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0652 (FENCE) 1984 1111111IIIII III IIIII ILII o2 PERMIT APPLICATION �-�- ?6 d 0_&a4� City of La Ouinta IE 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 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 Prolessions.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. X457California. License Class tics.Number1 t Date Applicant Date Contractor, _ '��`�•,` �' NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Workers' t-,l 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 OWNER-BUILDER DECLARATION: I hereby affirm tha 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 oftheContractor'sLicenseLaw ❑1 hireby*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 heis exempt made in connection with work authorized by this permit,and that no building structure,scaffolding,lalsework,or therefrom and the basis.for.thealleged 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.Sec 341,Title 8. _ subjects the applicant toa civil penalty of not more than live hundred dollars($500.): C.A.C.) O 1,as owner of the property,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.It,however.,the O,Division,,of Industrial Safety Permit No. building or improvemm 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 ❑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.Q. 7044.Business and Professions Code:The Contractor's License Lawdoes 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 O 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,or-a ,certificate of Workers'Compensation Insurance,or,a certified copy thereof(Sec.3800.Lab.Q. Signature of Applicant or Agent Date „Policy No. _ Company CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: Lcertifylhavereadthisapplicationandstatethat • ❑Certified copy is hereby furnished. ., the information given is correct.I agree to comply with all state laws and county ordinances relating to buidling -`'Nertitiedopyi .ile��Y�wl h he City Building Inspection Depart en e C+ny^ Department. construction;and authorize a'representative of the City of La Ouinta DepartmenUof Building and Safety to enter �2trY�J�j" Applicant �ry `" upon the property for which I have applied for this permit for the purpose of making inspections. Date Signature of Applicant or Agent Date Print Applicant/Agent Name APPL•IC_/�NTi[lAa fM�1((/{�Q. �-•t-j,t/T' APPL/PRMT „ ry JOA . !N/f—�J'l_1 J� ��r- ;�`�•l,(J �y7� �A■ *.- IC/11 ADDRESS_y-!� ., 1 F'� i, - �r _ _ i• v� yV7„(/� / 9W7— JOB �f� CITY/COMMUNITY/STATE/Zit_ V• C4 W7—• �Uv�I///I �d �e�.3`/�/ /”�V' �i/l`T� � JO`��SIiTF`�''�AJDL�hSI C�E f' .. C7 /"/< (.3 7 r CITY/COMMUNITY/STATE/ZIP All � BOK PAG :PRC C TNM RNG SE S ``\-`! '� (,�• `: T TRACT LOT.. MOD SB TRACT NAME ) t OWNER NAME(L.F.Mlf`[ C)Jb, J CONTFACTOR-F�NAME ItV�\�J� i�v'v ADDRESS2/-1-b - -• _ �// , ice CITY/C6?I� ;OMMM ITY/STA-7IP^� pgllt� 71loD p"Cf157"I ARC/ENG FIRM NAME - - ADDRESS CITY/COMMUNITY/STATE/ZIP - PHONE• LICNC I; - USE OF PERMIT , BL- ZON FS8 SSB, SSB RS8 OFC_ ' G ZONE ORD N LOT SZ - .END SIDE' �, 'TOTAL FEE BLDG.DEPT. VALUATION C%� 1CO'- ' NO. OPERATION DATE INSPECTOR NO. OPERATION• DATE INSPECTOR ^� BUILDING APPROVALS. MECHANICAL APPROVALS 1 Set Back 33 Ventilation System 2 Ftgs& Frms 3 .7/ ` 34 Plenums.&Ducts - ^« 2A Slab Grade 35' Furnace Compart. 3 Steel ! 36 Inlets&Outlets• , •4 4 Grout Blocks 37 Combustion Air ` 5' Bond Beams — g 4( 38 Compressor 6 Roof Deck 39 Appl.Clearance. 7 Framing 40 Fire Damper 8 Vents 41 Smoke Detection'Device - w . 9 Garage Fire Wall 42 Commercial Hood 10 Fireplace P.L. ❑ 43 Final . 10A Fireplace T.O. ❑ NON ADDITIONAL INFORMATION 1.1 Exterior Lath / )) 2OrY 12 Internal Lath �/� 12A Drywall r 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 SEWAGE.SYSTEM SIZE& LOCATION ' Tank Pit L. Line ELECTRIC APPROVALS. REAR OF. PROPERTY LINE 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring } 29A Grounding Wire PSL P/L 29B Bondingg 30 Fixtures 31 Service 32 Final STREET"NAME