0349 (BLCK)PERMIT APPLICATION
City of La Ouinta'
Department of Building and Safety '
' This permit becomes void if work not commenced within .180. days from date of issuance, --OR, it work has been suspended or abandoned for a period oti180 days.
ADDRESS -
51-251 Avenida Obregon
CERTIFICATEOF EXEMPTION FROM WORKERSCOMPENSATION INSURANCE: This section need not be completed it
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed. under provisions' of Chapter 9 `
the permitis 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 employany person inany mannersoasto become subject to the Workers' CompensationLaws.of -
and effect. "'
California.
License Class - Lic. Number
Date Applicant
• Date Contractor -
NOTICE TO APPLICANT: If, after making th)s Certificate.of.Exemption, you should become subject to the Workers '•
' OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt Irom the Contractor's.License Law loathe .
"Compensation proyisions.ot the Labor Code, you must forthwith' comply with such' provisions or this permit shall
b deemed revoked..
' 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 applicantfor .`
DIVISION OF INDUSTRIAL, SAFETY PERMIT CERTIFICATION:
. • •such permit to file'asigned statement thathe.is licensed pursuant lo. the.provisions of the Contractor's License Law.-
' ,' '0.lhereby�ertify that n6excavation five (5) & m6re feet in depth into Which a person is required todescenif-willbe.
(Chapter 9(commencing with section 7000) of Division 3 of the 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 of Section 703.1,5 by any applicant for.a.permit
demolition or dismantling thereof, will be mo-ielhan thirty-six (36) fee high. (Chap -3.2,Q 2, Art -2, Sec 341, Title B.
subjects the applicant to a civil penalty of not more than five hundred'dollars($500.): '
C.A.C.) c111 ivw
O1 as owner of the property, or my employees with wages as their sole compensation, will do the work, and the-
0 As -owner -builder, f will not employ -anyone to do work which. would require a permit from the Division of'
•. structure is notintended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License
Industrial Safetvasnoted'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 •
W. I r
through his own employees: provided that such improvements are not intended or offered for sale. If, however, the
O Division of Industrial Satety.Permit No.
building orimprovemntissold within,oneyear 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 agencyfoi the performance i..''
`70 I, 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. 3097, Civ. C.). -. -
7044. Business -and Professions Code: The Contractor's License Law does not apply to an owner of property who. '
Lende'r's Name' K
builps or improves thereon: and who contracts for such projects with'a contractor(s) licensed pursuant to the
SSB
Contractor's License'Law.).
Lender's Address
O lam exempt under Sec. :. B..B 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 s
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 consem.toself-insure, or a'
'END.
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 applicationand state that '
+t ❑ Certified copy is hereby furnished.
the information given is correct. I agree to comply with all state laws and countyardinances relating to buidling
0 Certified copy is filed with the City Building Inspection. Department or`City '. Department..
construction, and authorize a representative of the City of.La Ouinta Department of Building and Safety to enter
Gupon
In 7 f, qm ningJA! `fl
the property for which I' have applied for this permit for the purpose of:making inspections: s
Date Applicant
Signature of Applicant or Agent Date
APPLICANT NAME (L. F, MI) -
Bmce & Cynthia a Robinscm
ADDRESS -
51-251 Avenida Obregon
CITY/COMMUNITY/STATE/ZIP _jLa (M 92253
G6
JOB SITE ADDRESS/SPACE
Sam As Abave
CITY/COMMUNITY/STATE/ZIP ,
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TRACT NAME
QYVNER MAU. F.MI��oMbv� -
CONTRACTOR -FIRM NAME
27�crmtia3ser CAnstYtZL't1m Co.
ADDRESS Posada Way
C, IT,1
Y/COQ UNICaj�TY/,TACA 72201
""0;9160
j3`415`771
ARC/ENG FIRM NAME
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ADDRESS =. F••d` '+„ „ ... -
CITY/COMMUNITY/STATE/ZIP
PHONE •
LICNC
USE OF PERMIT S71Bl .� ck 14b.11 1
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'END.
SIDE
Print Applicant/Agent Name
APPL/PRMT 192 /-83
Bldg. .
t to construct 13 Lineal. Feet of °Biock
{P
7�
Ehi.iding Permit 'Fee
$10.50
r
O' V
�.�:.MIT Ml Ion_
nr•''
City o' a 'FAit a
TOTALL
FEE
s.10.50 .
a BLDG. DEPT.
w VALUATION $325.00" /
V -
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
� l '(
/ �V
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 1 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