000990 (SATT)PERMIT APPLICATION
City of La Ouinta
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 period of 180 days.
LICENSED CONTRACTORS DECLARATION:,1'hereby affirm thatbl 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. t f
License ClassLic. umbe
Date. �r %j Contractor- % ��
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.lo its issuance, also requires the applicant for
such permit to file a signed statement that.h a is licensed pursuant to the provisions of the Contractor's License Law
(Chapter.9 (commencing with section 7000) o1 Division 3 o1 the Business and Professions Code) or thathe is exempt.
,T, 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 (S500.): 1. .
I 0 I, as owner of the property. or my employees with wages as their solecompensation, 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. It, however. the _
building or improvemnt is sold within one year of completion, the o�yner-builderwill 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. 8 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.
0 Certified copy is filed with the City Building Inspection Department or City Department. `
Date Applicant
APPLICANT NAME (L. F. MI) .
ADDRESS
P.O. Box 780
CITY/COMMUNITY/STATE/ZIP
Ta aiinta. M 1Q2P1;3
JOB SITE ADDRESS/SPACE
CITY/COMMUNITY/STATE/ZIP
la Qufnta. CA 92253
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PRC
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TT4T496-3
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291.20
CW3
SB
TRACT NAME Santa lbsa (�^_=__
OWNER NAME (L. F. MI) L"![I.�CIl ., ••
CONTRACTOR -FIRM NAME '
en
ADDRESS abme -
CITY/COMMUNITY/STATE/ZIP.
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PNDN56
Plumbing Free
`I4-1315 333762
ARC/ENG FIRM NAME Barry Berkm
ADDRESS 1531 •Chapala Street
CITY/COMMUNITY/STATE/ZIP
Santa Barbara, CA 93101
PHONE .
805 963-8901
-LICNC .
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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 Labor Code, 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, falsework, or.
demolition'or dismantling thereof, will be more than thirty-six (36) feet high, (Chap 3.2,.Grp 2, Art 2, See 341. 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
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. t
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 1 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
co struction, a authorize a representative of the City of La Ouinta Department of Building and Safety to enter
upon the prop Et for w,Kich I have applied for this permit for the purpose of making inspections.:
Signatureeot`Applicant or Agent Date
Print Applicant/Agent Name
APPVPRMT "Ong
DATE
lr�•-19-84
S.F.D.
Pei nit W 6cnitnxct 2,326 sq.
ft. of
single family f1mlling withattalcPbed
garage.
t
Meeh. Fee
26.00
Plan Check Flee
291.20
Cm st. Fee
448.00
Elect, Flee
36.90'
SMI Fee
7.39
Plumbing Free
73:00
Prop. Devel, Fee
450,00
'Ali,
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Per
816,'i7n OF
EP �'AiF�
•U
TOTAL .
FEE.;
q
BLDG. DEPT.
VALUATION 105,867.60
-.
s
Ah
Ak
NO.
OPERATION ATE INSPECTOR
NO: OPRATION 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 a
.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
r
Final
'10A
Fireplace T.O. ❑
NON
ADDITIONAL INFORMATION
/
;
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior. Lath
12 Internal Lath
12A Drywall
03 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
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final
Tank Pit L. Line
ELECTRIC.APPROVALS
REAR.•OF PROPERTY LINE
PSL Pi
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring ..<
29A Grounding Wire;,
29B Bonding:
30 Fixtures.
31 ervice-*"`
32 Final