000991 (SATT)PERMIT APPLICATION "
City of La Ouinta
• Department of Building and Safety
This permit becomes void it 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 Sof the Business and Protessions•Code; and my license is in full force
and effect.
License Class- Lic. Nl/Inb1er�1�
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 lile 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 30t 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 (5500.):
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.). r :'
1 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. •
iPolicy No. Company
0 Certified copy is hereby furnished. e
0 Certified copy is filed with the City Building Inspection Department.or City Department.
Date Applicant
APPLICANT NAME (L. F. MI)-
ADDRESS'
P.O. Boat 780
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
JOB SITE ADDRESS/SPACE
77-200 Avenida Fernando
CITY/COMMUNITY/STATE/ZIP -
Ia Quin*a, CA 92253
BOK
PAG
PRC
C
-
TWN
RNG
SE
S
TRACT
14496-3
LOT-
59
SMI Fee
1 1
MOD
Cm -1
SB
Pzcperty Deis, Fee
TRACT NAME
Santa Imsa Cbw
OWNER NAME (L. F. MO L'rklen '
CONTRACTOR -FIRM NAME '
Atm
ADDRESS
abam
CITY/COMMUNITY/STATE/ZIP -
abme
PHONE •
564-1315
TOTAL
FEE
LICNC •
333762
-
ARC/ENG FIRM NAME
Ba=y Berkus
ADDRESS 1531 Chariala Street
CITY/COMMUNITY/STATE/ZIP
Santa Barbara. CA' 93101
PHONE •LICNC
805 963-8901
USE OF PERMIT
• Siwle family d llina
8L
ZON
FS8
sse 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 in any manner soas 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 Labor Code, you must forthwith comply with such provisions or this permit shall
be deemed revoked. / V"
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
0 1 hereby certify tfiat 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, falsework, or
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2. Sec341, Titlell.
C.A.C.) "
0 As owner -builder; I wilf 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 Divisign.of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
s, 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 buildingconstruction, 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•correct agree to comply with all state laws and county ordinances relating to buidling
construction, and a ah6ofize'a'representative of the City of.La Ouinta Department -of Building and Safety to enter
/ upon the proyperti for which'I have applied for this permit for the purpose of making inspections.
� /!�f - � •- • �-� '�%'cam-�'✓
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPL/PRMT ■ K ri l7!):DA
10-17'84 S.F.D.
Permit to cimstnictt 2,758 sq. ft. of
single family filling with attached
garage,
t
Mech. Fee
26.06'
Plan Ck Fee
326.95
Const. Fee
503.00
Elect. Fee
42.16
SMI Fee
8.93
Plumbing Fee
73.00
Pzcperty Deis, Fee
450,00
V EL
ad" Q a LUfNTA • .. .
t9.
TOTAL
FEE
•i Q
VALUATION
BLDG. DEFT.
Ah
NO.
OPERATION ATE
INSPECTOR
NO.
OP ATION I 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
f
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.
❑
OP N
ADDITIONAL INFORMATION
-
SEWAGE SYSTEM SIZE&LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 ,Finish Grade
INSULATION Thick R
Value.
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
147 Final
PLUMBING APPROVALS
15 Ground Plumb rj
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
i
Tank Pit L.. Line `
ELECTRIC APPROVALS.
REAR OF PROPERTY LINE
P/L P/L
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29, Wiring .
29A Grounding.-%( e; m
298 Bonding, �"
30 Fixtare5'i
31. Service
32 Final'