001013 (SATT)APPLICANT NAME (L, F; MI)
kidw oorp.
'ADDRESS
P.O. B= 780
PERMIT APPLICATION
City of La Ouinta
Department of Building and Safely
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
BOK
This permit becomes void it work not commenced within' 180 days from date of issuance. OR, if work has been suspended or abandoned for a period of 180 days.
PRC
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This sei7ficn need not be completed if
undler, provisions of Chapler'9
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I aml[icensed —
the:permit is for one hundred ($100) o. less. I certify teat in the performance of the work for which this permit is,.,, CA
(commencingewith Section 7000) of Division 3 of the Business and Pro ressions Code, anb my license is in full force -
.issued, I shall novemploy any person inany mannersixasto become subjectto the Workers,Compensation Laws of L,;
and effect.
California.
License Class
Date Applicant
Date Contractor
NOTICE'TO AiPPLICANT-1.'If, � ifte'i'mZking this Cerlifica e'of Exemption, you should become subject to the Workers'
DECLARATION: I hereby affirm that I'am.exempt from the Contractor's License Law` the
OWNER -BUILDER '' L
Compensation provisions of the,Labor Code, you musl forthwith comply with such provisions or is permit shall
th
following reason (Sec. 7031.5. Business and Professions Code: 'Any city or county which requires, a permit to -
be deemed revoked.
construct• alterJmprove' demolish• or repair any structure, prior to its issuance,- also requires the applicant for
DIVISION OF INDUSTRIAL SAFETY PER ' MIT ' CERTIFICATION: -
such permit to file a signed,stateme.nt that he is licensed pursuant to the pi�ovisions of the Contractor's License Law
01 her . iby certify that no excavatioii live (5) or more I. el in depth into which a person is required to descenii, will be
(Chapter 9(commencing with seclion.7000) of Division 3 o the Business and Professions Code) or that he is exempt.
made in connection 'with.work authorized by this pernil, and that no building*structure: scaffolding, falsework, or
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5by any applicant for a permit
, ,
demolition or dismantling thereof,,will be more than tFirty-six (36) feet high. (Chao 3.2, Grp Z Art 2, Sec341, Tilli&'-
I
subjects the applicant III a civil penalty of not more than five hundred dollars ($500.): L: �-L -
. . " , , I . . .
C A.C.) . .1 ..,
0 Vas owner of the properly, or myemployees with wages as their sole compensation, will do the work; and the -
0 As'owner-builder, I'will riot employ anyone to d i.work Which would require a permit from the, Division of ti
structure is not intended or offered.forsale (Sec. 7044, Business and Professions Code: The Contractor's License -
Industrial Safety, as"noted aboVe,-unless'such pe'rscn 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
-BL'
through his own employees. provided that -such improvements are not intendedor offered for sale. If; however, the x O.Division of Industrial Safety. Permit No.
building or improverrint is sold within one year of completion, the owner -builder will have the burden of proving that
Date - Applicant
he did not build or. improve for the purpose
. '. I - . . . - . .. , I. . J �_ I .
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the piriormance -
• 0 1, 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 I(Sec. 30F7, 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 contractor(s) licensed pursuant to.the
-ZONE ORD #
Contractor's License Law.).
Lender's Address -
0 1 am exempt under Sec.. B. & P.C. (Attached Certificate).
I certify that I have read this application and state thot the.above information is correct. I agree to comply with all
Date Owner
city and county ordinances and state laws relating c: building construction, and hereby authorize representatives
'4
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, or a'.
• certificate'of Workers' Compensation Insurance , ora certified copy thereof'(Sec: 3800. Lab. C:).,."-�
Signature of Applicant or Agent Date
Policy No. Company
'shed-
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I berlify I have read thisapplication and state that
0 Certified copy.is.hereby furnished.
,
'-;the informal ion-given'is-Correct. I agree to comply vith all state laws and county ordinances relating to buidling
)�r-.presentative Mily La auinta Department Building
d copy is filed with the City Building Inspection 0 ep'artm'ent or City ,Department.
0 Certified
ibriz of the of of and Safetyto enter
construpion, and authorize
GwhichJ
Date Applicant
hii; applied for this permit for the'purpo
.upon thkpioperl, or r se of making inspections.
I
Signature of Applicant or Agent Date
APPLICANT NAME (L, F; MI)
kidw oorp.
'ADDRESS
P.O. B= 780
CITY/COMMUNITY/STATE/ZIP - 92253
La
JOB SITE ADDRESSISIPACE
49-294 Av&d& Vista Bonita
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
BOK
PAG
PRC
C
Elect. Fee = 19.45
TWN
FIND
SE
S
TRACT,
144!�64_
LOTOD
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TOTW -w
FEE
IGIA-3
I SO
TRACT NAME
. Santa Rosa Umle
OWNER NAME (L. F. MI)•
CONTRACTOR -FIRM NAME
Arden
ADDRESS
abow
.CITY/COMMUNITY/STATE/ZIP
abme
PHONE#
564-1315
LICNC 0 -
33370
ARC/ENG FIRM NAME
Ba=y Berkus
ADDRESS
1531 -Chapala Street
CITY/COMMUNITY/STATE/ZIP
Santa Barbara, CA 93101
PHONE A
LICNC #
USE OF PERMIT
simle. fcamtUy dmlLing
-BL'
ZON;
FSB
SSB-
SSB
RSB
OFC
-ZONE ORD #
J- LOT SZ -
END n
SIDE
Print Applicant/Agent Name
'APPUPRMT
NMI,, 0-2 S.F.D.
Pemit to construct 2,3265 sq.. ft. of -
single family11mfling witbwc attached ched
garage.—Thi-
st w 3e�]A(:5e�
_-00427`EX PIrd0.—.
1,0 h. F%ee'
Plan Check Fee 1-2'
Const. Flee 224 *.00 .
Elect. Fee = 19.45
Plimbing Bw
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CITY OF LA QUINTA
BUILDING DEPARTMENT
It I
U
TOTW -w
FEE
321.6t%;
rr '
VALUATION
BLDG. DEPT..E
Ah
NO.
OPERATION TE
INSPECTOR
NO.
OPITATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
,2 �''
34
Plenums & Ducts
2A.
Slab Grade
Q
�� •
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
-
SEWAGE SYSTEM SIZE .& LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R" p �i
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 a S
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 P/L
-
STREET NAME
26 Power -Pole
27 Conduit
28 Service Entrance.
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final 6 S