001136 (RR)d
APPLICANT NAME (L, F,.MI)
Mission Valley Roofing
ADDRESS -
8627 Hacienda Road
- PERMIT
APPLICATION
City of La Ouinta
Department of
Building and Safety .
PRG
008
s.
This permit becomes void if work not commenced within 180 days from,date of issuance: OR, if work has been suspended or abandoned for a period of 180 days.
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CERTIFICATE OF EXEMPTION FROM WORKERS' -COMPENSATION INSURANCE: This section need not be completed if .+.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter' 9.
the permiLis 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 Sof the Business and Professions Code; and my license is in full force' : : ,
.. issued; I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of • . '
and effect. -
California.
License Class " LL''c. Number S" ^ P
Date Applicant
Date tor X =_ �`A-flims it. / aC-
`` Contrac
NOTICE TO.APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'
OWNER -BUILDER DECLARATION: "1'h"ereby affirm that 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.' 4
following reason (Sec. 7031.5. Business and Professions Code>Any city -or county which requires a permit to .
CITY/COMMUNITY/STdf,E/Z
construct, alter; improve. demolish, or repair any structure, prior-to'its issuance, also requires the'applicant for ..
DIVISION OF INDUSTRIAL SAFETY PERMIT,CERTIFICATION:
- suchpermittofileasignedstatementthatheislicensedpursuanttotheprovisionsoftheContractor:sLicenseLaw
01 hereby certify that no excavationfive (5)ormore feet indepth inibwhich aperson isiequiredtodescend, will be .
(Chapter 9 (commencing with section.7000pof Division3 of the Business and Professions Code) or that he is exempt, - ;
' •made inunneclibn with work authorized by this permit. and that'no building structure, scaffolding, lalsework, or .
therefrom andthe basis for the alleged exemption. Any violation ol.Secti6n.7031.5 by anyapplicantlor a permit_.
.. demolition or dismantling thereof, biill'be more.ttian thirty=six (36) feet high. (Chap 3.2, Grp Z. Art -2, Sec 341; Title 8,
subjects the applicant to a civil penalty of not more than five hundred dollars ($500:):
.. C.A.C.) `. .- • •• ::'.a"=;:: - -
' ❑ I. as owner of the property, or my employees with wages as their sole compensation, will do the work, and the :
p As owner-buildei, 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
Induslrial: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 offereflor safe. If, however, the
O Division of Industrial Safety Permit No..
buildi%or improverrint is sold within one Y.Par of completion, 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
O 1, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec.
of the work'for which this permiris issued (Sec. 3097, Civ. C.): '
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 contractors) licensed pursuant to the
Contractor's License Law.).
lender's Address—
0 1 am 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 '
' Date Owner
city and county ordinances and state laws relating to building construction, and hereby authorize 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.).w.'
Signature of Applicant or Agent Date
Policy No. Company
•+ .
,CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certilya have read this application and state that `
o Certified copy is hereby furnished.
_
.the information 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 Department orCity Department.
constructiorNml authorize a Yepresentative of the City of La Ouinta Department of Building and Safety to enter
'
upon the properly which I have applied for this permit for the.purpose of making inspections.
Date Applicant
-. �'Signaturejof"App1icant1 o'Agent Date
Applicant/Agent Name
d
APPLICANT NAME (L, F,.MI)
Mission Valley Roofing
ADDRESS -
8627 Hacienda Road
CITY/COMMUNITY/STATE/ZIP
Santee, CA 92071
JOB SITE ADDRESS/SPACE.
51-180 Avenida Obregon
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253±
BOK
773,052
PAG
PRG
008
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TRACT-
LOT 8
TOTAL>•
FEE •
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TRACT NAME
None
OWNER NAME L. F. MI) - ..
Bruce Robinson
CONTRACTOWFIRMNAME-
ADDRESS above
CITY/COMMUNITY/STdf,E/Z
PH. It -44.9.-9744
'`I°tt"°• /
3 -
ARC/ENG FIRM NAME -
'ADDRESS
CITY/COMMUNITY/STATE/ZIP -
PHONE •
LICNC 0
USE OF PERMIT Re -roof ,
BL
ZON.
FS8
SSB
SSB
.RS8"
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ZONE ORO • (: •
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,BEND
SIDES
APPUPRMT DATE
• a 12-14-8- Bldg.
Permit to 22'h squares
with ashphalt.shingles aspen,
manufacturers specs and
applicable codes.
Permit 20.50
Penalty 20.50
• y rl�er
TOTAL>•
FEE •
41.��
BLDG. DEPT.
VALUATION 1,1251 -LO
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.
❑
NPON
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 P/I
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
298 Bonding
30 Fixtures
31 Service
32 Final