PLBG (000917)APPLICANT NAME If., F. MO
71 ,.,4 UA er�,e.1 57. '
ADDRESS . • - -
.. PERMIT APPLICATION
- T City
of La Duinta j
" Department of Building and Safety
PAG
PRC
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.
" , • : - s s -
�' CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed it
' -LICENSED CONTRACTORSDECLARATION: 'I hereby affirm -that.) am licensed under provisions: of Chapter,9 ••.
:' the -permit is for one hundred ($100).o; less. l -certify that in the performance of the work for which this permit is -m
• (commencing with Section 7000) of Division'3 of the Business and P.colessions Code, and my license is in full force • .
issued, I shall not employ any person in any manner sa as to become subject lathe Workers'Compensation laws of
and effect. ! �� (�`{�' i
'�` Lic.���i M • / J
California.
Date Applicant y
License Class
Date3 _ Gntrachrr - 'I.s t,.c� �NOTICE.TO APPLICANT: If, after making this Certificati of Exemption. you should become subject:to the Workers' `.
OWNER -BUILDER DECLARATION: I hereby affirm that I am.exe�mtp�t Prom 'the C ntractor's License Law loi.the
,- i•• .' Compensation provisions of the Labor Code, you must torthwith'compty with such provisions or -this permit shall
' °
/
following reason (Sec. 7031.5, Business and Professions Code: Any city occounty which requires'a permit.to
: be deemed revoked.
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 licensed,pursuant to the provisions of the Contractor's License Law". .:,
'0 1 liereby'certif*y thit'no exci4ation five (5) or more feet in depth into which a personis req , uired 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 connectionwithwork authorised 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 applicantfor a permit n
demolitionor 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.): ' ' ,.ra G)
C:A.C.);
_0 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 not employ anyone to do 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 .
0 Division of Industrial Safety Permit No.
building orimprovemntissold within one year ofcompletion. the owner -builder will have the burden of proving that...
- .' -Date '' Applicant. '
he did not.build or improve for.the purpose of sale.). t; ,•'.
CONSTRUCTION LENDING AGENCY: I hereby affirm thaf there is a construction lending ageney for the performance
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.).
7044. Business and Professions Code:- The Contractor's License Law does not apply to an owner of property who
Lender's Name °
builds or improves thereon, and who.contracts for such projects with a contractor(s) licensed pursuant to the
f
Contractor's License Law.).
Lender's Address
,ci.0 I'am exempt under Sec. 1 A. (Attached Certificate).
' I certify that.l have read this application and state that the above information is correct: I agree to comply with all •.. .
Date a Owne*r city and county ordinances and state laws relating to building construction, and hereby authorize representatives • '
ZSIDE
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
y
certificate of Workers' Compensation Insurance'. or'a certified copy thereof (Sec. 3800. Lab. C.):
of Applicant or Agent Date
Policy No. Company
RSignature
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OFfNTRY l certify t have read this'applicationand state that . '
. 0 Certified copy is hereby furnished. 1 . _
,. the information given is correct. I agree to c.-ply_with all state laws and county ordinances relating to buidlmg
61y.of
O Certified copy is filed with the -Pty Building Inspection Department -or -City :-' '_Department."
construction, and author'ze a'representative of the La Ouinta Department of Bui ding and'Safety to enter
- J.. ,,, / ,� -
forrWhichd'have fo_r,.tthhis-permit of
Date M Applicant
upon)ihiprlopeerty applied forthe purpose makingpnspections
Signature of Appficant' or Ageri� X Dae o
tf/Prin1Applicant/Agent°Name
'i •
APPLICANT NAME If., F. MO
71 ,.,4 UA er�,e.1 57. '
ADDRESS . • - -
CITY/COMMUNITY/STATE/ZIP '
JOB SITEADDRESS/SPACE -
Z116 - 21-) 3 ,9v,E �o�v T4 lcv
CITY/COMMUNITY/STATE/ZIP '
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TRACT NAME '
OWNER NAME (L. F. MI)
A. GviL D
CONTRACTOR -FIRM NAME • .. • .. ' '
.ADDRESS
CITY/COMMUNITY/STATE/ZIP - ..
PHONE a - ' •
LICNC / _
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ARC/ENG FIRM NAME
ADDRESS '
CITY/COMMUNITY/STATE/ZIP
'PHONE* •
LICNC I1
USE OF PERMIT
SL
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-: ,END- --
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APPUPRMT DATE
71
r.
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 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
f=ireplace T.O.
❑
NPON ADDITIONAL INFORMATION '
-
)�% V / a �
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
23Water Service
24' Gas Test
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
PSL P/1
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire •
29B Bonding
30 Fixtures
31 Service
32. Final