001022 (SATT)PERMIT APPLICATION
^� City of La Dg a
AC:,-..� " • 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 abandonedlfor a period of 180 days.
LICENSED CONTRACTORS DECLARATION: .1 hereby affirm that .l am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions•C -d e, aqd my license is in full force
and effect.
License Class LicLic. Nbmherb
Date' ✓'J� �' Contractor— '
OWNER -BUILDER DECLARATION: I hereby affirm that 1 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 3of theBusinessand Professions Code) or that he is'eximpt
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.): .
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 o1 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.). t
;,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.).
O 1 am exempt under Sec., B, 8 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 ,-ora certified copy thereof (Sec. 3900. Lab. C.).
Policy No. Company,
O 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. MI
C CMP.
'ADDRESS
P.O. Box 780
CITY/COMMUNITY/STATE/ZIP -
La Quinta, CA 92253
JOB SITE ADDRESS/SPACE
L.,
49-500 Avenida Vista Bonita
CITY/COMMUNITY/STATE/ZIP
La Q¢ainta, CA 92253
BON
-PAG
PRC
C
TWN
PING
SE '
S
TRACT
14496-2
LOT
n
w
Cftst, Free
251.50
MOO
G-1
Se
Plumbing Flee
TRACT NAME �+�� / W�.r,
Santa Rma YG�
OWNER NAME [L. F. MI)
CONTRACTOR -FIRM NAME -
Arj&m
ADDRESS �MM
abiwe
CITY/COMMUNITY/STATE/ZIP '
abom
PHONE NLICNC
564-1315
N
333762
TOTAL
FEE
ARC/ENG FIRM NAMEBarry Berk'wus.^
ADDRESS
1531 Chapala Street
CITY/COMMUNITY/STATE/ZIP -
Santa Barbara. CA 93101
PHONE N
LICNC N
USE OF PERMIT
simle family dweilina
SL
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 certif-' that in the performance of the work for which this permit is
issued, I shal I not employ any person in any manner ;o as to become subject to the Workers' Compensation Laws of
California t l
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 mast forthwith comply with such provisions.or this permit shall'
be deemed revoked:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
0 I hereby certify that no excavation five (5) or morefeet in depth into which a person is required to descend, will be
made in connection with work authorized by this pe mit• and that no building structure, scaffolding, falsework, or
demolltibn or dismantling thereof, will be more than :hirty-six (38) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8,
0 As owner -builder, Twill not employ anyone to to work which would require a permit from the Divisiombt
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 flat there is a construction lending agency for the performance
of the work for which thispermit is issued (Sec. 307, Civ. C.)..
Lender's Name
Lender's Address
I certify that I have read this.application and state Mat the above intormation.is correct. I agree to comply with all
city and county ordinances and state laws relating I I 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
CERTIFICATEOF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
the information given is correct4agree,to comply with all state laws and county ordinances relating to buidling
consir5ction ed. a!p o ie a representative of theCity of La ouinta Department of Building and Safety to enter
-upon Itie property for which.lhave,applied for thisgpermit for the purpose of making inspections.
Signature ofA pplicant or Agent Date
Print Applicant/Agent Name
APPLIPRMTnn-1 o /I
• DATE .
10-32-84 S.F.D.
pwrmif ,-n
2.751A Prx_ f+_ of
simlte fannily dm11,i m with attached
Cla2"dge. Mjis I;JpCidt t10 revilwe
4 041MGMM.
Mech. Fee
13.00
Plan Check Free
32.70
w
Cftst, Free
251.50
Elect. Flee
21.08
Plumbing Flee
36.50
O
TOTAL
FEE
354.78
BLDG. DEPT. VALUATION —0—
►m
I♦ Ak P—
NO.
OPERATION MTE
INSPECTOR
NO.
OP TION DATE INSPECTOR
BUILDING APPROVALS
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
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
PI P/I
STREET NAME
26 Power Pole
27. Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final