RR (001227)51085 Avenida Martinez
001227
PERMIT APPLICATION
City of La Duinta
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.
LICENSED CONTRACTORS•DECLAR41ON: I hereby affirm that I am -licensed under provisions of Chapter 9
(commencing with Section _7000) of Division 3of the Business and Professions Code, and my license is in full force
and effect.
License Class Aic. Number _
Date Contractor X
OWNER -BUILDER DECLARATION: 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 the applicant 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) orthat 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. If, however, the
building orimprovemntissold within one year ofcompletion. the owner -builder will have the burden of proving that .
he did not build or improve for the purpose of sale.).
0 L.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
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. 3900. Lab. Q.
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
APPLICANT NAME L. F, MI) Bob t'fw. .w.. T1od frog
yn
ADDRESS 33-J7L977 wast hihingtoi Dr.
CITY/COMMUNITY/STATE/ZIP Ywap3a, CA . 92399
JOB SITE ADDRESS/SPACE 51 -095 Martinez .
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{.CA
'•L Qui ta,
CITY/COMMUNITY/STATE/LIP
LCR 92253 _
BOK
PAG
PRC
Stns Fee • 81
TWIN
RING.
SE
S
TRACT
LOT
TOTAL
FEE •
MOD
S8
TRACT NAME
OWNER NAME (L. F. MI) Dr. Yazt' BocEi er '
CONTRACTOR -FIRM NAME Applicant .
r
ADDRESS AbpY
L
CITY/COMMUNITY/STATE/ZIP ai:; a '
PHONE / 714-73'7-6G0 L. 7,7VG'
LIDNQ165 90
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE $
LICNC •
'
USE OF PERMIT Rea-Zoof
BL
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FSB
SSB
SSB
R58
OFC•
ZONE ORD N •
LOT SZ
ENO '
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed it
the permit is for one hundred ($100) o. less. I certify that in the performance 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
California.
Date Applicant
NOTICE. TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'
r -a 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 no excavation five (5) or more feet in depth into which a person is required to descend, w ill be
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
a demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, AA 2, Sec 341, Title 8,
C.A.C.)
0 As owner -builder, I will not'employ anyone to do work which would require a permit from 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 perfbrmance
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. . A
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
the information given iscorrect. 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 to which I have applied for•this per`it for the purpose of making•inspections. / C
Signature of Applicant or Agent
Print Applicant/Agent Name
Date
I. 7 DIATE `, •
APPL/PRMT n n 12.
Kermit to clean off old rock. Dail on
one -30# felt paper. Hot imp on three
#15 felt paper.' Hot map on ruck.
Permit Fee fns 92.50 -
Stns Fee • 81
TOTAL
FEE •
R,93.3t
VALUATION 11,L2L.UU
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 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.
❑
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
_
P I L PiI
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final