001197 (SFD)PERMIT APPLICATION
City of La Duinta
Department of Building and Safety
This permit becomes void it work not commenced within 180 days from date of'issuance. OR, if work has been suspended or abandoned fora 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 3 of the Business and ProfessionsCode, and my license is in full force
and effect.
I 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).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 (SSOO.): r '. .
0 I, as owner o1 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 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 lhe,pi pose 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-uhil See: 1_0 B. B'P.C. (Attached Certif.cate). .
Date' 0/r"'/6 Owner .7/-.,i �i. mss.'
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
0 Certified copy is hereby. furnished.
0 Certified copy is filed with the City Building Inspection Department or City Department...
Date Applicant
APPLICANT NAME1ir F. Y O' B..,...r.ho for
r�� ll�J1
52-766 Eis�LWW..IILLLL
ADDRESS
Eisenhower ` .
CITY/COMMUNITY/STATE/1L�P Qu nt , CA 92253
JOB SITE ADORESB/BPAC54-435 Eisler
CITY/COMMUNITY/STATHZIF�t Quint,, -C 92253-
+{.Gi
BO`K 4
1432
P0522
C
.�•t�
TWN
RNG
SE
S
TRACT
LOT10MOO
C7anst. Fee
328:00
Elect. Fee
se
SMI Fee
TRACT NAME None
OWNER NAME (L. F. MI) AWlicaft - -
CONTRACTOR -FIRM NAM
ADDRESS above,' v
CITY/COMMUNITY/STATE/ZIP� .,
PHO�E��4-1069
1,163,64
LICNC .
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP '
PHONE •
LICNC •
- -
USE OF PERMIT singlefamily f mlUng
BL
ZON
FSB
SSB
SSB
RSB
OFC ,
' ZONE ORD N
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 rot employ any person in any manner so as to become subject to the Workers' Compensation Laws of
California.
Date - Applicant -
NOTICE TO APPLICANT: IL 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 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, iv ill 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. Sec341, 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.
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. Q.
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 Opinta Department of Building and Safety to enter
u% the pr6perty,'fofwhieti" have applied for this permit fo the purpose of makirig.inspections.f
Sighature of Applicant or Agent Date
Print Applicant, Agent Name
APPUPRMT n, { i 1 q7
1023-85 1 S•F•L•
Permit to caonstnict 1244 sq. ft. of
s.f.d. plus 100 set.
ft., of porch and
and 420 sq. ft. of garage as per
appy plans.
Grading Permit
22.00
Mach. Fee '
16.00
Plan Check Fee
264-.42-
C7anst. Fee
328:00
Elect. Fee
28.70
SMI Fee
4.52
Plu[rbing Fee
50.00
Prop. Devel. Fee
450.00
1,163,64
Plan Check Dep. (200.00)1-10-85
963.64
47 TOTAL
3 FEE • +
BLDG.DEPT
VALUATION 64,7U4.0-0
NO.
OPERATION DATE INSPECTOR
NO. OPERATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33 Ventilation System
2
Ftgs &. Frms
j
34 Plenums & Ducts
2A
Slab Grade
35 Furnace Compart.
3
Steel
36 Inlets & Outlets
4
GrouvBlocks
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.
❑
NPON ADDITIONAL INFORMATION'
/�/-'s 2.'Ss11� Py
' 'L'/L �go/
s
V
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal LathZ
12A Drywall
13 Finish Grade
INSULATION Thick
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb o2 [o
16 Water Piping
17 Rough Plumb 7
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 APPRO ALS
REAR OF.PROPERTY LINE
P/L P/I
STREET NAME
26 Power Pole /A l
27 Conduit
28 Service. Entrance
29 Wiring 8
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
V--"