001016 (SFD)PERMIT APPLICATION
City of La Duinta
• 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 or 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 3 of the Business and Professions`Code;:and my license is in full force
and effect. /) 1 /
License Class Lic Numh` r l �J
Date ��e�1 U`Y Contractor.—, �41-11
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 permitto fileasigned statement that he is licensed pursuant to the provisjons 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 yiolation.of Section 7031.5.by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars (5500.):
0 I. as owner of the property, or my employees witbwages 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 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).
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
0 Certified copy is hereby furnished.
0 Certified copy is filed with the City Building Inspection Department or City Department. .
Date Applicant
APPLICANT NAME (L, F. Mnyy��������,�� - -
['YJLJLI,Cloirp.
ADDRESS -•
P.O. Brut 780
CITY/COMMUNITY/STATE/ZI�' 0jintal, A 922y533
JOB SITE ADDRESS/SPACE
49-240 Avenida Vista Bonita
CITY/COMMUNITY/STATE/Zlv
aJR a Quintal CA 92253
BOK .
PAG
PRC
C
Mech. Fee
TWN .:
PING
SE
S
TRACT 4496- ?
LOT
18.45
Plumbing Flee
MOD
SB
TRAIT NAME Santa Ftisa Cam
OWNER NAME (L. F. MI) Anfie1
CONTRACTOR -FIRM NAME ,
ADDRESS '✓ bom
CITY/COMMUNITY/STATE/ZIP
PHONE
564-33151
LICNC a
333762
ARC/ENG FIRM NAME Barr y Berkus
ADDRESS
. 1531 Chapala Street
CITY/COMMUNITY/STATE/ZIP r
Santa Barbara, CA 93101
PHONE 1
LICNC M
,
USE OF PERMIT
simle family dwelling
SL
ZON
FSB
SSB
SSB
RSB
OFC
ZONE ORD-*
LOT SZ
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMP _NSATION INSURANCE: This section need not be completed if
the permit is for one hundred ($100) o, less. I certify that in the performance of the work for which this permit is
issued, I shall not employ any person in any manner E) as to,become subject to the Workers' Compensation Laws of
California.
Date Applicant
NOTICE TO APPLICANT: If, after making this Certific rte of Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall .
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
O 1 hereby certify that no excavation five (5) or more eet in depth into which a person is required to descend, will be
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
demolition or dismantling thereof, will be more than -hirty-six (36) feet high. (Chap 3.2, Grp•2, Art 2, Sec341, Titfeif, ;A
C.A.C.)
0 As owner -builder,$ will not employ anyone to xo work which would require a permit from the Division of
Industrial Safety, as noted above, unless such perE)n has a permit to do such work from that division.
0 Qivision of Industrial Safety Permit No.
Date - Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm t rat there is a construction lending agency for the performance
of the work for which this permit is issued (Sec. 307; Civ. C.):
Lender's Name
Lender's Address
,I certify that I have read this application and state flat the above information is correct.I agree to comply with all
city and county ordinances and state laws relating tD building construction, and hereby authorize representatives .
of this county to enter upon the above-mentioned lroperty for inspection -purposes. '
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE.AND.AUTHORIZATIOt. 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 at,
(orize i representative of the City of La Duinta Department of Building and Safety to enter
.upon the property to which I,Kave.applied for this_ permit for the purpose of making ins echons. . .
Signature of Applicaiit or Agent Date
Print Applicant/Agent Name
APPUPRMT 001 1 n i f
1D_/)TIE-22-84 S.F.D.
Pendt to constrict 2,326 sq. ft, of
single family dwelling with attached
garage. This pennit
to replace # 0430
ExPnW also address chance.
Mech. Fee
13.00
Plan Check Fee
29.12 '
Oohs{.. Flee
.YO
Elect. Free
18.45
Plumbing Flee
36.50
kJMOP19
TOTAL FEE
VALUATION —¢
BLDG. DEPT.
r -I
NO.
OPERATION MTE
INSPECTOR
NO.
OP ATION DATE INSPECTOR
BUILDING APPROVAL.
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. ❑
NON
ADDITIONAL INFORMATION
l
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath / (p
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 r
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final
Tank Pit L. Line
ELECTRIC -APPROVALS
= ,
REAR OF PROPERTY LINE
PIL P/1
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final