001017 (SFD)PERMIT APPLICATION
City of La Dug a •
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 abandonec 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 3o1 the Business and Professi` d��cense is in full force
and effect.
License Class Li`c. N /ber
Date . '� Contractor
OWNER -BUILDER DECLARATION: I hereby affirm that (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 Contra ctor'sLicense 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:):r r ,
0 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. It, 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.).
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 under Sec. B. & P.C. (Attached Certificate).
Dale 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. 3800.1ab. C.).
,Policy No. Company
0 Certified copy is hereby furnished. -
O Certified copy is filed with the City Building Inspection Department or City
Date Applicant
Department:
APPLICANT NAME (L. F. MI) Y '
TN��S7A ♦"►1
ADDRESS .a
P.Q. Bax 780
CITY/COMMUNITY/STATE/ZIP
La ouinta. CA 92253
JOB SITE ADDRESS/SPACE '
49-222 Avenida Vista Bonita
CITY/COMMUNITY/STATE/ZIP '
La t laainta. CA 92353
BOK
PAG
PRC
C.
TWN
RNG
SE
S
TRACT
449F-- 2
LOTMOD
25
N....I
Crl
SB
-
TRACT NAME
soma P40M cbm
OWNER NAME (L. F. MI)
CONTRACTOR -FIRM NAME
Ar����aax1e�� - . •-
n
ADDRESS
abom
CITY/COMMUNITY/STATE/ZIP
above
PHONE •
564 1315¢
LICNC 8
333762
ARC/ENG FIRM NAME
Barryp'��' -
Berkms '
ADDRESS
1531 C. ap ala Street
CITY/COMMUNITY/STATE/ZIP
Santa Barbara CA 93101
PHONE •
LICNC /
USE OF PERMIT
Simla famil.V Mina
SL
ZON
FSB
SSB
SSB
RSB
OFC
ZONE ORD n
LOT SZ
END
SIDE .
CERTIFICATE OF EXEMPTION FROM WORKERS' CONDENSATION INSURANCE:' This section need not be completed if
the permit is ionone hundred ($100) o, less. I certi-:y 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 Applican-
NOTICE TO APPLICANT: If, after making -this Certifi-ate of Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you rr ust 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 morn feet in depth into which a person is required to descend, will be
made in connection with work authorized by this pr rmit, 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 tondo work which would require a permit from the Division of
Industrial Safety, as noted above, unless such peison has a permit to do such work from that division.
10 Division of.lndustrial Safety Permit No.
Date Applican
CONSTRUCTION LENDING AGENCY: I hereby affirm :hat there is a construction lending agency for the performance x '
of the work for which this permit is issued (Sec. ZD97, Civ. C.).
Lender's.Name
Lender's Address
I certify that l have read this application and state that the above information is correct.) agree to comply with all
city and county ordinances and state laws relating :o 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 AUTHORIZATI04 OF ENTRY: I certify I have read this application and state that
the information given is,cor ei c (agree to comply'with all state laws and county ordinances relating to buidling
construction, and authorize a -representative of the City of La Ouinta Department of Building and Safety to enter
upon the pioper446r which°I have'applied for 66 permit for the purpose of making inspections.
Signature of Ap`plicant or Agent Date
Print Applicant/Agent Name
APPUPRMT +( 90-22—A4 S.F.D.
Permit to oansfi. 2,758 sq. ft. of
single family dwelling in with attach
garage, perwit is to replace
".-^ s
# 0432 MIRED also address change.
mach. Fee 13.00
Pian" Cb6ck Fee 32.70
Const. Fee 251.50
Fee 21,08
—Elect.
Plumbing Flee 36.50
N....I
� OFP�RTNTA
M
TOTAL
FEE
354.78
BLD1G. DEPT. VALUATION 1 —0—
Alk
NO.
OPERATION TE INSPECTOR
NO.
OP TION DATE INSPE'&.TOR
BUILDING APPROVALS
MECHANICAL. APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
35
1 Furnace Compart.
'3
Steel
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6.
Roof Deck
sJ
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.
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)
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
Tank Pit L. Line
ELECTRIC APPROVALS
REAR.OF PROPERTY LINE
PSL PSI
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
296 Bonding
30 Fixtures
31 Service
32 Final