001276 (SIGN)PERMIT APPLICATION
City of La Ouinta
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 for 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 Sof the Business and Professions Code, and my license is in lull force
issued, I shall not employ any person inanymannerso asto become subject tothe Workers' Compensation Laws of
and effect.
California.
License Class Lic. Number _
Date Applicant
Date Contractor'
NOTICE TQAPPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's 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 a signed statement that he is licensed pursuant totheprovisionsoftheContractor'sLicense Law
01 hereby certify that no excavation five (5) or more feet in depth into which a person is required 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 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, Sec 341, Title 8,
subjects the applicant to a civil penalty of not more than live 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
0 As owner -builder, I will not employ anyohe 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.
Law does not apply to an owner of property who builds, or improves thereon, and who does such work himself or
Industrial Safety, as noted above, unless such person has a permit to do such work from that division.
through his own employees, provided that such improvements are not intended or offered for sale. ll, however, the
0 Division of Industrial S%Iety Permit No.
building orimprovemntissold within oneyearofcompletion, the owner -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 affirm that there is a construction lending agency for the performance
0 I, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec.
of the work for whichthis 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 r •
Lender's Name
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. 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 t "' ' f Owner � ` / "� T
city and cou my ord i nance s and state laws relating Io 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.
Policy No. Company t -
0 Certified copy is hereby furnished.
0 Certified copy is:filed with the City Building Inspection Department or City' Department.
Date Applicant
APPLICANT NAME (L, F. MI) Yx. W L1 I ATO iVocawn
ADDRESS 76-670 .Mark Lcii''
CITY/COMMUNITY/STATE/ZIP Indian Wells, CA 92210
JOB SITE ADDRESS/SPACE SwthbastcornerHW 111
CITY/COMMUNITY/STATE/ZIP
La Quanta, CA 92253
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TRACT NAME
OWNER NAME (L. F. MI) AWlc•t
CONTRACTOR -FIRM NAME _ -^_
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CITY/COMMUNITY/STATE/ZIP ],,,�
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PHONE N
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ARC/ENG FIRM NAME ,. .
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE N
LICNC
USE OF PERMIT
On-site "FOR LEASE° sign
BL
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FSB
SSB
SSB '
RSB
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-END
SIDE
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and 'state that
the information given is correct. I 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....
i ` Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPL/PRMTnn-1
n1 2'{ s 30 -AE
T.3 -8S MISC•
Permit o install one on-site hi Vit l IMW
sign not to exoeed 4' x 6' in size -with'
arid'overall height frau' top of grade
ori which sign will . be located of 8 -feet,
as Per aPfaroved plai-s.
-TOTAL
FEE •
2a.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
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.
❑
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)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final Z
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
pL - PiI
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance `
29. Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final