BLDG (001174)i�
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 fora period of 180 days.
-I.
1
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
LICENSED CONTRACTORS DECLARATION: I.hereby affirm that ,l 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 oft a 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' Compensation Laws of
and effect. �—>� T'(.L_fp
California.
License Class. —ic.,N�um_beeF g t 1,
Date Applicant
Y Q� �� z ^�
SE
Date •' - Contractor / - / -
i OWNER- BUILDER DECLARATION: I hereby affirm'that I am exempt from the Contractor's License Law for the -.
NOTICE TO APPLICANT: If, after making this Certificateol Exemption, you,should become subject to the Workers'
Compensation provisions of the Labor Code, you mustforthwith comply with such provisions or this permit shall
be deemed revoked. `- -
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 •.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION>
such permit to file a signed statement that he is licensed pursuant to the provisions of the Contra ctor'sLicense Law,
0 hereby certify that no excavation five (5) or more feet in depth intowhich a person is required to descend, will be '
(Chapter9(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, falsework'or
therefrom and the basis for the 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 2 Art 2. Sec341. Title B.
subjects the applicant to a civil penally 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 '
❑ As owner -builder, I will not employ anyone to do'work which would require a permit from the Division ot.
structure is not intended or offered for sale (Sec. 7041. Business.and Professions Cade: 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 •
,
O Division Permit No.
through his own employees. provided that such improvements are not intended or offered for sale: If; however, the
ot.lndustrial Safety ;
building orimprovemntissold 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,). . . I.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the perfoimance
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.).
7041. Business and Professions Code: The Contractor's License Law does not apply t6•an owner of property -who
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builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the'.
Lender's Name .
Contractor's License Law.). , +.
Lender's Address
O 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. I agree to comply with all
Date' Owner r
city and county, ordinances and state laws relating to building construction, and hereby authorize representatives
LOT SZ
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.
END
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. -C.). I
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
.O Certified copy.is. hereby furnished.
theinformation given is correct. -I agreeto comply with all state laws and county ordinances relating to buidling
O Certified copy is filed with the City Building Inspection Department -or City Department.
construction. and authorize a'representative of the City of La Duinta Department of Building and Safety to enter
upon the property for which I have applied for this permit for the purpose of making inspections.
Date Applicant
t'. T
V
c� Sig6ture of'Applicant or Agent r' Date
Print Applicant /Agent Name
,
APPLICANT NAME (L, F, Ml) C.V. Roofing
ADDRESS P.O. Box 1256
.
CITY/COMMUNITY/STATE/ZIP . Indio, CA 9'2201
JOB SITE ADDRESS/SPACE 49-4A1A75 Nbntero.
5
CITY/COMMUNITY/STATE/ZIP La Q•{ry..;, CA 92253
8061-1
%G31
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TWN
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TRACT
19
TOTAL
FEE -
MOD
SB
TRACT NAME Atone
OWNER NAME (L. F. MI)
CONTRACTOR -FIRM NAME Am licant -
ADDRESS above -
CITY/COMMUNITY/STATE/ZIP above
iJ1JV
PHONE • 398-5186.
L'C" 3452007
ARC/ENG FIRM NAME
ADDRESS -
CITY/COMMUNITY/STATE/ZIP
PHONE 1 1
1 LICNC••
USE OF PERMIT R-1- foo f -
SL
ZON
FSB
SSB
SSB
RSB
OFC -
' ZONE ORD •
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END
.SIDE
APPL/PRMT� 1-,A1i7-85 BIG•
Permit'to remove -all loose rock and reroof
canplete house using 1 layer 307b base
sheet and 2 layers of 151b felt new metal
tririi and small crushed rock and coated
w LLbe•
i t
-Permit 44.50
SMTP .50
p
TOTAL
FEE -
:x.00
VALUATION
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
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
j
SEWAGE SYSTEM SIZE & LOCATION''
11 Exterior Lath
12 Internal Lath
t2A 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