BLCK (001344)54085 Avenida Madero
001344
PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
4 -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.
x CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: -This section need not be completed if
LICENSED CONTRACTORS .DECLARATION: I hereby affirm that Lam 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 Contractor • ,
OWNER-BUILDERDECLARATION: I hereby affirm that I 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 theapplicant for
such permit to file a signed 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.):• •: V:.
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. If, 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. ="- r . B. 8 P.C. (Attached Certificate).
Date "I Owner t/i@ sl', \ x\t 1. i( , :i'0 !
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 thereott(Sec:•38W. Lab. C.). -
Policy No. Company _ y`
0 Certified copy is hereby furnished -
0 Certified copy is filed with the City Building Inspection Department or City • Department.
Date Applicant
APPLICANT NAME (L. F. MI)
Ray -Carvajal
, a
ADDRESS 54-065 Avenida Madero
CITY/COMMUNITY/STATE/ZIP La Qainta,CA 92253
JOB SITE ADDRESS/SPACE
. cairn
CITY/COMMUNITY/STATE/LIP _
saffle
BOK
PAG
PRC •
C
Plait: Check Fee'
TWN
RNG
SE _
S
TRACT
LOT
MOO
SB-
,
TRACT NAME -
OWNER NAME (L. F. MI) _ L -
"p'tL" r {•
CONTRACTOR -FIRM NAME
applicant
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP 7, ..
above ,,
PHONE a
LICNC .
ARC/ENG FIRM NAME -
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE II
LICNC
TOTAL
FEE •
USE OF PERMIT
Stucco FEWe
BL
ZON
FS8
S58
SSB
RSB
OFC
- ZONE ORD M .
LOT SZ
END
SIDE ,
Date _ Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' .
K, 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 I hefeby certify that no 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, falsework, or
demolition or dismantling thereof, will'be mote -than thirty-six (36) feet high. -(Chap 3.2, Grp 2, Art 2, Sec341; Title8.
C.A.C.)
0 -As owner -builder, I will not employ anyone to do work which would require a.permitfrom the Division of
Industrial Safety, as noted above, unless such person has a permit to do such work from that division.
0 Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: I 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:I certify ]have read this application and statethat
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
construction, and authorize a'representative of the City of La Ouinta Department of Building and Safety to enter
upon/tie property for whi'c1h I hive applied for this permit for the purpose of making inspections.
t
Signature of Applicant or Agent ( Date
Print Applicant/Agent Name
APPL/PRMT nni 3
N—EyS,
Peja t to coanstnict 60'
of 4' t}igh and
64' of 6 ft. high stucco fence as per
pipproved plans.
Plait: Check Fee'
11.37
Permit Fee
17.50
SMI Fee
.50
3
TOTAL
FEE •
29.37
A 0 8 0 6 4 24
VALUATION 954.00
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
1 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
1 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.
❑
NON
ADDITIONAL INFORMATION
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
PSL P/1
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final