000992 (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: I hereby. affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division Sof the Business and Professions Code and my license is in full force
and effect.
License Class--L—CN�� .�f1 l. u Der
Date •'�z- . Contractor T
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) of Division 3 of 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 ($500.): .• -
t0 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 Contractors 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 o r, 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.).
O I, as owner of the property, am exculsively contracting with licensed contractors to conslrucl.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. 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.
O Certified copy is filed with the City Building Inspection Department or -City' Department.
Date Applicant
APPLICANT NAME (L. F. MI)
LH1�L••1•7A><wJwl .
ADDRESS
P.O. Box 780
CITY/COM MUN ITY/STATE/ZI P
La Wnta, la 92253
JOB SITE ADDRESS/SPACE 7-230 Avenida Fernando
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
BOK
•PAG
PRC
C
SMI fee 7.39
TNM
FIND
SE
S
TRACT
14496-3
LOT
62
® CITY OF LA OUINTA
BUILDING DEPARTMENT
MOD
G-3
SB
TRACT NAME
Santa now cove
OWNER NAME (L. F. MI) NxIe <
CONTRACTOR -FIRM NAME
ADDRESS
. above
CITY/COMMUNITY/STATE/ZIP
above
PHONE •
564-1335
LICNC 0
333762
ARC/ENG FIRM NAME
Barry Ber)tus
ADDRESS
1531 Chapala Street
CITY/COMMUNITY/STATE/ZIP ..
Santa Barbara CA 93101
PHONE M 1 1 LICNC
805 963-8901
USE OF PERMIT
simle family dwe JJ=
BL
ZON
FSB SSB
SSB
RSB
OFC
` . ZONE ORD •
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: 11, after making this Certificate of Exemption; you should become subject to the Workers' `y
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 1 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, Sec 341, Title 8.
" O' As owner -builder, I will not employ anyone to do work which would require a permit from the Division of r
Industrial Safety, as noted above, unless such person has a permit to do such work from that division.
O_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 correct: I agree to comply with all state laws and county -ordinances relating to buidling
construction, a11d authorize a representative of the City of La Ouinta,Department of Building and Safety to enter
Cupon the plop qty for,which'I have applied for this permit for the purpose of making inspections,•
i -.� �'"c.� -.��1 •
Signatu�sof Applicant or Agent Date
Print Applicant/Agent Name
APPI/PRMT � on DATE
IP�l_/ 3.0-19-84 S.F.D.
A i/J11
PeBnit to c&mtruct 2,326 sq. ft. of
single family dwelling with attached
garage.
Meeh. Fee 26.00
Plan check Fixe 291.20
Oonst. Fee 448.00
Elect, Flee 36.90
SMI fee 7.39
Plumbing Flee 73.00
PrW. Dwel. Fee 450.00
/
19
® CITY OF LA OUINTA
BUILDING DEPARTMENT
TOTAL
FEE
a'• o {;/, _ ., VALUATION 1415.S7.c7h/
BLDG. DEPT. !-
NO. OPERATION ATE
BUILDING APPROVALS
1
Set Back
2
Ftgs & Frms
2A
Slab Grade
3
Steel
4
Grout Blocks
5
Bond Beams
6
Roof Deck
7
Framing
8
Vents
9
Garage Fire Wall
10
Fireplace P,L. ❑
10A
fireplace T.O. ❑
11
Exterior Lath
t2
Internal Lath
12A
Drywall
13
Finish Grade
INSULATION Thick
7A
Walls (Batts)
12B
Ceiling (Batts)
12C
Ceiling (Blown)
14 1
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
ELECTRIC APPROVALS
26 Power Pole
27 Conduit
28 ServiceEntrance
29 Wiring Y
29A Grougding UVire;
296 ipriding'
30 -Fixtu Ot
31 Service
32 Final
ADDITIONAL INFORMATION
:SEWAGE SYSTEM SIZE & LOCATION
Tank Pit L. Line
REAR OF PROPERTY.LINE
P/L Pi
STREET NAME,
INSPECTOR
NO. OP .rtATION DATE INSPECTOR
MECHANICAL APPROVALS
33 Ventilation System
34 Plenums & Ducts
35 Furnace Compart.
36 Inlets & Outlets
37 Combustion Air
38 Compressor
d
39 Appl. Clearance
40 Fire Damper
41 Smoke Detection Device
42 Commercial Hood
43 Final
ADDITIONAL INFORMATION
:SEWAGE SYSTEM SIZE & LOCATION
Tank Pit L. Line
REAR OF PROPERTY.LINE
P/L Pi
STREET NAME,