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0325 (PAT)° PERMIT 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. . LICENSED .CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions 'of Chapter 9' (commencing with Section 7000) of -Division 3 of the Business and Professions Code, and my license is in full force and effect. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if the permit is -for one hundred ($100) o, less. I certify that in the performance of the work for which this permit is • issued, I shall not employ any person i n any manner so as to become subject to the Workers' Compensation Laws of California. License Class - Lic.NNu/mber Date Applicant _ ' Date v �/ :w • • Contractor / . ` NOTICE TO APPLICANT:. It, after making this Certificate of Exemption; you should become subject4o the Workers'.,, . OWNER -BUILDER DECLARATION' I hereby affirm that I am exempt from the Contractor's License Lew 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 PAC 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 fileasignedstatementthatheislicensedpursuanttotheprovisionsoftheContractor,'sLicenseL•aw "• 01 hereby certify that no excavation five (5) oir more feet in depth into which a peison is requiied to descend, will be (Chapter 9 (commencing with section 7000),of Division 3 of the Business and Professions Code) or thathe is exempt made in connection with'work authorized by this permit, and that no building structure, scaffolding, fatsework, or ' • therefrom and the basis for the alleged exemption.. Any violation of Section 7031.5 by any applicant for a•permit , ,; - • demolition or dismantling thereoi,"vvill 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.)° 0 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the 0 Al owner -builder, I will ndt employ anyone to do work which -would require a permit from the Division of structure is not intended or offered for sale (Sec. 709, Business and. Professions Code: The Contractor's License ' Industrial Safety is noted above, unless such person has'a permit to do such work from that division. Law does not apply to an owner of property builds, or improves thereon• and who does such work himself or CONTRACTOR -FIRM E '. <�n es through his own employees, provided that such improvements are not intended or offered for sale. It. however, the- : 0 Division of. Industrial Safety Permit No.. ' building or improvemnt is sold within one year 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.). 0 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 buil(fs or improves thereon, and who contracts for such'projects with a contractor(s) licensed pursuant to the ' Contractor's License Law.). 0 I am exempt under Sec. B. 8 P.C.'(Attached Certificate). Date ` Owner ' 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 0 �Certified copy is hereby furnished.. CT Certified copy is filed with the City Building lnsti tion/,peparl pe f t, I Department. DateIOIII�1 J Applicant �^r ( C APPLICANT ADDRESS ' 79 �azjc% CITY/COMMUNITY/STATE/ZIP rl err JOB SITEDDRESS/SPACE ' ..., fXJ� %Lp CITY/COMMUNITY/STATE/ZIP BON PAG PAC C TWN FIND SE S TRACT LOT MOD SB ' TRACT NAME OWNE��RyNAME (L. F. Mg - CONTRACTOR -FIRM E '. <�n es ADDRES,.S� �Al/ //{ AX 91 •CITY/COMMUNITYY//STATE/ZIP 'i1-• CIZ lex— I PHONE IILICNC Q e*'BS _ *63 - ARC/ENG FIRM NAME - ADDRESS CITY/COMMUNITY/STATE/ZIP - PHONE 0 LICNC ' USE OF PERMIT ' BL ZON FSB SSB SSB RSB OFC ZONE ORD 0 LOT SZ END. ' SIDE CONSTRUCTION LENDING AGENCY: I hereby affirm that there 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 the above information is correct.I agree to comply with all 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. Signature of Applicant or Agent Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling construction, and authorize, "representative of the City 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. " Signature of Applicant or Agent Date Print Applicant/Agent Name APPL/PRMT 0.1 21 ri Id i � r ef:2_ %�P� ✓J l% Alllldl'Ap, drewi74' 6 e TOTAL FEE VALUATION r. S NO. OPERATION DATE INSPECTOR NO. OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS 1 Set Back* 33 " Ventilation System 2 Ftgs & Frms /� �3 j 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 ® Z- 39 Appl. Clearance T Framing_ /D 40 Fire Damper 8 Vents 41 Smoke Detection Device. , % Garage Fire Wall 42 Commercial Hood 10 Fireplace P.Li ❑ 43 Final 10A Fireplace T.O. ❑ NOON ADDITIONAL INFORMATION ✓�% ..1 -2 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 M,