RR (000912)51371 Avenida Martinez
000912
' 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.. • "
"
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
,:LICENSED CONTRACTORS DECLARATION: l hereby affirm that I am 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 (` _34J J 7 if G,
License r Lich umber
_Date Applicant
Date_, fe •+. - } J. Contractor fA _ .J // _A _
.:. NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'
OWNER -BUILDER DECLARATION: I hereby affirm that I am exemptfrom the,Contractor's License Law'for the
Compensation provisions of the Labor Code, you must forthwilh.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 deeinedrevoked. a
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 a signed statement that heislicensedpursuant tothe provisions ofthe Contractor's License Law
01 hereby certify that no excavation five (5) or more feet in deptifinto 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.SeFtion,7031.5 by any.applicantfor a permit,
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2: Sec 341, Title 8,
subjects the applicant to a civil penalty of not more than.five hundred dollars ($500.):
C.A.C.)
•.O •I. as owner of the property. or my employees with wages as their sole compensation, will do the work, and the
0 As owner -builder, I will -hot employ anyone to 116 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
-.
through his own employees, provided that such improvements are not intended or offered for sale. If, however, the
❑ Divisiomof Industrial Safety PeIsnit No.
building orimprovermit is sold within one year of completion, the owner -builder will have the burden of proving that
Date Applicant
• he did 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. 3097, Civ. C.). - ••
'l 7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of properly who
Lender's Name
builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the
SSB
Contractor's License Law.). _
Lender's Address
0 4'am exempt under Sec. B. & 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
DateOwner
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 lot inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby. affirm that I have a certificate of consent to self -insure, ora
• •
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
0 Certified copy is hereby furnished.. , , „ ,, . •
the information given is correct. 1 agree to comply with all state laws and county ordinances relating to buidling
❑ 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 the property for which l have applied for this permit for-the.purpose of making inspections.
Date Applicant.
Signature of Applicant or Agent Date
APPLICANT NAME (L. F. MI)
Mrs. Stott
ADDRESS - -
51-371 Martinez
CITY/COMMUNITY/STATE/ZIP la Qui ta, CA 92253
JOB SITE ADDRESS/SPACE
Sam
CITY/COMMUNITY/STATE/ZIP Fra QuinL,'LQ, CA. 92153 .
BOK
PAG
PRC
C'
2 layers l5 1b fes, small crushed
TWN
RNG
SE
S
TRACT
LOTMOD
SB
,
TRACT NAME
OWNER NAME (L. F. MI)
CONTRACTOR -FIRM NAME : ••
J•Y
ADDRESS 78-550 Darby Rawl
CITY/COMMUNITY/STATE/ZIP ••
Indio, CA 92201
PHONE .
L ICNC M
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP ..
PHONE II -
,
LICNC
2`14 921
USE OF PERMIT
ire -roof
BL
ZON
FSB
SSB
SSB
RSB
OFC
,ZONE ORD . ,.
LOT SZ • . '
END
SIDE
Print Applicant/Agent Name
APPUPRMT
n n q DATE -
9 -5 84 RIDG
Permit to tp-ar off and ric-r of
ca"oplete house, using new metal
Inn ndaes I latex 30 lb felt with
2 layers l5 1b fes, small crushed
rock and coated white.
Permit 44.50
SNAP .50
45.00
my °
NOTAL ^ .
fl : FEE TZ.00
,
V V
BLDG. DEPT. VALUATION 3,190.—
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
1OA.
Fireplace T.O.
❑
OWN
ADDITIONAL INFORMATION
v
/
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/I
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final