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0575IIIIIIIIIIIIIIIIIIIIIIIII 44 IE PERMIT APPLICATION City of La Duinta Department of Building and Safety x/020 .,va-i- • 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 ff the permit is lor•one hundred ($100) 0. less. 1 certify that in the•perlormance 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^ LICENSED CONTRACTORS. DECLARATION: I hereby alIirm'that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code• and my license is•in'full force' and effect. • License Class tic' Number ' Date • Contractor • • OWNER -BUILDER DECLARATION: 1 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 aligned 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 ($500.): .0 I. as owner of the property. 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. It, 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.). , . . . 0 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.). • . . • 0 1 am exempt under Sec. • B 8 P C (Attached Certificate). ' Date Owner `7 WORKERS' COMPENSATION DECLARATION:• I hereby affirm that I have a certificate of consent to self -insure, or a l certificate of Workers' Compensation Insurance . or a certified copy thereof (Sec. 3800. Lab:. C.). • • • Policy No.. Company 0 Certified copy is hereby furnished. • 0 Certified copy is filed with the City Building Inspection Department or City ' • Department. Date • Applicant AP A� /NAM' F 0, j7. Y/�_./ • • ADDRESS /� 4; X.C.0 DASts . s7 CITY COMMUNITY/STATE/ZIP TALL/0 . f!� 4 . . JOB -5$1 &"oPACE4 V,lL,4Dv 6 AAA/ , k. . /7,202 CITY/COMMUNITY/STATE/ZIP -S Zia BOK PAG 'PRC C • TWN RNG SE S TRACT // scad.2 LOT MOD SB TRACT NAME OWNER NAME (L. F. MI) CONTRACTOR -FIRM NAME ADDRESS - CITY/COMMUNITY/STATE/ZIP 34/7-6 2 /3,066,7 ARC/ENG FIRM NAME ADDRESS CITY/COMMUNITY/STATE/ZIP PHONE N LICNC 0 -• - USE OF PERMIT • 8L ZON FSB SSB .• SSB RSB OFC. • ZONE ORD II + LOT SZ ' ' ' •• • END ,- -SIDE 4, California. / / c. Date 1'24 Applicant NOTICE TO APPLIC NT: If, after making this Certificate of:E�you should subject to the Workers' • Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. - . DIVISION OF.INDUSTRIAL SAFETY PERMIT CERTIFICATION: • 0 1 hereby certify that n b 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, talsework, or • • demolition or dismantling thereof, will be more than thirtysix (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341, Title8, C.A.C.) .. u•:. • • 0 As ov ner-builder, I will not employ anyone t� do work which would require a permit from the Division of Industrial Satety, as noted above, unless such person has a permit to do such work from that division. ' 0 Division of Industrial Satety.Permit No. Date Applicant ' CONSTRUCTION LENDING AGENCY: 1 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: )'certify I have read this applicationand state that the information given is correct. I agree to comply with all state.laws and county ordinances relating to bufdling construction, and authorize a representative of the City of La Quints Department of Building and Satety to enter upon the property for•which I have applied for this permit for the purpose of making •inspections. Signature of Applicant or Agent Print Applicant/Agent Name Date IIS 7 5 /7:34.4i P47/0 Q‘3(14 i) A'/) /7 7o /3 i /4 4 "041 it, ' 0ov/cX' la -P.' APA , 0t.iTgi ,414A 1. AAA/ , k. . /7,202 PLc47,r ffc SC/• 0 • TFEE // scad.2 BLDG. DEPT. VALUATION /.SSo. D d NO. OPERATION DATE INSPECTOR NO. OPERATION DATE IINSPECTOR 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' ir07/lfS" Thi 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. I. NO. O ADDITIONAL INFORMATION �7 �/ �i /t : ,,i �/o7 //G ef 7/4'(. . . SEWAGE.SYSTEM SIZE & LOCATION; _ 11 Exterior Lath 12 .Internal Lath . 12A Drywall . 13 Finish Grade . INSULATION Thick ' 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 jest 25 Final Tank •Pit L. Line REAR OF PROPERTY LINE .ELECTRIC APPROVALS • - . 26 Power Pole P/L P/L • 27 Conduit • 28 Service Entrance 29 Wiring 29A Grounding Wire 298 Bonding 30. Fixtures • 31 Service 32: Final ' STREET NAME '