAME