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0294 (SOTB)PERMIT APPLICATION 3 L . *�,�,� �/✓ City of La Duinta D 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 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 (commencing with Section 7000) of Division 3 of 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 Contractor _ NOTICE TO APPLICANT_ If, after making. this Certificate of Exemption,,you should.become subject to the Workers' OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Caritractor'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. 41 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 - 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 01 hereby certify that 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 he is 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, Art 2. Sec341. Title 8!, suecec the applicant to a civil penalty of not more than five hundred dollars ($500.): "' 'C.A.C.) 1, as owner of the properly, or my employees With wages as their sole compensation, will do the work, and the- ❑ As owner -builder, 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 .. 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. build ing,qr improverrint is sold within one year 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 ❑ 1, 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.). 5 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. Lender's Name" Contractor's License Law.). Lender's Address O.1am exempt der S_ec r 8 P.CC Attached Cerfifiioodle): I certify that I have read this application and state that the above information is correct. I agree to comply with all Date V —� Owner city and county ordinances and state laws relating to building construction, and hereby authorize representatives Y of this county to enter upon the above-mentioned property for inspection purposes. WORKERS' COMPENSATION DECLARATION: I hereby affirm that I• ave a certilicate of consent to self -insure, or a certificate of, Workers' Compensation Insurance , ora 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 application and state that O Certified copy is hereby furnished. ,, - dhe 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 Duinta Department of Building and Safety to enter Date Applicant upon the property for which I have applied for this permit for the purpose of making inspections.. APPLICANT / NAME (L'. F. �, ,e�ibr,�q /a,S �J�_'7�i�/ • ADDRESS, r ..53—To/ ©br ,* CITY/COMMUNITY/STATE/ZIP JOB SITE ADORESS/SPACE . SQA CITY/COMMUNITY/STATE/ZIP J Q� BOK_ , PAG. !15 PRC im // C r • TNM RNG SE = S TRACT LOT 17R'l A. n MOD SB p 7�i TRACT NAME .. ' OWNER NAME (L. F. MI) CONTRACTOR -FIRM "ME ADDRESS CITY/COMMUNITY/STATE/ZIP • , P?V;y— y77-5 LICNC N ARC/ENG FIRM NAME ADDRESS CITY/COM MUN ITV /STATE/ZI P PHONE • LICNC'a USE OF PERMIT BL I ZON FSB SSB SSB RSB OFC ZONE ORD II LOT SZ END SIDE Signature of Applicant or Agent Print Applicant/Agent Name Date APPVPRMT „s> g/ID EY 41/06, r • RECEIVED AUG 2 5 19.83 CRY Of La Quanta 4 17R'l A. n r m i FEE p 7�i VALUATION -V -11s BLDG. DEPT. 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 f=ireplace T.O. ❑ NPON ADDITIONAL INFORMATION Nl (� �1 . 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) 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/t STREET NAME 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service 32 Final