0306 GradingPERMIT APPLICATION '
APP iCANT'NAME (L, F Mp
i F MI)
QgT2glE
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 fora period of 180 days. .
/
PRC
• CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENbATION 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 3 of the Business and Professions Code, and my license is in full force
issued, l shall not employ any,person in any manner so oto 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 Certificati Exemption, you should become subject to the Workers. `•
. OWNER -BUILDER DECLARATION: I hereby.aftirm that I�am exempf'Irom 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 counjy;which requires a permit to
TRACT NAME
construct, alter,:improve-demolish, or repair any structure, prior to its issuance, also requires the applicant for
- -. DIVISION OFANDUSTRIAL SAFETY PERMIT CERTIFICAT ON: .
such permit to file a signed statement that he is licensed pursuanttothe provisionsoftheContractor's License Law ;.
0 1 hereby certify that no ekcavation five (5 or morefei in dilpth into which a persori required to descend, will be --
(Chapter 9 (commencing with section.7000) of Division 3 of the Business and Professions Code) or,that he isexempt
made i6 connection•witli work authoiized'bythis permit, and'that rio building structure, scaffolding, falsework; of ..'
:. therefrom and the basis for the alleged exemption: Any violatiomol Section.7031.5 by.any applicant fora permit , .
demolition'or-di§mantling thereof; will be more than thir y -six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec341,.Title8:. -
subjects the applicant ti civil penalty of not more than live hundred dollars ($500.): e:as,;a6
_ ' C.A.C.)" • -
:' ❑• I: as owner of the property, pi employees with wages as their sole compensation, will do the work, and the - . •
s' .0 'As owner -builder, I will not employ anyone tddo vark which would.require a -permit from tfie Division of
structure is not imended.or offered for sale (Sec. 7044; Business and Professions Code: The Contractor' s. License ...
Industrial Safety, as noted above, unless such person eas 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:
USE OF -PERMIT
• -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 orimprovemniissoldwithinoneyearofcompletion. theowner"builder will have the burdenof provingthat
Date' -Applicant
he did not build, or improve for the purpose of sale.).
CONSTRUCTION LENDING AGENCY: I hereby Affirm that IhWeeis a construction lending agency for the performance
❑ I, as owner of the property: am exculsively contracting with licensed contractors to construct the project [Si '
of the work for -which this permit is issued (Sec. 3097; Civ: C.)!I...
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 acontractor(s) licensed pursuant to the
- _ .• - '
.Contractor's License. Law.).
Lender's. Address
❑ lam exempt under SecaB. 8 P.C.,(Attached.Certificate).
I certify that I have read this application and state that he above information is correct. I agree to comply with all
«
Date "'' ' Owner' `
city and county ordinances and state laws relating to bolding construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property, for inspection purposes: a t
: WORKERS' COMPENSATION DECLARATION' I hereby -affirm that I have a certificate of consent to.self•insure. ora.
' certificate of Workers''. Compensatiomtnsurance , or a certified copy thereof•(Sec: 3800. Lab. C:)..' *
vv
Signature of Applicant or Agent ' Date .
Polfcy o._ Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify l have read this application and state that '
Certified copy is hereby furnished..
the information given is correct. I agree to comply with all state laws"and county ordinances relating to buidling .
O Certified copy is filed with the City Building Inspe ,tin Department or City' Department,
construction, and authorize a'representative of the Cit- 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.
Date Applicant
Signature of Applicant or Agent Date
APP iCANT'NAME (L, F Mp
i F MI)
QgT2glE
CIIITTY!�OO�MMMUUNNIITTYYISTATTFJZIP '0
JOB SITE ADDRESS/SPA E
:S ; ` Ave i �.^
CITY/COMMUNITY./STATE/ZIP -
BOK
PAG
PRC
C.TWN
I Vi S
Cityo a Quint.a
FIND;
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TRACT • ,
LOT
MOD
SB
TRACT NAME
OWNER NAME -(L. F. MI) .. ..
CONTRACTOR -FIRM NAME '
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE 0
'1911C
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ARC/ENG FIRM NAME �• - ..
ADDRESS -
CITY/COMMUNITY/STATE/ZIP
PHONE •
• LIC NC II
,
USE OF -PERMIT
BL
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FSB
SSB
SSB '
RSB
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• .4"ZONE ORD N
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LOT SZ _
END 7
BIDE'
Print Applicant/Agent Name
'
APPL/PRMT�n. DATERn fi.
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I Vi S
Cityo a Quint.a
• TOTAL ' .'• "
FEE
O} /
: x 'JALUATIOv
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
1.0
Fireplace P. L.
❑
43
Final
10A
fireplace T.O.
❑
NADDITIONAL INFORMATION
O.
NO.
e^
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
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/1
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
298 Bonding
30 Fixtures
31 Service
32 Final