001378 (GRES)PERMIT APPLICATION
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.
LICENSED CONTRACTORS DECLARATION: 1 hereby'affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3of the Business and Professions Code, and my license is in full force
and effect.
License Class Lic. Number
Date Contractor.
OWNER -BUILDER DECLARATION: I hereby affirm that I am 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 provisionsof the Contra ctor'sLicense Law
(Chapter 9 (commencing with section 7000) of Division 3of the Business and Professions Cade) or that he is exempt
therefrom.and the basis for, 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 (5500.):
O I. 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, avid 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 orimprovemntissold within one year ofcompletion. the owner -builder will have the burden of proving that
. he.did not build,or improve for the purpose of sale.). J
O I, as owner of -the property, am exculsively contracting with licensed 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.).
O 1 am exempt under Sec. - B. 8•P.C. (AltacheC Certificate).% %
Date, Z—
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
O Certified copy is hereby furnished.
O Certified copy is filed with the City Building Inspection Department or City Department
Date Applicant
APPLICANT NAME (L. F. MI) KexalG1.h f_ Janim Hall
ADDRESS 53-470' Avehida Ramirez
CITY/COMMUNITY/STATE/ZIPr 1 �ta, CA 92253
JOB SITE ADDRESS/SPACE 5•3L-470 Avenida Pwdrez
CITY/COMMUNITY/STATE/ZIP
La Quanta,, CA 92253
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Const. Fee
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TRACT NAME.
OWNER NAME (L. F. MI) "Wlicant'
CONTRACTOR -FIRM NAME ,
applicant
ADDRESS
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CITY/COMMUNITY/STATE/ZIP .
abow
PHONE a '
LICNC •
ARC/ENG FIRM NAME
ADDRESS ,
CITY/COMMUNITY/STATE/ZIP
PHONE •
LICNC •
TOTAL
FEE •-
USE OF PERMIT
Detached Blaralge
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SSB
SSB- RSB
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END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENS ATION INSURANCE: This section need not be completed if
the permit is for one hundred ($100) o, less. I certify tha. in the performance of the work for which this permit is
issued, I shall not employ any person in any manner so.aslo become subject to the Workers' Compensation Laws of
California.
Date Applicant
NOTICE 10 APPLICANT: If. after making this Certificate of Exemption, you should become subject to the Workers'
Compensationprovisions'.of the Labor Code, you must fcrthw_ith comply with such provisions or this permit shall
be deemed revokeb.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATICN:
O'thereby certify that noexcavation tive(5)ormorefeet ndepthintowhichaperson isrequired todescentLwillbe
made in connection with work authorized by this permit,-and.thatno building structure, scaffolding, falsework, or
'demolition or dismantling thereof. will be more than thirt<=six (36) feet high. (Chap 3.2, Gip 2, Art 2, Sec -341, Title8,
C.A.C.),
O 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 tilere 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 tt-j above information is correct. I agree to comply with all
city and county ordinances and state laws relating to Dui ding construction, and hereby authorize representatives
of this county to enter upon the above-Ynentioned propety for inspection purposes.
Signature of Applicant or Agent Date
CERTIFICATEOF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
the information given is correct:,) agree+to comply with all state laws andcountyordinances relating to buidling
construction, and authorize a' representative of the City of La Duinta Department of Building and Safety to enter
upon the property for. ich I -have applied for this petrit for the purpose of making inspections.
X 1i .ti Li4C) _4 2
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPL/PRMT ����� ,DATE
"r'~1J—BS .L+IJ.IT•
Permit to build
detached garage as Per
approved plans.
Plan ChAmk Fee
57.82
Const. Fee
80.50
Elect. Fee
22.00
SMI Fee
.70
TOTAL
FEE •-
161.02
A 1 0 3 6 5 15 1
BLDG. DEPT. VALUATION F 9.274•
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
j y
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
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 AP ROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
•19 Sewage Disposal
20 Sewer
21 " Water Heater
`22 ' Water Softener
23j Water Service
24f. 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