0579 (SFD)PERMIT APPLICATION
• City of La Duinta '
Department Building Safety
ADDRESS ... .. .. . _. ..
400 N. matin Avem e, Shite 231
of and
.. • This permit becomes void if.work not commenced.within 180 days from date of.issuance,'OR, if work has'been'suspended oe.abandoned for period of 180 days.
ITY/COMMUNITY/STATE/ZIP -
La Winta,, CA - 52253
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1• ; ''' ..' $-
• • CERTIFICATE OF EXEMPTION FROM WORKERS'.COMPENSATION INSURANCE: This section need not 'be completed if
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter. 9 ..
. •' the permit is for one hundred ($100)o. less. I certify that in the performance of the work for which. this permit is '
' (commencing with Section 7000) of Division 3of the Business and Professions Code; and my license is in full force
issued, I shall not employ any person in any manner so as to become subject to the Workers.Compensation Laws of +
and effect.
California.
t
License Class'.-,' Lic. Number
Date Applicant.
Date Contractor
NOTICE TO APPLICANT: It, after, making, this Certificate of Exemption, you should become subject to the Workers'
OWNER -BUILDER DECLARATION: I hereby alfirm:that I am exempt from the Contractor's License Law for the �
Compensation provisions at the Labor Code, you must forthwith comply with such provisions or this permit shall
be�deemed revoked. - ...
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a.permit to ,
TRACT NAME '• •
Lacuna De La Pax,, Ltd.
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
such.permit to file asigned statement that he is licensed pursuantto the provisions of the Contractor's License Law
.. 0 1 hereby certify I . hat no excavation five (5) or more feet in depthinto whichapersonis required to descend, will be `
• .(Chapter 9 (commencing with section 7000) of Division 3of the Business and Professions Code)or that he is exempt . '
_ 'made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
therefrom and the basis for the alleged: exemption. Any violation of Section. 7031.5 by any applicant for a permit -
demolition or dismantling thereof; will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8,
subjects the applicant to a civil penalty of not more than five hundred dollars (5500.):
C.A.C.)
O 1. as owner of the property, or my employees with wages as their sole compensation, will do the work, and.the
0 As owner -builder, I will not employ anyone to-do" work which would require a permit from the Division of,-,
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License
Industrial Safety, as noted above, unless such person has a permit to'do such work from that division.
Law does not apply to an owner of property who.builds, or improves thereon, and who does such work himself or
USE OF PERMIT/ ` ti{
S/F/D itxrA=' nium)
through his own employees: provided that such improvements are not intended or offered for sale. If, however, the
a. Division of Industrial, Safety Permit No.
building or improvemntis.soldwithin one year ofcompletion, the owner -builder will have the burden of provingthat -'
:, Date = Applicant
he did not builifor improve, for the purpose of sale.).
" CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
❑ I, as owner.of the property, am exculsively contracting with licensed contractors to construct the project (Sec.'-
of the work for which -this permit is issued (Sec. 3097, Civ. C.):
7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who -'•
.. '
Lender's Name
builds or improves thereon, and who contracts for such projects with'a contractors) licensed pursuant to the
Contractor's License Law.).
Lender's Address
❑ 1 am exempt under Sec. B. 8 P.C..(Attached Certificate).'
.. I certify that I have.read this application and state that the above information incorrect: I agree to comply with all
r '
Date Owner
city and county ordinances and slate laws relating to building construction, and hereby authorize representatives
•
of this county to enter upon the above mentioned property for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, ora
certificate of WorkersCompensation Insurance , or a certified copy thereof (Sec^3800. Lab. C.).
- Signature -of Applicant or Agent Date
Policy No. Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:, I certify l have read this application and state that '-
❑ Certified copy is hereby furnished.
the information given is correct. I agree to comply with all state laws and county'ordinances relating to buidling
' ❑ Certified copy is filed' with the City Building Inspection Department or City Department.
c' 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.
Date Applicant
_
Signature of Applicant or Agent Date
ApyPU�PPLICA•NNT NAMyE'(�L. MSM MI)
ADDRESS ... .. .. . _. ..
400 N. matin Avem e, Shite 231
CITY/COMMUNITY/STATE/ZIP -
Santa Arta; CA 92705
JOB SITE A RES$/SPACE
Semm
ITY/COMMUNITY/STATE/ZIP -
La Winta,, CA - 52253
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PRC-•
C-
Paid V
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RNG
SE'. '.
S
TRACT
13640-3
LOTa•
36
Plumbincr Fee
-.
MOD
1BR.
.SB•
TRACT NAME '• •
Lacuna De La Pax,, Ltd.
OWNER NAME (L. -F. MI)•
Sam as abbe
'CONTRACTOR -FIRM NAME' -
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE t I
(714)558-3766
LICNC 0
Vn-
ARC/ENG FIRM NAME -
ADDRESS
CITY/COMMUNITY/STATE/ZIP - -
PHONE N
$ 976.75
' LICNC 1
-
USE OF PERMIT/ ` ti{
S/F/D itxrA=' nium)
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END
SIDE
Print Applicant/Agent Name
APPVPRMT DATE
1-26-84
Condo
Ptetnit to =otn=t 11662. Sq. Ft. Of S/F/D
and 400 Sq. Ft. of Garage ger ag=aved plans
Mechanical Fee
$ 18:00
Plan Cis Fee
Paid V
Cbnstruetim Fee,
412,00
Electrical. Fee
31,77
SMI Fee
-48
6.
Plumbincr Fee
5$'; 50
-Property Dmel6mimt Fee
• :450.00
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+ 'mow e° ••:! .1
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TOTAL
FEE.
$ 976.75
VALUATION $921,461,20
BLDG. DEPT.
Ah.
Ah
NO.
OPERATION TATE
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
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.
❑
NO
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)
126 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
P/L P/I
STREET NAME
26 Power Pole
27 Conduit ♦ .
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding ,
30 Fixtures
31 Service
32 Final 9!-�