001396 (PAT)'PERMIT - ••
3
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 a period of,180 days. > '
• 'tt •- •.
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
'LICENSED CONTRACTORS DECLARATION:'P 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). o1 Division 3 of the Business and Professions Code, and my,license is in full force
- . issued. I shall ,not employ any person inanymannersoasto 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, you must forthwith comply with such provisions or this permit shall
be deemed; revoked.
following reason (Sec: 7031.5, Business and Professions Code: Any city or county -which requires a permit to
OWNER NAME (L. F. MI) _ -
applicant
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 to the provisions of the Contractor's License Law
,' ❑•I hereby certify t'hatnoex ca vation five (5) or more feet in depth into which aperson is required to descend, will be
'.. (Chapter 9(commencing with section 7000).of Division 3 of the Business and Professions Code) orthat he is exempt ; .
made in connection with"work authorized by this permit, and that no building structure, scaffolding, falsework, or r
therefrom and the basis for the alleged exemption. Any violation/o1.Section 7,03.1.5 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, Sec341, Title8,_
subjects the applicant to a civil penalty of not more than five 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 ...
'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
c
through his own employees; provided that such improvements are not intended or offered for sale. If, however, the • -
O 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.).
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
O 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
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
O 1 am exempt under Sec. k• B. 8 P.C. (Attached Certificate). -
.l certify that [have read this application and state that the above information is correct. ) agree to comply with all,
Date Owner `�+ �' ^' ' * `� A•� a s - �'e
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
• " . j
of this county to enter upon the'above-mentioned property forinspection purposes.
' WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, ora
I- certificate of Workers' Compensation Insurance , or a certified copythereof (Sec. 3800. Lab. C.).
"» Signature of Applicant or Agent Daie . '•
Policy No. Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
O Certified copy4s hereby furnished.
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
❑ Certified copy is'lited with the City Building Inspection Department or City Department.
construction, and authorize a'representative of the City of La Ouinta Department,ot Building and Safety to enter
u upon ti? property for which I have applied, for this permit for, the purpose of making inspections.
Date Applicant,
/
Signature of Applicant or Agent z' Date
'
Print Applicant/Agent Name
APPLICANT NAME'(L. F. MI) MM
'AODRESS 53-490 RIabio Ave.
CITY/COMMUNITY/STATE/ZIP uih a, . CA 92253 '
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TRACT NAME -
OWNER NAME (L. F. MI) _ -
applicant
CONTRACTOR -FIRM NAME •- '
ADDRESS abom
CITY/COMMUNITY/STATE/ZIP
abwe
PHONE A
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ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP '^
PHONE A
LICNC I
USE OF PERMIT _ ,{, ,
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BLDG. DEPT. .
APPL/PRMT f l .jqR/ C ATTEV""oS alaiG•
Pmt to construct pt1t1A Colmr as
per approved PSS and applicable
bodes add ordinances.
Plan (beck Fee 20.15
Const. -Fee 31.00
+1I .50
-TOTAL
FEE
51..65 ,
6 ,+ 3
VALUATION 1,881.00
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.
❑
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)
126 Ceiling (Batts)
12C Ceiling (Blown)
14 Final 7
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)
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final