001351 (ELEC)APPLICANT NAME (L, F. MI) Art- 4 •,
PERMIT APPLICATION
CITY/COMMUNITY/STATE/ZIP la. A _ . __ta/ C • 92253
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, if work has been suspended or abandoned -for a period of 180 days.
- }- • ••
. - CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if '
LICENSED CONTRACTORS DECLARATION: I'h"ereby affirm' that I' am licensed under provisions of Chapter- 9 '
the permit is for.'one hundred ($100) It, less. I certify that in the performance of the work for which this permit is '
(commencing with Section 7000) of Division 3 o 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 Lic: Number
Date Applicant
Date Contractors- . -,-.
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'
OWNER -BUILDER DECLARATION: I hereby affirm that 1 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
'
following reason (Sec. 7031:5. Business and Professions Code: Any city or county which requires a permit to',
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 statement that he is.licensed pursuant to the provisions of the Contractor's License Law
0 hereby 6ertifi'lltitt 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 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 7031.5 by any applicant for a permit
demolition or dismantling thereof, will be more than thirty-six (36) feet high: (Chap 3.2, Grp 2, Art2, Sec341. Title B.
subjects the applicant to a civil penalty of not more than five, hundred dollars ($500.):
C.A.C.)
• O Las owner of -the property, or my employees with wages as their sole compensation, will do the work, and the . ' •
❑ As owher•builder,'l wilrnot employ anyone to do work which would require a permit from the Division of
structure isnot intendedlor offered for sale (Sec. 7044,: Business and Professions Code: The Contractor's LicenseIndustrial
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
D Divisign of;lndustrial Safety Permit No.
building orimprovemntissold.wilhinone year ofcompletion, the owner -builder will have the burden of proving that,,,_.
D'afe' Applicant'
he did not build or improve for the purpose ofsale.).
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
-❑ L -as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec' • .'?
of -the work'tor which this permit isissued(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
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
❑ 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.] agree to comply with all
Date Own e'r-V a ' '� "" ^ "� 'y �'t
city and county ordinances and stale.laws relating to building construction, and hereby authorize representatives
'A
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, or
certificate of Workers' Compensation Insurance , or a certified copy thereof'(Sec. 3800. Lab. C.). ••
Signature of Applicant or Agent Date -
Policy No. Company. a
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: 1 certify I have'read thisapptication 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:.or City Department.
construction, and authorize a'representative of the City of La Ouinta Department of Building and Safety to enter
u,� n the property for which I have applied, fo this permit for the purpose of making inspections.
Date Applicant
/ Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPLICANT NAME (L, F. MI) Art- 4 •,
ADDRESS 53-660 Avenida Qbrego
CITY/COMMUNITY/STATE/ZIP la. A _ . __ta/ C • 92253
JOB SITE ADORESS/SPACE above '
CITY/COMMUNITY/STATE/ZIP above
BOK
PAG -
PRC
C
TNN
FIND
SE
S
TRACT
LOT
MOO
SB
TRACT NAME
q
OWNER NAME (L, F. MI) aWZCant
CONTRACTOR -FIRM NAME
applicant
ADDRESS
above,,.,
CITY/COMMUNITY/STATE/ZIP -
PHONE 11
LICNC 4
ARC/ENG FIRM NAME - -
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE • -
LICNC o
'
USE OF PERMIT '
meter rea-set
BL
ZON
FSB
SSB
SSB
RSB
OFC
ZONE ORD 9
LOT SZ.
END
SIDE
APPVPRMT n J .JS DATE 5
RR ��i j: lwt •
Permit for a meter reset.
TOTAL
FEE 22.50
A08,10 4 24 p
BLDG. DEPT. VALUATION
'
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
L/
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)
14T 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 I L
STREET NAME
P/I
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final