001019 (SFD)PERMIT APPLICATION
• City of La Dg a
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 abandonec for a period of 180 days.
r.
LICENSED CONTRACTORS DECLARATION: I hereby -affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3of the Business and Professions Code my license is in full force
and effect. _
License Class Lic Nu/mber
,Date ZJ ✓Y --tet Contractor 1 • / . f . J / -
OWNER --BUILDER DECLARATION: I hereby.atfirm 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 7010) 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 (5500.): ' ^
O 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 otfered•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 ofprovinglhat -
he did not build or improve for the purpose of sale:)::
O 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 I 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 , or a certified copy thereof (Sec. 3800. Lab. C.). + '
Policy No. Company
O Certified copy is hereby furnished.
O Certified copy i's filed with the City Building Inspection Department or City . Department.
Date Applicant
APPLICANT NAME (L, F, yyI) '
`xien carn.
ADDRESS
P.O. Box 780
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
JOB SITE ADDRESS/SPA19-510 Avenida Vista Bonita
CITY/COMMUNITY/STATE/ZIP ^l � ' CA 92253
BOK
PAG
PRC
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Const. Fee
TWN
RNG
SE
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TRACT
14496=
LOTMOD
10
8U In OF'lA
1
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1 C,-3
SB
TRACT NAME '
. Santa Rosa QWe
OWNER NAME (L. F. MI) - •.
Andm
CONTRACTOR -FIRM NAME _
fRy�.��e��wa
ADDRESS '
above
CITY/COMMUNITY/STATE/ZIP -
above
PHONE*
564-1315
'.
LICNC
333762
ARC/ENG FIRM NAME
Bexki.h7
ADDRESS
1531 Chapala Stmt
CITY/COMMUNITY/STATE/ZIP
Santa Barbara, CA 9n 3101
PHONE M
-LICNC 4
USE OF PERMIT
simel famil dwelling
BL
ZON
FSB
SSB
SSB'
RSB
OFC .
ZONE ORD N
LOT SZ
t
_17END
• SIDE -
CERTIFICATE OF EXEMPTION FROM WORKERS' COM°ENSATION INSURANCE: This section need not be completed if
the permit is for one 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
ZCalifornia.
Oate 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 n 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 mor, feet 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 thar thirty-six (36) feet higfi. (Chap 3.2, Grp 2,' Art 2, Sec 341, Title 8. -
C.A.C.) It ;
O As owner -builder, I will not employ anyone lo,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.
O Division of.lndustrial Safety Permit No.
Date Applicam
CONSTRUCTION LENDING AGENCY: I hereby affirm [hat there is a construction lending agency for the performance
of the work for'which'this permit is issued (Sec. Z)97, Civ. C.).
Lender's Name
Lender's Address
I certify that I have read this application and state hat the above information is correct. I agree to comply with all
city and county ordinances and state laws relating a building construction, and hereby authorize representatives
of this county to enter upon the above=mentioned 3roperty 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
theinformation given is correct. I agree to comply with all state laws and county ordinances relating to buidling
construction, and'authoriie representative of th. City of La Ouinta Department of Building and Safety to.enter
upon she pr ei -for whiich•��e applied for ihi: permit for the purpose of inspections.
f �f
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPL/PRMTnol DAT
l) 9 U_fj2�'84 S.F.D.
P=At to construct 2,326 sq. ft. of
sine family dwelling with attached
garage. This permit to replace # 0416
EXPIRM.
Mach. Fele 13.00
Pian Check See 29.12
Const. Fee
Elect. Fee 18.45
Pl�abing Fee 36:50
no T
8U In OF'lA
TOTAL
FEE
321.07
BLDG.VALUATION —,—
DEPT.
a
NO.
OPERATION ATE 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
/ b2%Ti�
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.
❑
OP'NO.
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick "13-
Value
3Value
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
_
P/L 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