The URL can be used to link to this page

0411 (COMB)PERMIT APPLICATION 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. ADDRESS 3 ✓ AA /�/o�! C�� riV . 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 certifylhat 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 anymannersoasto become subject to the Workers'Compensation Laws, of and effect. California. License.Class Lic. Number. • Date Applicant Date -Contractor. - NOTICE TO.APP..LICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' OWNER -BUILDER DECLARATIOW I hereby affirm that. I am exempt'from the Contractor's. License Law for the Compensation rovisions•'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: y 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 asigned statement that he is licensed pursuant to the provisions of the Contractor's License Law 0A hereby cer . tify that no excavation five (5)or Tore 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 (36j feet high.•(Chap 3.2, Grp Z. Art 2, Se_c341, Title8, subjects the applicant to a civil penalty of not more.than five hundred dollars ($500:): C':WCyi, • O I, 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 .PHONE • through his own employees, provided that such improvements are not intended or offered for sale. If, however, the ❑ Division of Industrial Safety Permit. No. •..building rimprovemntissold within one year ofcompletion, the owner -builder will have the burden of proving that Date Applicant he die. 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. 3D97. Civ. C.).- .).7044. 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:.(Att"ached Certificate).. I.certify that.l have read this application and state that the above information is correct. l agree to comply with all Dat 2 } 5 Owner;: v`� a city and county ordinances and state laws relating to building construction, and hereby authorize representatives WO KERS' COMPENSATION DECLARATION: I he by affirm that I have a certificate of co4ent to.self-insure, or a. of this county to enter upon the above-mentioned property for inspection purposes. certificate of Workers' Compensation Insurance : or a 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 I have read this application 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 O 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 ' •upon - - - ~`Applicant the property for which I have applied for this permit for the purpose of making inspections. Date- ._ N kAME / F A7/ ADDRESS 3 ✓ AA /�/o�! C�� riV . CITY//CCOMMUN I TY/STTTAAAT/E/')ZI P JOB SITE ADDRESSISPACE CITY/COMMUNITY/STATE/ZIP BOK PAG PRC C TWN RNG SE S TRACT LOT TOTAL FEE MOD SB TRACT NAME ' OWNER NAME (L. F. MI) cONlFLAc .i?KoK- ADDRESS CITY/COMMUNITY/STATE/ZIP PHONE�� LICNC• • ' ARC/ENG FIRM NAME ADDRESS - CITY/COMMUNITY/STATE/ZIP - -. .PHONE • LICNC M USE OF PERMeO � BL 'ZON FS8RSB SSB SS8' .OFC. ZONE ORD •' LOT S2 - END • SIDE_ Signature of Applicant or Agent Print Applicant/Agent Name Date "APPL/PRMT /DATEIS o le lei ca -o wmedl i 1 ra TOTAL FEE VALUATION /�� BLDG. DEPT. NO. OPERATION DATE INSPECTOR NO. OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS 1 Set Back 33 Ventilation System , 2 Ftgs & Frms%? 7 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. ❑ OP'N ADDITIONAL INFORMATION NO. SEWAGE SYSTEM SIZE & LOCATION 11 Exterior Lath 12 Internal Lath J 12A Drywall cw b 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 L� '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/I STREET NAME 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service 32 'Final I