001018 (SATT)Andm 0wo.
PERMIT APPLICATION PLiC--
.2
1 /-2 7
lt-.City La Quinta!
of
Department of Building and Safe
CITY/COMMUNITY/STATE/ZIP -
•' - T—n
JOB SITE ADORESSfSPACE
* - 49-520 - Mranilda Vista Bmita
or
This permit b void if work nut commenced within 160 daysirom,date
of issuance; OR, it work.has been suspended abandoned for -a period of 180 days
PAC
CERTIFICATE OF EXEMPTION FROM WORKERS'COMPEf;.3ATION INSURANCE: This section need not be completed if
LICENSED CONTRACTORS DECLARATION: I- hereby affirm that.lam:licensed under provisions of Chapter4,1-,,
the permit is foronehundred ($100) o., less. I certify that in.the performance of the work for which this permit is
(commencing with Section 7000) of Division 3 o the Business and Professions Codenanimylicense is in full force m-.:4 I issued; I shall notemploy an! e soniianyrnannerso is to become subject to the Workers'Compensation Laws of
and effect.
California. y
I
License Class . Lic. NuihbeT—' . - - .. I
... ' ' Date Applicant,
0 ✓Contractor -
NOTICE.10 APPLICANT. If, after making this Certificate of Exemption, you shoulZecome.subject to the.Workers' -
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the
Compensation provisions of the Labor Code, you mus forthwith comply with such provisions or this permit shall;--.
be deemed revokiid.,`
following reason (Sec. 7031.5. Business and Professions Code: Any city or county,which requiris.a permit to
14496�-2
construct, altei, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for
-•%t DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICA-JON:
-
such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
0 1 heie6y t certify that no ex'caval'ion five (5) o rmore fe -t in depth . into which a person is required to de . scend. will be
(Chapter 9fcommencing with section 7000) of Division 3 of the Business and Professions Code) or that he is exempt
madein connection with work,authorized by this permit, and that no building structure, scaffolding, falsework:6r
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by -any applicant for a permit,
demolitioffor dismantling thereof; will be more than th , ty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8,
subjects the applicant to a civil penalty of not more than, five hundred dollars ($500.):
C.A.Cff-t-d
kkien
ADDRESS
abom
0 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
0 As -owner -builder, I will not employanyone to dorwork which would require a permit from the Division of,
structure is not intended or offered for sale (Sec. 7044. Business and Professions Code: The Contractor's License
Industrial Safety, as noted iiboVe; unless such person 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
in for It, however,
ivisior
E3 0 I of Industrial Safety Permit No.
•tended or offered sale. the
-es, provided that such improvements are not
through his own employe
_ I
building or improverrint is sold within oneyear of completion. theowner-builder will havethe burden of proving that..
Date Applicant
he-,Oid not build. or improve.for the purpose of sale.).*
CONSTRUCTION LENDING AGENCY:; I hereby affirm thac there is a construction lending agency for the performance
L 11 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 (Sec. 309:,,Civ. C.J.
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
it Contractor's License Law.).
A Lender's Addresssr
0 1 am,exempt under Sec. B. & P.C. (Attached Certificate):'
i certify that I.have read rhis application and state thai theabove information is correct. I agree to comply with all
n. W f: `6
Date Own
-city and county ordinances and state laws relating to' wilding construction, and hereby authorize representatives
SSB
of this county to enter upon the above:menlioned pr- perty for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to elf -insure, or a .
-r
certificate of -Workers' Compensation Insurance— or a certified copy thereof (Sec. 3800. Lab. C.).
. I
— , . Signature of Applicant or Agent i t Date
Policy No. company I - _', . U
CERTIFICATE OF COMPLIANCE-AND;AUTHORIZATION CF ENTRY, I certify I have read this application and statethat
0 Certified copy is hereby furnished.
the information given,iscorrect..iagree to comply wiih all state laws and county ordinances relating to buidling
0 th the City Building Inspection Depairtment br'City - Npartment
Certified copy is filed with
nstr�cfiqn, andon the , It
�aul orize.a representative o I S et
i co I he,Gly of La auinta Department of Building and Safety to enter
for
or which,LhuelappRid for this r—rmit for the purpose of making inspections
,Dale Applicant
ai'
�p
Signature ofApplibant or Agent Date
ZONE ORD JIv6..�,.,
Print Applicant/Agent Name
LOT. SZ
APPLICANT NAME'(L. F, MI)
APPUPRMT
SIDE
-A
J,
77
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Andm 0wo.
ADDRESS
.,P.O. B= 780
CITY/COMMUNITY/STATE/ZIP -
•' - T—n
JOB SITE ADORESSfSPACE
* - 49-520 - Mranilda Vista Bmita
CITY/COMMUNITY/STATE/ZIP I . I I � � . . - -
I . La Quinta,' CA 92253
SOK . i
PAG
PAC
C
29*A2
TWN
AND
SE
S -
TRACT
LOT''.
Do
Se
VV
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9
81JOry LA�dOF
,
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T.
TOTAL '
FEE
TRACT NAME
I -_ Santa Asa Owe
OWNER NAME (L. F. MI)
Anden
CONTRACTOR -FIRM NAME .- .
kkien
ADDRESS
abom
CITY/COMMUNITY/STATE/ZIP
abmie
PHONE N '
LICNC 0
I '. I 564-i�i57
_ I
. 333762,1d
'ARC/ENG FIRM NAME
jqarry rnoerk=
ADDRESS
1531 Ulhapia3a Strdet
CITY/COMMUNITY/STATE/ZIP
Sat*^ Barbara. CA 93101,
PHONE 0
LI CNC
USE OF PERMIT
7' sinciike f zwnil�r
BL
ZON
FSB
SSB
SSB
Asa: i
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OFC
ZONE ORD JIv6..�,.,
LOT. SZ
END
SIDE
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77
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40
4
ZJ 11 1
VALUATION
BLDC;. DEPT.
DATE
.Ple=dt t6lcmistruct 2,326 - ft: ,of
single fftanny &,ellulig with �Lttadvia
qarage. ellhis-pe=it--replace,.-
4, 0415;ETIEW-0
Rach. Fee
13.00 -
Pian il Check' Fee
29*A2
Omst. Pee
18.95
Plurbincr Flee
36.50"
VV
C6I
1A I
ft)
ur-2'
81JOry LA�dOF
,
T.
TOTAL '
FEE
21
I" ;,'j 507"
40
4
ZJ 11 1
VALUATION
BLDC;. DEPT.
rj
NO.
OPERATION TE INSPECTOR
NO.
OP ATION DATE INSP'�CTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
% p2
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.
❑
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
P/L PiI
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 _ Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final