001034 (RER)APPLICANT NAME (1-J. MI) -
Bruce Rnbingm.
ADDRESS
51-180 0breaon
PERMIT
APPLICATION
City
of La Ouinta' ?;
Department of Building, and. Safety
1 +
• . . - This permit becomes.void if work not commenced within 180 days from dale of. issuance. OR, it work has been suspended.or abandoned for a period of 180 days.' • '
C
CERTIFICATE.OF EXEMPTION FROM,WORKERS'.COMPENSATION INSURANCE: This section need not becomptetedif '•
' LICENSED -CONTRACTORS DECLARATION: I 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 -.1
(commencing with Section 7000) of'Divisiom3 of the Business and Professions Code, and -my license is in full force
issued; I shall notemploy.any person inany:manner.so as to become subject to the Workers'CompensationLaws of 4 4'
and effect.
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' J
OWNER -BUILDER DECLARATION: 1 her affirmthat I am exempt from the Contractor's License Law, lor;the
Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shall
following reason (Sec. 7031.5. Business and Professions Code: -Any -city or county which requires.a permit tit'
be deemed revoked.
construct; alter, improve. demolish, or repair any structure, prior to its issuance,.also requires the.applicant for
DIVISION OF .INDUSTRIAL.SAFETY PERMIT CERTIFICATION:.
:,.,such permit to file a signed statementthatheislicensed pursuant tothe provisions ofthe Contractor'sLicenseLaw,
Olherebycertifythat noexcavation five (5)ormore feet indepthintoWhictiAperson isrequired todescend:will be" 0
(Chapter.9 (commencing With section 7000) of Division -3 of the Business andProtessionsCode) orthat heisexempi
made in connection with work authorizedby this permit; and that no building structure, scaffolding, falsework, or
therefrom and.lhe. basis for the alleged exemption.Any violation -of Section 7031.5,by any applicant�far a permit.,
demolition or dismantling thereof, will be more than thirty-sixy36).feet high. (Chap 3.2, Grp 2, Art 2; Sec341. Title 8,
subjects the applicant to a civil penalty of not more than five. hundred dollars ($500.): ;+.;? ..
C.A:C.)
.0 I, as owner of the property, or my employees with wages,as their sole compensation, will do the work, and theY"s
ovine'r-builder, I will not employ anyone to do work which would. require a permit from the Division of
structure is. not intended or oftered.for sale (Sec. 7044, Business and Professions Cade: 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, 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
O Division of Industrial Safety_ Permit No.
building or improvemnt issold within one year of completion. the owner -builder will have the burden of proving that.
Date-" Applicant r %-
he did not build or improve for the purpose o..sale.).
CONSTRUCTION LENDING AGENCY: I hereby afjirm.that there is'a construction lending agency for the performance .
.. O. I, as'owner of the property, am exculsively contracting with licensed contractors to construct the project
of•the.work for -which this permit is issued (Sec..3097, Civ. C:).
7044, Business and Professions Code: The Contractor's 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
Contractor's License Law.). `
Lender's Address
O 1 am exempt.under Sec. B. 8 P.C. (Attached Certificate).
I certify that I have -read this application and state.thatthe above information is correct. I agree to comply with all .
.rl fi3 i;' -• �,..,,.... .
(Daie Owne(' moi,•
city and county ordinances and state laws relating to building construction, and herebyauthorize representatives '
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, ora
- -
- certificate of Workers" Compensation Insurance , or a certified copy,thereof (Sec. 3800. Lab. C.). ",
,•
Signature of'Applicantor Agent Date 'c
Policy. No. Company
,.CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify l have read this application and statethat '.
.0 Certified copy is hereby furnished. '.
;.,.• thetinformation given is correct. I agree to comply with all state laws and county ordinances relating to buidling
Certified copy is filed with the City'Building Inspection Departmentbr City Department.
O '
construction; and authorize a *representative of the City of La Ouinta Department of Building and Safety to.enter
: a _ . . .
upon the property for which l have applied for this permit for the purpose of making inspections.
DatApplicant
e
Signature of Applicant or Agent Date'
APPLICANT NAME (1-J. MI) -
Bruce Rnbingm.
ADDRESS
51-180 0breaon
CITY/COMMUNITY/STATE/ZIP
La (k isaa, CA 92253
JOB SITE ADDRESS/SPACE
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CITY/COMMUNITY/STATE/LIP ,
T.a oui.nta. CA ' 92253
BOK.
PAG
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TWN - RNG
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TRACT ,.
LOT
MOD
SB
TRACT NAME
OWNER NAME (L. F. MI) -• - -
Amli cant
CONTRACTOR -FIRM NAME .. .
A nl ina t
ADDRESS
a
CITY/COMMUNITY/STATE/ZIP
a3xi��n
PNONE •
LICNC 0
ARC/ENG FIRM NAME -
ADDRESS
CITY/COMMUNITY/STATE/ZIP - »
PHONE •
_LICNC II
USE OF PERMIT �ro
Stuwo+& .add patio
BL
ZON
•FSB_
SSB
SSB -
RSB -
0 F
..'+. rZONE ORD N...
., LOT SZ
_. y.••(:t'
". END.-,
.SIDE . • -
Print Applicant/Agent Name
. APPL/PRMT -
.DATE
l.1--
15--84 EU)G.
Permit to stuoao exterior and add
to P3dstina natio cover as per
ar Ynrrnmwi nlans
and annlicable poles
• aru9 n i na1'1feF�4, _
Tal av„ ['�1
25 iia�l
Pemit +
38.50
CMT VC -4-
TOTAL
FEE .;: -
•
6a:'�,
a BLDG. DEPT. �*
VALUATION ,2,'000.00
r
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
�`^%�%� j� J�� O �G ��•
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath / f�
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 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