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RPL (0403)77438 Calle Mazatlan 0403 ADDRESS a PERMIT APPLICATION City of La Quinta Department of Building and Safety I. _107, - This permit becomes void it work not commenced- within 180 days from date of issuance. OR, if work -has been suspended or abandoned'for.a period of'180 days. ' C- CERTIFICATE OF EXEMPTION FROM WORKERS'•COMPENSATION INSURANCEi This section neednot be completed if • LICENSED CONTRACTORS. DECLARATION: I hereby affirmrlhat .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. Lic. Number. Date Applicant. Date Contractor - NOTICE TO APPLICANT: <:If,after.making:this Certificate o1.Exemption, you should become subject to.the•Workers'. • T- DECLARATION: I hereby alfirm,fhat I am exempt Iron the Contractor's OWNER -BUILDER Licenselaw for the '. Compensation provisions.of.th'e;LaborCodepyou 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.permitto .., 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 asignedstatement that heislicensed pursuant tothe provisions ofthe Contractor's License Law . 01 hereby certifyth'atnoexcavation five'(5)ormore' feet indeoihinto Which aperson isrequiredtodescend,will be• ' :'(Chapter 9(commencing with section 7000) o1 Division 3 of the Business and Professions Code) or that he is exempt :• - • .made in connection with work authoriied by this permit, and that no building struciuie, scaffolding;.falsework, or therelrom.and thebasis for the alleged exemption. Any violation of Section 7031.5 by.any applicant for. a permit ' demolition or dismanthrig,the'reof. will -be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec341, Title8, ` subjects the applicant to a civil penalty of not more than,five hundred dollars ($500.): p ) S ;;ar+- 0 I. as owner of the property, or myemployees.with wages as their sole compensation, will.do the work, and the 0 As'owner-builder, I will not employ anyoie'to do work which would require a permit -from the. Division of ; -structure is not intended or,ofiered for.sale (Sec: 7044. Business and Professions Codet.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 r ' through his own employees. provided that such improvements are not intended or offered for sale. If; however, the. 0 Division of Industrial Safety.Permit. No. building or-improverrint is sold within one year of completion. the qwner-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 a8irm that there is a•construction lending agencyfor the performance , 0-1, asowner 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.). • •1 , • .. -7z' 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who, 'builds Lender's Name or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the LOT SZ.., .Contractor's License Law.).' Lender's Address 0:1 am exempt under Sec. B. 8 P.C. (Attached Certificate): I certify that I have read this application and state that the above information is correct l agree to comply with all r„ ' Date Owner °J " ' 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. •' WORKERS'.COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, ora ' ' • certificate o1 Workers' Compensation Insurance,: or a certified copy thereof'(Sec: 3801: Lab. C.). Signature of Applicant or Agent Date -' Policy NCompany . a. — 7 .. - - 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. I agree to comply with all state'laws and county *ordinances relating to.buidling - O Certified copy is filed'with the City.BuilAing Inspection%Depariment'or Cl** -• artenI. construction, and authorize a' representative of,the City of La Ouinta Department of Building and.Salety to enter. i Ley Date 2 ~'! •/+ upon the property for which l have applied for this permit for the purpose of making inspections. _ -Appl'cant Signature of Applicant or Agent 'Oate* +• i 1 Print Applicant/Agent Name APP CANT ME (L. F, y • .. 49,17 ADDRESS CITUyOMMUNIT STATE//ZIP 1 JOB SITE ADO,PE ACE .. . . ' CITY/COMM UN ITY/STATE/ZI P - 77y3'9 y Az 1r %J BOK PAG -PRC C- ' TWN "GSE ', S TRACT - LOT . I TOTAL FEE I MOD .SB. 'TRAC AME e,/7,C- OWNER NA CONTRA TO -FIRM NAME- ori ADDRESS CITY/COMMdf QU6TA / PHONE a ' LICNNCC 0 ARC/ENG FIRM NAME - ADDRESS .. CITY/COMMUNITY/STATE/ZIP - - - 'PHONE N LICNC II USE OF PERMIT BL ZON FSB' SSB SSB RSB OFC = ZONE ORD'#' ..' °/"" LOT SZ.., -END' .SIDE APPUPRMT DATE l°llll c,oz -to a&, vq y .- _ /- __. o , g1" ...s.AQ_ tea© eo i / •:Cr U, , . Nh.. TOTAL FEE ` BLDG. DEPT. a_ _ VALUATION n. P 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. ❑ NADDITIONAL-INFORMATION O. NO. 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 pI STREET NAME P/I 26 Power Pole 27 Conduit 28 Service Entrance 7 7 7U -7714 29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service