000967 (AC)LICENSED CONTRACTORS DECLARATI
• (commencing with Section 7000)'of Divi
and effect.
License Class I Lic. Number
Date Contractor -
OWNER -BUILDER DECLARATION: I hereby affirm that I aih exempt from the Contractor's License Law for the
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 Contra ctor'sLicense Law
(Chapter 9 (commencing with section 7000) of Division 3 of"the Business and Professions Code) or that he is exempt,
therefrom and the basisfor 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.):
0.1. as owner of the -property. or my employees with wages as their sole compensation, will do the work, and the
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
through his own employees, provided that such improvements are not intended or offered for sale. If, however., the
building or improvemnt is sold within one year of completion, the owner -builder will have the burden of proving that
he did not build or improve for the purpose of sale.).
0 I; as owner of the property, am exculsively contracting withficensed contractors to construct the project (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 contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
0 1 am exempt under Sec. B: 8 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 or a certified copy thereof (Sec. 3800. Lab. C.)..
Policy No. Company
0 Certified copy is hereby furnished.. -
0 Certified copy is'filed with the City Building Inspeciion Department'or City Department.
Date Applicant
PERMIT APPLICATION " ' { -1 & y
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 for a period of 180 days. +
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
ON: I hereby affirm that I am licensed•under provisions of Chapter 9 • the permit is for one hundred ($100) o, lessA certifythatin the performance of the work for which this permit is
sign 3 of the Business and Professions Code, and my license is in full force issued. I shall not employ any person inany mannecso asto become subject to the Workers'Com'pensation Laws of
California.
APPLICANT NAME (L. F. MI) Witmer
L.....er Cohd
Dmig Air . .
�.vs.�+
ADDRESS - ' - P.O. Boat 1521 - "
CITY/COMMUNITY/STATE/ZIP
Indio, CA 92201 '
JOB SITE ADDRESS/SPACE
78-401 B Ha 111
CITY/COMMUNITY/STATE/ZIP
La Ouinta CA 92253
BOK
PAG •
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TRACT I
I LOT
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TRACT NAME Plaza La '
OWNER NAME (L. F. MI) _
CONTRACTOR -FIRM NAME
Kretz Oonstruction
ADDRESS
0-950 Starlight Lane
CITY/COMMUNITY/STATE/ZIP "
Bernmda Dunes, CA 92201
PHONE . `
345-4604
31984
ky Of
IICNC .
ARC/ENG FIRM NAME 1k
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE.
LICNC N
USE OF PERMIT
BL
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FSB
SSB
SSB
.RS8
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: "
0 1 hereby certify that no elicavation 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. Title8.
C:A.C.)
0 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.
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. I 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. I.
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify l have read this application and state that
-the informal%n given is correct. I agree to comply with all state laws and county ordinances relating to buidling
construction; and authorize a yepresentative of the City of La Ouinta Department of Building and Safety to enter
upon the"pioperty to whit .I havye applied for this permit for the purpose of making ins ections.
Signature of Applicant or Agent Date
Print App icant/Agent Name
APPL/PRMT
H n n R i 8 f
DATE
10�3'��4 lJ1.dlSI•
Permit to,�install
a roof mounted
twin Q..LL W1 xUtion= R heat
ccmrercial build.
Mech. Few
15.00
F,lect. Fee
5.00
Plumbing Tee
5.00
31984
ky Of
r
TOTAL .'
FEE
255.00.
BLDG. DEPT. VALUATION 3,000.00
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.
❑
NPON ADDITIONAL INFORMATION
(/,� /
,12A
tc17f
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
126 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/L
STREET NAME
26 Power Pole
27 Conduit
28, Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final