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PAT (0304)APP •IGANT NAME (L, F Mot • - ADDRESS" All PERMIT APPLICATION ..- City of La Duinta Department of Building and Safety �• C + This permit becomes void it work not commenced within 180 days fromdate of issuance. OR, if work has been.suspended or abandoned for a period of 180 days. . '• • t::: '. 1 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed it 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 mannecso as to become.subject tothe Workers'Compensation Laws of ��_�.// and effect. Califor ia. 1 License Class Lic. Number Date _ Applicants :- Date - Contractor - , . •,. NOTICE TO APPLICANT:If�after making this Certificate of Exemption, you should become subject to.the•Workers' • - '+ r +''' 'OWNER -BUILDER DECLARATION:" I hereby affirm that tam exempt the Contractora License law for the Compensation provisions of the Labor Code, you 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 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 asignedstatemen•thatheis,licensedpursuanttothe provisions ofthe Contractor's License Law 01 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, vv ill 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 Qasis: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!2i Sec341, Title8, - subjects the applicant to a civil penalty of not more than five hundred dollars ($500.): 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.: O' 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 SafetyPermit No.. building orimprovemntis.soldwithin one year of.completion.the owner -builder will havetheburden:ofproving that, Date Applicant . he did not build or improve for the purpose of sale.). :''/• h CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance - . 0 1, 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 - t ' builds or improves thereon, and who, contracts for such projects with a' contractor(s) licensed pursuant to the Contractor's License Law.). Lender's Address 0 1 am exempt under Sec. B. & P.C: (Attached Certificate).. :1 certify that I have, read this application and state that the above information is correct. I agree to comply with all Date— �' Owner 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, or a ... .. . ' certificate of.Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. Q. '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. :<, • o �' the information given is correct. I agree to comply with all stateaaws and county ordinances relating to buidling ._ 0 Certified copy is filed with the'City Building Inspection Department.or City Department..' • .. 'Date uthorize a'replresentative of the City.of La Ouinta Department of Building and Safety to_ enter construction, and-authorize upon t e proper for which l'have pp red'lor this permit for the purpose of makin(j:inspections� "� Applicant �• d . �. .. JCC% Siggature of "Applicant or Agenntt% Date Print Applicant/Agent Name APP •IGANT NAME (L, F Mot • - ADDRESS" All CITY/COMMUNITY/STATE/ZIP y - JOB S TE ADORESFfl//�V PACE _ CITY/COMMUNITY/STATE/ZIP BOK .PAG PRC C ,. TNM RNG c SE S TRACT 'LOT MOD .SIB . TRACT NAME ' OWNER F. MI) CO�N. VTRYA�QCTO�R�-iF'ISRM_•- ME .=G�ale . ADDRESS CITY/COMMUNITY/STATE/ZIP PHONE 6. LICNC N - ARC/ENG FIRM NAME . ADDRESS - - CITY/COMMUNITY/STATE/ZIP PHONE II LICNC 8 USEmy �PE�M1T "'de SZ/OONN BL FSB SSB SSB. RSB' OFC .•.. ZONE ORD a LOT SZ - ' END SIDE''• -• APPLNRMT . ¢' � A ■��, �� DAT` 04, GO V le O ,OeC/` QWvq o aJ 10, IN City of L QuinfS r. TOTAL FEE • T BLDG. DEPT. %i VALUATION /��3 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. ❑ OP'NO. ADDITIONAL INFORMATION. SEWAGE SYSTEM SIZE & LOCATION 11 Exterior Lath 12 Internal Lath 12A Drywall 13 Finish Grade INSULATION Thick R Value 7A Walls (Batts) W 12B Ceiling (Batts) 12C Ceiling (Blown) 14 Final 1.Qb , PLUMBING APPRQ<JALS 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 296 Bonding 30 Fixtures 31 Service 32 Final .