Loading...
0099 (PLBG)PERMIT APPLICATION City of La Duinta ,Department of Building and Safety 5�— CS dk� ==`,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. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of ,Chapter 9 (commencing with Section 7000) of Division 3of the Business and Professions Code, and my license is in' -full force and effect. License Class Lic. Number Date Contractor OWNER -BUILDER DECLARATION: I hereby affirm that 1 am exempt from the Contractor's License Law for the 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 applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom -and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (S500.): o I, as owner of the properly, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License 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 building or improvemnt is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.). O I, as owner of the property. am exculsively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.). ❑ 1 am exempt under Sec. Owner B. 8 P.C. (Attached Certificate). WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.). Policy'No, Company ❑ Cert�d.copy is hereby furnished. O•Certified copy is filed witl he �City Building Inspection Department or'City !'�%r ar mens. Date • '� r �'✓ Applica/nt/S� APPLICANT/NAME (L, F, MI)� ADDRESS CITY/COMMUNITY/STATE/ZIP JOB SITE ADDRESS/SPACE v� CITY/COMMUNITY/STATE/ZIP BOK PAG PRC C TWN FIND SE S TRACT LOTMOD SB TRACT NAME OWNER NAME (L. F. MI) CONTRACTOR,r�l/F gM.NA'TeI ADDRESS {`C�L•%�j// CITY/COM MUN I TY/STATE/Z I P P/HON.yE�ya LICNC N r/ TOTAL FEE ARC/ENG FIRM NAME ADDRESS CITY/COMMUNITY/STATE/ZIP PHONE a LICNC N USE OF PERMIT 81. ZON FSB SSB SSB RSB OFC ZONE ORD M LOT SZ END SIDE CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed it the permit Is for one hundred ($100) o, less. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you�iriustforthwith comply with such provisions or this permit shall be deemed revoked. 1`°ti DIVISION OF INDUSTRIAy SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2. Grp 2, Art 2, Sec341, Title B, C.A.C.) O As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from that division. ❑ Division of Industrial Safety Permit No. Date Applicant CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all 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. Signature of Applicant or Agent Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that the information given is correct. I agree to comply with all state laws and county ordinances relating to.buidling construction, and authorize a'representative of the City of La Ouinta Department of Building and Safetyeto enter upon the property for which I have applied for this permit for the purpose of making inspections. Signature of Applicant or Agent Date Print Applicant/Agent Name APPL/PRMTxY ,FY P�} Q f 9 DATE r 100, u. D -21.963 TOTAL FEE Arrow Printing 250/1-83 White: Finance Canary: Assessor Pink:, Applicant Tag: Bldg. Dept. VALUATION NO. OPERATION DATE INSPECTOR NO. OPERATION DAT., 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) 126 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/l STREET NAME 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service 32 Final KIN --- _. 0— ♦ \ I Q - APR 2 21983 Y_ City of la Quinta 41 THIS APPROVAL GRANTED BY THE DEPARTMENT -OF PUBLIC -HEALTH IS VALID FOR ONE (1) YEA1; FROM DATE OF -APPROVAL: - - - iK vinSIDE COUNTY DEPARTMENT OF PUBLIC HEALTH DIVISION OF ENVIRONMENTAL HEALTH _ J Food Establishment x.lLr"'j Sewage Disposal Trailer Park do✓il So Gal. Septic Tank -. - - - - Motel, Apt'., Hotef� Sq. t. of Leach -Line - - - — 1 Dwelling Seepage Pit Commercial Building Connection to Sewer J�1 Swimming Pool — - t No on-site regenerating water softening devices• may be discharged into the individual sewage disposal v system herewith approv--d-withcut clearance from the Water Quality Control Board. _ Water supply serving this installation must be from an approvzd source. All sewage dispesa insio.iation must conform with requirements of current Uniform Plumbing Code: Any cutting,-grading,•c> f:.;ing in cx_-ss of four (4) feet will nullify sewage disposal approval. — Approval has ba:n ob.,a.n,d from the Regional Water Quality ControlBoardfor installation of the sew- age disposal system. his is to certify that the Riverside County Department of Public Health approves for oeGiopap.4wy, construction .,r installation the item(s) checked above. s %c b�nc (,• ac .� w �o rvr (_c r I do tp N ,h 9 f} Receipt No. -13S '23r District: Riverside ❑ Indio U Hemet ❑ DISTRIBUTION: WHITE - Office File YELLOW - Applicant DOH SAN 122 (Rev 10/82) Issued By Date (/ _ X r 9.? PINK - Building Dept. GOLDENROD - Pending File RIVERSIDE COUNTY DEPARTMENT OF HEALTH PERMIT APPLICATION FOR A SUBSURFACE DISPOSAL SYSTEM Applicant: Submit this form with three copies of a scaled plot plan drawn to county specifications required on the attached checklist. Anon refundable filing fee of $15 is required when the application is submitted. Check must be made payable to County of Riverside. Name Mailing Address Q Z o City ' ' �. GL w t �. c.' State Zip Code 3 Phb e 4 6 2 Z Y b 'Property Address 'City or Community 'Legal Description of Property (Lot, Parcel Map, Tract) 'Assessors Parcel No. Water Serving Property From Lot size ' gnature of Applicant / ,/ Date / ( 'The above information must be verified from Building Application V Staff Use — Do Not Write Below This Line Initial Date WQCB Clearance required Yes ❑ No y �' V -k (- Soils feasibility report required Yes ❑ No r. Detailed boring report required Yes ❑ No Detailed contour plot required Yes ❑ No ih Comments: Z O Soils or boring report by Date U Approved by Date � Soils Map Page Soil Type Tract File No. Zo Other Number of Bedrooms Septic Tank Size (gallons) Rate Required Type of System New Addition Replacement Leach line sq. ft. of bottom area trench Leach bed (sq. ft. of bottom area bed) Seepage Pit Diameter Number of Pits Seepage.Pit Depth B.I. Total Deptti of Pit 5'❑ 6'©� , Location of System A �y ca ✓ � \ru a. r/I Additional Requirements V A permit is a ?yj4denied for the design of a subsurface disposal system as indicated on the accompanied plot plan Z using the requirements set forth in Section B above: A building permit is necessary for the installation of the above 2 designed system. w U) Signature -of Health Official Date a ' Receipt No. -13S '23r District: Riverside ❑ Indio U Hemet ❑ DISTRIBUTION: WHITE - Office File YELLOW - Applicant DOH SAN 122 (Rev 10/82) Issued By Date (/ _ X r 9.? PINK - Building Dept. GOLDENROD - Pending File