000911 (PAT)APPLICANT NAME (L; F,,MI) L.J. Haixmer Confit. Cb.
ADDRESS
1322 Be110Un.1t 1-N
PERMIT APPLICATION _ <a U J
City of La
Ouinta'
' Department of Building
and Safety
eriod "of 1BO,days.
This permit becomes void if work not commenced within 180 days from date of issuanceiOR, it work.has been suspended -or abandoned for ap'
s+
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?000) of Division3oftheBusinessand,ProtessionsCode,`andmylicenseisimlull.force'.':.:
ssued',lshall not employany person inany manner soastobecome subject totheWorkers'CompensalionLaws of .
and effect. —7'
t I
California.
-. License Class 1 Lic. Number12lf ' /
.. .-.
Date Applicant
.a
Date - Conlractor. �'. � �Usi '� /'•f ig! .
,-Compensation
NOTICE TO APPLICANT:.If, after making this Certificate of Exemption, you should become subjecLto lhe.Workers
/
' DECLARATION' :1 hereby' affirm that'I exempt from the Contractor's License Law for the'
provisions of the labor. Code, you must forthwith comply with such provisions or -this permit shall
OWNER -BUILDER am
'following reason (Sec. -7031.5; Business and Professions Codec Any city or county which requires a permit to •.
be deemed revoked.'
" construct::alter,•improve,`demolish, or repair anystruliture, 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 C - ontractor's License Law .._
plhere bycertify thatnoexcavationfive (5)ormorefeetindepthinto whicriapersonisrequiredtode's cend,will be-•..'
(Chapter 9 (commencing with -section 7000) of Division 3 of the Business and Professions Code) or that heis exempt ••
-made in.connection'with'work 'autho ized by this permit, and that no building structure, scaffolding, fatsework, or'
' therefrom and the basis for the alleged exemption.,Any violation of Section 703:1.5 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 2,4Sec341'Titlell, - . .
subjects the applican :to a civil penalty of not more than five hundred dollars .(S600.): .
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 '
046 wner,-.builder*. I' will'not employ anyone to do work which wouldrequirea permit Irom.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, theme ' - , .
0 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 herebyaffirm4hat there is a construction lending' agency for the performance
. ,0 I, as owner. of the property, am exculsively contracting with licensed contractors to constructthe.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
Name'01. -
builds or improves thereon, and who contracts for such'projects with'a contractor(s)'licensed pursuant to the'.
,Lender's
Contractor's License Law.).
Lender's Address '
01 am exempt under Sec. ..B..& P..C..(Attached Certificate)..%.,,-.
I certify that Ihave 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.,C.).' a
Signature of Applicantbr Agent ' Date'
Policy No. Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF. ENTRY:' I certify l have read this application and state that
0 Certified copy is hereby furnished.
th6�inlormation given is correct: 1 agree to comply with all state laws and county ordinances relating to.buidling s
O'Certified copy is filed with the City Building:lnspection Departmenicor'City Department.
construction, and authorize,a representative of the City.of•la Ouinta Department of Building and Safety to enter
upon the property -for. I have applied: for- this permit for the purpose'ol making inspections.
Date Applicant
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPLICANT NAME (L; F,,MI) L.J. Haixmer Confit. Cb.
ADDRESS
1322 Be110Un.1t 1-N
CITY/COM MUN ITY/STATVZI P
JOB SITE ADDRESS/SPACE '
52-105 Avenida Ramirez
CITY/COMMUNITY/STATE/ZIP L8 Q�ta�. 'CA :92253
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TRACT NAME
OWNER NAME (L. F. MI)
CONTRACTOR -FIRM NAME .. '
.ADDRESS
.CITY/COMMUNITY/STATE/ZIP
1
,PHONE .
LICNC .
ARC/ENG FIRM NAME
ADDRESS'
CITY/COMMUNITY/STATE/ZIP -
'PHONE .
LICNC 1
USE.OFPERMIT '
Screen ti�isl i Patio
RL
ZON
-FSB
SSR .
, SSB
ASP:
.OFC , `.
• ZONE ORD..',
LOT'SZ
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- END
SIDE
APPL/PRMT•n 9l N'. OAp q � .. .
. nnn--- AAA O-2 9 —OY. .. • ,
Penni t to screen exsistinq patio
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fff' ION- 1:1 ULI
TOTAL ' i--- ..
FEE s._ J5.00
` •' f# VALUATION 3200°00
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.
❑
NON ADDITIONAL INFORMATION
(j, / �� �%`✓�/
!/ / O `�
i
SEWAGE SYSTEM SIZE & LOCATION.
11 Exterior Lath
12 Internal LathF7
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
PSL PiI
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final