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BLCK (001066)54295 Avenida Madero 001066 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. • ' ' • • /" " r 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 (St(0) o, less. I certify that in the performance of the work -for which this,permit is - ' (commencing with Section 7000) of Division Sof the Business and Professions Code, and my,license is in full force- issued, I shall not employ any person in any manner soasto become subject to the Workers'CompensationLaws of and effect. - California. - License Class Lic. Number .- Date Applicant • Date' - Contractor NOTICE TO APPLICANT: IL after making this Certificate of Exemption, -you should become subject to the Workers'. OWNER -BUILDER DECLARATION: I' hereby aftirm'lhat I am exempt from the Contractor's License Law for the Compensation provisions of the Labor Code, you must.lorthwith 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. r 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 Contracto,r'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) orthat he is exempt made in connection with work authorized by this permit, and that no building structure, scaffolding, falsewdrk, or therefrom and the basis 100he 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 Z Art 2, Sec34.1,,Titlell, subjects the applicant to.a civil penalty of not more than.five hundred dollars ($500.): - CAC) -• ..'rr-,,•,, O I, as owner of the properly, or my employees,with wages as their sole compensation, will do the work, and the'. O 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, orimproves thereon, and who does such work himself or CITY/COMMUNITY/STATE/ZIP .. , 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. - buildingo,rimprovemnt is sold within one year of completion, the owner -builder will have the burden,ofproving that Date Applicant he did not build or improve for the purpose of sale). CONSTRUCTION LENDING AGENCY: I hereby affirm IhaCthere is a construction lending agency.for the performance .O 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. C.), 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Lender's'Name l builds or improves thereon, and who'contracts for such projects with a contractor(s) licensed pursuant to the SSB Contractor's License Law.). Lender's Address O 1 am'exempt under Sec. A. 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 )9 L +vt/ 1—) i 11 1 i, T L G city and county ordinances and state laws relating to building construction, and hereby authorize representatives 1 of this county to enter upon the above=mentioned property for inspection purposes. WORKERS' COMPENSATION DECLARATION: I hereby af_tirm 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. C.). . • Policy No. Company .c - O Certified copy is hereby furnished. , O Certified copy is filed with the City Building.lnspection Department or City Department. Date Applicant APPLICANT NAME (L, F. MI) James Domenoe ADDRESS - 54-295 Madero CITY/COMMUNITY/STATE/ZIP La Quinta, CA 92253 JOB SITE ADDRESS/SPACE same CITY/COMMUNITY/STATE/ZIP . same BOK.PAG 77 233 PRC 01 C. ,. TNM RNG SE S TRACT LOT.3- MOD SIB - TRACT NAME OWNER NAME (L. F. MI) , James Domenoe CONTRACTOR -FIRM NAME • .. , Owner ADDRESS above CITY/COMMUNITY/STATE/ZIP above PHONE • -LICNC • ung 3 0 iso op ARC/ENG FIRM NAME ADDRESS .. CITY/COMMUNITY/STATE/ZIP .. , PHONE » 25.00 LICNC M USE OF PERMIT ' Fence BL ZON FSB SSB SSB RSB ZONE ORD N -LOT SZ END SIDE. - Signature 61 Applicant or Agent Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that 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 the property for which I have applied for this permit for the purpose of making inspections. l1 Signature of Applicant or Agent Date Print Applicant/Agent Name APPUPRMT nl ng 11T-30-8 .. BLDG Permit to construct 175 lineal feet of 6' high fence as per approved plans. Permit Fee 25.€0 ung 3 0 iso op TOTAL FEE 25.00 BLDG. DEPT. VALUATION 1,488.00 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 Fireplace T.O. ❑ OP'NO. - ADDITIONAL INFORMATION /^ Q 7 7 - 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 T77 i 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 w^ REAR OF PROPERTY LINE PSL PiI STREET NAME 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 298 Bonding 30 Fixtures 31 Service 32 Final.