001169 (SOTB)PERMIT APPLICATION
City of La Duinta
Department of Building and Safety
e This permit becomes void if work not commenced within 180 days1rom:date of issuance, OR: if.work has been suspended or, abandoned for a period of 180 days.
'ADDRESS 3226 EBlvd.
C, CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
LICENSED CONTRACTORS DECLARATION: A hereby affirm that I •am licensed under provisions of Chapter 9
the permit is for one hundred ($100) o, less. I certify that in the performance of the work,for which this permit is
(commencing with Section 7000) of Division 3 of the Business and Professions C ode;,and.my license.is in full force ..
issued, I shall not employ any persomin any mannerso as to become subject to the Workers' Compensation Laws of
and effect. �:� /41 �/
California.
License Class -- Lic. Number
Date Applicant,
' Date Contractor
NOTICE TO APPLICANT-,, If, after.making this Certificate of Exemption, you should become subject to the Workers'
' OWNER -BUILDER DECLARATION: I hereby affirm1hat I am exempt from the Contractor's License Law•for the
Compensation.provisions of the. Labor Code, you must forthwith comply with such provisions or this permit shall
be'deemed revoked. °
following reason (Sec. 7031.5. Business -and Professions Code: Any city or county which requires a.permit to
construct; alter, improve, demolish, orrepair any structure, prior to its issuance, also requires the+applicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
-such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's license Law .
O I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be
(Chapter 9 (commencing with section 7000) of Division 3,otthe Business and Professions Code) or that heis exempt
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
.therefrom and the basis for the alleged exemption. Any violation o1.Section 7031.5 by anyapplicant for a permit
demolition or dismantlirig:theieof, will be more than thirty-six (38) feet high. (Chap 3.2, Grp 2, Art 2; Sec341. Title B; '
subjects the applicant to a civil penalty of not more than five hundred dollars (S500.):
C.A.C.)
❑ I, as owner of.the property,.or my employees with wages as.their sole compensation, will do the work,'and the
❑ As owner -builder, I will not employ anyone -to do work 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 above, unless such person has a permit to do such work from that division..
Law does not apply to an owner of property who builds; orimproves thereon, and who does such work himself or
r
'through his own employees, provided that such improvements are not intended or offered for sale. If; however, the V4
❑ Division of Industrial Safety;Permit..N
building orimprovemntissold within one year ofcompletion, the owner -builder will have the burden of proving that
Date Applicant
he did. not build or, improve for the -purpose of sale.)
CONSTRUCTION LENDING AGENCY:.I hereby affirm that there is a construction lending agency for the performance
D.1, as owner of the property, am excutsively contracting with licensed contractors to construct the project (Sec.
of the,work for which this permit'is issued (Sec. 3097, Civ.•C'.). a
7044. Business and Professions Code: The Contractor's License Law does -not apply to an owner of property who
Lender's Name
builps or improves thereon, and who contracts for -such projects'with a contractor(s) licensed pursuant to the.
RSB-'
Contractor's License Law.).
Lender's Address -
ddressO.1
0. 1am exempt under Sec. B: 8 P.C..(Attached Certificate).
I.certify that I have read this application and state that the above information is correct. I agree to comply with all
8
Date Owner
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
'a
of this county to enteiPi n the above-mentioned property for inspection purposes:
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I'have a certificate of consent to self -insure, or
SIDE
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.):
Signature°of Applicant or Agent Date
Policy No. Company
CERTIFICATE OF COMPLIANCE AND. AUTHORIZATION OF ENTRY: I certify l have read this application and statefhat
❑ Certified copy is hereby furnished.
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
r. •
❑ Certified copyis filed with the City Building Inspection De Sartment or City, /Department.
construction, and authorize'a'representative.of the City of La Ouinta Department of Building and Safety to
/
/ /i .a
Date Applicant
upon the property for which I have applied for this permit for the purpose of making inspeclio%c
Si nature of App icani or'Agenl. Date
_
Print Applicant/Agent Name
APPLICANT NAME (L, F. MI) Russell and 1-kissell
'ADDRESS 3226 EBlvd.
CITY/COMMUNITY/STATE/ZIP Los Angeles, CA 90023
JOB SITE ADDRESSBPACE 49-421 Avenida Obxegon
CITY/COMMUNITY/STATE/ZIP La O=ta- ' CA 92253
5•����
BOK
PAG
PRC
C
Plan Check Fee
TWN .
FIND
SE
S'
TRACT
LOT
MOD
SB
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TRACT NAME 1>a ( umtaHotel Sll its club
OWNER NAME (L. F. MI) �x�ark^^- -
CONTRACTOR -FIRM NAME ��•1•n11t - .. ,,
ADDRESS abo
CITY/COMMUNITY/STATE/ZIP ...L.....e •
1IFI1 3-252- '1 61 .
PHONE 213-262-116
JAN • ��.
LICNC M '
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE n
LICNC .
”
USE OF PERMIT plewp • Bleachers � ' iCv1is
Bl.
ZON
1
FSB
SSB
SSB
RSB-'
OFC.
. ZONE,ORD N
LOT SZ .
END
SIDE
APPL/PRMT nfill 1 F a w 1
1.017-85 1' isle• -
Permitt,'o install 6900 t�oraiy bleachers
t0 be taken Clown
Plan Check Fee
'203.45
Const. Fee.
313.00
SMI Fee
4.20 -
. WORK Na TO J.iEI7dLV UNTIL PEM1I IS OIJ16]11=
P II _ W
JAN • ��.
TOTALTT
FEE
520.65
-
VALUATION 60,000.00•
BLDG. DEPT.
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION 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
PSL PA
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A .Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final