0397 (ELEC)APPLICANT NAME (L. F, MI(
-
PERMIT
APPLICATION
City
-
of LaOuinta -
fr•
-r Department of Building and Safety. ,. '- „(
This permit becomes void -if work not commenced within 180 days from date of issuance. OR, if work has beensuspended or abandoned for a'period'of'180 days. -• ` ? ;
• ;;
CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE: This section need not be completed if n .
' LICENSEDCONTRACTORS' DECLARATION: I hereby affirm that I -am licensed'under provisions of Chapter'g- •
'" : the permit is for one hundred ($100) o. less. l 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.
License.Class Lic. Number
Date Applicant `
Date-, • Contractor - •
NOTICE TO APPLICANT: 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, y96, must forthwith comply with such provisions or this permit shall ..
+
following reason (Sec. 7031.5, Business and Professions Code: -Any city or:6unty, 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 signqd statement that he is licensed pursuant to the proyisions of the Contractor's License Law '
. o Ifie - 6by certify , that no exicavatiorifhie (5) or more feet in depth into whicha person is required to descend. will be
v (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 violatiRp.of•Section 7031.5 by.anyapplicant for a permit
y -demolition or dismantling thereof; will be more than'thirty-six (36) feethigh`(Chap 3.2. Grp 2, Art 2. Sec341; Title8::
subjects the applicant to a civil penalty of not more than.five;hundred dollars ($500.): � -
,
C.A.C'.j.
DLas owner of the properly, or my employees with wages as their sole compensation, will do the work; and the..
r
p 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 sLicense .
.. Industrial Safety, as noted above, unless such person Lias 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.
i
Q Division of Industrial Safety Permit No..
- building or improvemnit is sold within oneyear of completion, 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 which this permit is issued (Seca 3097, Civ: C:). .
-7044, Business and Professions Code: The Contractor's.License•Lawdoes not apply to'an owner of property who
Lender's Name
builds or improves thereon; and who contracts forsuch projects with acontractor(s) licensed pursuant to the'
,
Contractor's License Law.). _ .
Lender's Address
' 0 1am exempt under Sec: 8. 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 Owner �z"z"�— —
city and county ordinances and state laws relating to building construction, and hereby authorize rep resematives
of this county to enter upon the above=mentioned prdperty,for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that have a certificate of'consentto self -insure, ora
1`
certificate of Workers' Compensation Insurance', or a certified copy thereof (Sec. 3800. Lab. C.)_
D
tea,
Signature of Applicant or Agent Date
Policy.No. Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: 1 certify I have read this application and'statethat +*
�.
❑.Certified`copy is.hereby furnished.the
information'givemis correct. I agree to comply with all state laws and county ordinances relating -to buidling
O Certified copy is filed with the City Building Inspection Department: or City Department. ''•
construction, and,authorize a.representative of the City of La Ouinta Department of.Buifding and,Safety to enter
upon the property for which I have applied for this perm' for the purpose of -making inspections. * "'
Date'. Applicant
;
Signature of Applicant or Agent Date .�
�a.••
Print A Iicanl/A ent Name }
DD 9
APPLICANT NAME (L. F, MI(
'ADDRESS 14639
CITY/COMMUNITY/STATE/ZIP '
-L',aL tit E.
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JOB SITE ADORE CE
7,17C� /`7 r �U�•i�/D..
CITY/COMMUNITY/STATE/ZIP
GA
BOK
PAG
PRC
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'TWN'
RNG'
TSE -
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TRACT
L03
-Z 46
MOD
SS
'
TRACT NAME
OWNER NAME (L. F. MI)
CONTRACTOR -FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE # �
L�/� S
ARC/ENG FIRM NAME • ••
ADDRESS
CITY/COM MUN I TY/STATE/ZI P
PHONE M
LICNC e
USE OF PERMIT
BL'
ZON
FSB
SSB
SSB
'RSB
OFC
ZONE ORD'N
LOT.SZ
END .
SIDE .
APPL/PRMT DATE
..Y•
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7
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RF.CE8V''EQ
City 0�
telM.;a•
MN
TOTAL'' i,
FEE
VALUATION /�� 1
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
-Nj�0—
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
23 Water Service
24 Gas Test
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF. PROPERTY LINE
p/L P/I
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final