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BLDG (0678)PERMIT APPLICATION City of La Duinta � �C • Department of Building arid Safety This permit becomes void it work not commenced within 180 days from date of issuance, OR, if work fias 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: I 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. `, is ; License Class Lic. Number Date— Contractor . OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for4he 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 (Chapter9(commencing )Nithsection 7000)ofDivision3ofthe,Business. and Professions Code).or that heis 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:):1 , •,. O I, as owner of the property, or my employees with wages .astheir sole compensation, will do the work, and the structure is notintended.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. ll, however, the building orimprovemntissoldwithinoneyearofcompletion, the owner -builder will havethe burden of provingthat he did not build or improve for the purpose of sale.). ❑ 1, 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 anowner 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 I -am exempt -under Sec. •. B. & 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 , ora certified copy thereoV(Sec. 3800. Lab. C.). Policy No. Company - - /C\Certified copy is. hereby, furnished. ]: O Ce 'tied copy is ded with the City Building InsPedttion'Departme tjoxty Department Date ` G� 7 Applicantj�'�r✓� APPLIC �N,T NAME (L F, M1)w��Ql r� � ADDRESS' ` ,1- 723 �v� /t✓�r3N flu CITY/COMMUNITY/STATE/ZIP - iL• JOB SALE ADDRESS/SPACE OI'C�OMMUJNNNII T��YYpIS7TATE/ZI P BOK • PAG PRC I C TNM. RNG SE S TRACT LOT INED MOD Se La QuilRa , TRACT NAME ' CONTRA . yjIC/ ADDRESS� CITY/COMMUNITY/STATE/ZIP - - f PHONE .- LICNC N ARC/ENG FIRM NAME - ADDRESS CITY/COMMUNITY/STATE/ZIP - - PHONE N LICNC w USE OF PERMIT s" BL ZON ;FSB SSe SSB RSB OFC ZONE ORD . LOT SZ END SIDE: Date Applicant NOTICE TO APPLICANT: If, after making this Certificate,of Exemption, you should become subject to the Workers' _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:. O l hereby certify'that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized'by this permit; and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec341, Title B; + C.A.C.) 10 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. y O Division of Industrial Safety Permit No. Date Applicant CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency,for the performance :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. l 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. Signatul a of Applicant or Agent Date :CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certif 1 have read thisapplication and state that Y N the information given is correct. l 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. Signature of Applicant or Agent Print Applicant/Agent Name Date APPVPRMT DATE C -A Cc161 INED La QuilRa , TOTAL 7,i e / BLDG. DEPT. VALUATION 1 .y,12 _S 7,/ W NO. -OPERATION DATE INSPECTOR NO. OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS 1 Ser 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 z19 38 J 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 1 Final 10A Fireplace T.O. ❑ NPON ADDITIONAL INFORMATION Fop- r2cM®DcZ _ ` V " SEWAGE SYSTEM SIZE & LOCATION 11 Exterior Lath 12 Internal Lath 12A Drywall 13 Finish Grade „R,. INSULATION Thick Value 7A Walls (Batts)/C 12B Ceiling (Batts) 12C Ceiling (Blown) 14 Final i PLUMBING APPROVALS 15 Ground Plumb 16 Water Piping 17 Rough Plumb 771'- 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/L PiI STREET NAME 26 Power Pole 27 Conduit 28 Service Entrance '00,07"4W as 29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtuies 31 Service 32 Final