001068 (SATT)PERMIT APPLICATION
City of La Duinta
Department of Building and Safety
-This permit becomes void if work not commenced within 980 days from date of issuance, OR, if work has been suspended.or abandoned for a period of 180 days. - i
LICENSED CONTRACTORS DECLARATION:] hereby affirm that I am licensed..under provisions of. Chapter 9
(commencing with Section 7000)-ol Division 3 of the Business and Professions Code, and my license is in lull force
and effect.
License Class Lic. Number
Date ContractorX /�
OWNER -BUILDER DECLARATION: I hereby affirm that I amItexempt from the Contractyr's Licynse Lav for the
following reason (Sec. 7031.5. Business and Professionsl,Code: Any city or -county which requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also.requires theapplicant.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
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 mprovemnt 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.). wY
.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.).
` I am exempt under Seca B. Bp.C._(Attached Certificate).
Date "Owner' '"nom•.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificat of consent;self-insure, or a
certificate of Workers` Compensation Insurance -.,Cora 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.' Depaitment.
Date Applicant
-CA�j� ti_ 7
APPLICANT NAME'(L, F, MI)
M.D. .Lanes. Co.
ADDRESS
2950 Ai rwav Ave. Suite D9
CITY/COMMUNITY/STATE/ZIP -
Costa Mesa. CA 92626
JOB SITE ADDRESS/SPACE '
CITY/COMMUNITY/STATE/ZIP -
La ' ouin.ta.. CA 92253
BOK.
PAG
PRC
C
289.00
TWN
RNG.
SE
S
TRACTlOT
30.00
Prop. Devel. Fee 450.00
-
MOD
SB
�£�915�
•
144
G c3
TRACT NAME
Rga-fTF-et ion s
OWNER NAME (L. F. MI) - -
nn 1 i n.na n t'
CONTRACTOR -FIRM NAME
1ca10 1 � .
ADDRESSu u
above
CITY/COMMUNITY/STATE/ZIP ,
PHONE .
345-1436
.LICNC
ARC/ENG FIRM NAME
Alan Snaon Architect
ADDRESS
1 3400 Irvine Ave.. 4205 .
CITY/COMMUNITY/STATE/ZIP ,.
Newnort Beach. CA 92660
PHONE .
LICNC •
-
714-979-8842
USE OF PERMIT '
Sinale familydwelling
BL
ZON
FSB
_
SSB
SSB I
RSB
OFC
ZONE ORD . r
' 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 i n any manner so as to become subject to the Workers'Compensation Laws of
Californi�
Date Applicant C • 444 a_
w; NOTICE TO.A PLICANT: If, after making this Certificate of Exemption, you should become subjeVoihe-Workers'
Compensation provisions of the Labor Code, you must forthwith comply with such.provisions or this permit shall
be deeAed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
O l 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
:":denfolition or dismantling thereof, will be more than thirty-six (36) feet high: (Chap 3.2, Grp 2; Art 2, Sec 341, Title 8,
,ca .. C.A.C.J'
O As owner -builder, I will not employ anyone to-do work which would require a permit from the Division of -
Induslrial 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.). i
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 r lhis.pe.Mit for the purpose of making inspections.
(�„n _ ?AA�zv J,
Signature of Applicant or AgV /. Date
Print Applicant/Agent Name
APPL/PRMT o-1 ntJ
s
DATE -
12-4-84 S.F.D.
Permit to construct 926 sq. ft. of
S.F.D. and 235 sq.
ft. ofgarage
as per ap roved
'plans.
Mech. Fee
24.430
Plan Check Fee
246.00
Const. Fee
289.00
Elect. Fee'
23.50
SMT Fee
3.64
Plumbing Fee
30.00
Prop. Devel. Fee 450.00
. S
TOTAL
FEE
1.066--14
VALUATION 51, 669.00' .
BLDG. DEPT. 1 'A
Ah
Ah
NO.
OPERATION ATE
INSPECTOR
NO.
OPWATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL A PROVALS
1
Set Back
—0-/
33
Ventilation System
2
Ftgs & Frms
/ Z -/Z _ s
34
35
Plenums & Ducts •
Furnace Compart.
2A Slab Grade
3
SteelJ
y-/ ti iY
j G
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 I
10A
Fireplace T.O.
❑
FN
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
126 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 -C
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
P/L P/I
STREET NAME
26 Power Pole
27 Conduit lie
28 Service Entrance
Rlh-
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final