001029 (AR)PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
0 - Naiij,"
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
s CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed it
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. I,shall not -employ any person in any mannerso asto become subject to the Workers'Compensation Laws of
and effect. California.
License Class Lic. Number
Date / V, ' Contractor Lj-
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 provisions of the Contractors License Law
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) or that he is exempt
therefrom and the basis for the alleged exemption. Any.violation of Section 7031.5 by anyapplicant for a permit
subjects the applicant to a civil penalty of not more than five.hundred dollars ($500:): -
01. 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, and 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 or improvemnt is sold within one year of completion; the owner -builder will have the burden of proving that
he did no, 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
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant.to the .
Contractor's License Law.). —_
.0 1 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 sell -insure, or a '
certificate of Workers' Compensation Insurance , ora certified copy thereof (Sec. 3800. Lab. C.).
Policy No. Company
• 0 Certified copy is hereby furnished. l:
�O Certified copy is filed with the City Building Inspection Department or City - Department.
Date Applicant
APPLICANT NAME (L, F, MI)
scar Oonstructian
ADDRESS
40-825 Yucca lane
CITY/COMMUNITY/STATE'/ZIP
Beniusda Dunes CA 92201
JOB SITE ADORESS/SPACE '
49-980 Coachella St.
CITY/COMMUNITY/STATE/ZIP -
La 01L ta. CA 92253
BOK
PAG
PRC
C.
TWN -
PING
SE
S
TRACT
LOT
Plan Check Fee
89.38
MOD
SB
Elect. Fee
TRACT NAME
OWNER NAME (L. F. MI) • • ,. .
Erich Met
CONTRACTOWFIRM NAME
alr_x�Li.aazxt
ADDRESS
above aA ove
CITY/COMMUNITY/STATE/ZIP '
abarue
PHONE • 345-4048
LICNC .
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP •• -
PHONE • -
LICNC •
f
USE OF PERMIT -y,` `
rm-a al,,,�a�tion
BL
ZONFSB
'SSB
SSB
RSB
OFC
ZONE -ORD' 0
LOT SZ
END
SIDE
Date Applicant,
NOTICE TO APPLICANT: If. after making.this Certificato of Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
O I hereby cerlffy that no excavation five (5) or more feel in depth into which a person is required to descend, will be
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2: Grp 2, Art 2, Sec 341, Tille8,
C.A.C.)
0 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.
0 Division of Industrial5atety Permit; No.
Date Applicant.
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. Q.
Lender's Name
Lender's Address
I cerlify.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 tobuilding 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 a'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 . ,0 ' Date
Print Applicant/Agent Name
APPL/PRMT r�
01 1 � ry 7...
BLDG. DEPT.
DATE
10-29-84J. Bldq
Permit to eonstnict
330 sa. ft. of
roan addition as rer awed vlans.
Mech."Fee
15.00
Plan Check Fee
89.38
Const. Fee
98.50
Elect. Fee
11.25
PAID
OCT Z 9
f
TOTAL
FEE
• 214.13
VALUATION 13,200.00
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
j
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.
❑
NP'N 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 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
r
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
296' Bonding
30 Fixtures
31 •- Service
32. Final