000893 (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 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. '
License Class- Lic. Number
Date 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 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).o1 Division 3 o1 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.):
• O 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 i mprovemni 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.).
O 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.).
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. ^•""^e
O Certified copy is hereby furnished.
❑ Certified copy is filed with the City Building Inspect` io D f rttmeet�•orGi" , Department.
Date-�Applicant_ '1
V
APPLICANT NAME (L. F, MI)
Arkit-n terA
ADDRESS
P.O. Boat 780
CITY/COMMUNITY/STATE/ZIP
La iSAnta - M 42253
JOB SITE AOORESS/SPACE
77-225 AA,xt y,nilrlA FN+rnal x3n
CITY/COMMUNITY/STATE/ZIP -
T,A ("w6lrtl#•a _ ra Q707S A
K / PA�
v
/JJJy
TWN
FIND
SE
S
496-3
Plan Qt. Fee
LD4T5
�jC
Cbnst. Fee
5��_
r -D2
SB
31.25
TRACT NAME
Santa F4osa Dave
OWNER NAME (L. F. MI)
CONTRACTOR -FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE , '
SCA -121 S
G1�
LICNC /
1
V 817 °
� V
ARC/ENG FIRM NAME
r
ADDRESS
CITY/COMMUNITY/STATE/ZIP - •r
PHONE ,
LICNC o
USE O.� _ F PERMITle
•�''7-t'V�fiJ[�family dwelling
BLZON
FSB
SSB
SSB
RSB
OFC
ZONE ORO a �. ,
LOT SZ
.-
END
SIDE
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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:
O 1 hereby -cerjify that no excavation five (5) or more feet in depth into which a person is required to descend, w ill be
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
demolition or dismantling thereof, wilf'be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec341, Title B,
C.A.C.)
O As owner -builder, I will not employ anyone todo 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.
r ,
O Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the perforrrfance
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 correct. I agree to comply with all -state laws and county ordinances relating to buidling
construction, and authorize a' representative of the City of La Duinta Department of Building and Safety to enter
upon the property for which I have applied for this permit for the purpose of making inspections.
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPUPRMT n n II lA n �
DATE
fs-Y6-84 S.F.b
Pennit to oonstnict Model P-2 B
Dwelling
1,390 sa. ft.
Porch
112 sq. ft.
422 sq. ft.
mar Fee
31.00
Plan Qt. Fee
242.45
Cbnst. Fee
373.00
Elect, Flee
31.25
&MI Fee
5.57
• Plumbing Fee
48.50
Prop. Deva Flee
300.00
G1�
x
V 817 °
� V
TFEE
$ 1,031.77
VALUATION
BLDG. DEPT.
11
Exterior Lath
12
Internal Lath
12A
NO.
OPERATION DATE I INSPECTOR
NO..
OPE TION' DATE INSPECTOR ~
'
7A
BUILDING. -APPROVALS
12B
MECHANICAL APPROVALS .
1
Set Back
14
33
Ventilation System
2
Ftgs & Frms
Q
34
Plenums & Ducts
2A
Slab Grade
18
35
Furnace•Compart.
3
Steel
Sewer a/
36•
Inlets & Outlets
4
Grout Blocks
23
37
Combustion Air
5
Bond Beams
Final
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.
❑
NC.
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
PLUMBING APPROVALS
15
Ground Plumb
16
Water Piping
17
Rough Plumb
18
Vents
19,
Sewage Disposal..
20
Sewer a/
21
Water'Heater
' 22
Water Softener
23
Water Service
2TT
Gas Test
25 1
Final
ELECTRIC APPROVALS'
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
-31 Service
32 Final
SEWAGE SYSTEM SIZE & LOCATION
Tank Pit L. Line
RFAR nF PRnPFRTV LINF
STREET NAME