001389 (ELEC)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, it work has been suspended or abandoned for -3 period of 180 days
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)'x, less. I certify th;t 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 manner so a:to 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 Certificate if Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must mrthwith comply with -such provisions or this permit shall
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt' Irom the Contractor's License Law for the
be deemed revoked.
following reason (Sec. 7031.5, Business and Professions Code: Any city of county which requires a permit to
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 file a signed statement that he is licensed pursuant to the provisions of the Contra ctor'sLicense Law 01h . ereby cprtity that no excavation five (5) or more feez in depth into which a pirmis(equired todescend,will be
(Chapter 9(commencing with section 7000) o1.Division 3 of the Business and Professions Code) or that he is exemptmade'in connection with work authorized by this permit: and that no building structure, scaffolding, falsework, or
therefrom and the basis for the alleged exemption. Any violation•ol Section 7031.5 by any applicant for permit demolition or dismantling thereof, will be more than thiry-siz (36) feet high. (Chap 3.2. Grp Z Art 2, Sec34t, Title B,
subjects the applicant to a civil penalty of not more than'five:hundred dollars ($500.): C.A.C.)
O 1. as owner of the property, or my employees with wages as their sole compensation, will do the work, and the O As owner -builder, I will not employ anyone to do work which would require a permit from 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 was 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, the O Division of Industrial Sgatety Permit No.
building orimprovemntissold within oneyearofcompletion. theowner-builder will have the burden ofprovingthat Date Applicant
he did -not •build or improve for the purpose of.sale.).. CONSTRUCTION LENDING AGENCY: I hereby affirm that here is a construction lending agency for the performance
❑ I, as owner of the property, am exculsively contracting with.licensed contractors to construct the project (Sec: of the work for which this -permit is issued (Sec. 3097, Civ. Q.
7044. Business and Professions Code: The Contractor's License Law does poi apply to an owner ofproperty who
builds or improves thereon; and who contracts for such projects with a contractorLender's Names) licensed pursuant to the - ...
Contractor's License Law.). / '.- t . `�1.
Lender's Address
0 1 am exempt'under Sec. - . B: & P.CC.�(Attaclhed Certif}}iLcca..I certify that I have. read this application and state that he above information is correct. l'agree to comply with all
Date ' ' Owner.1 rOf`city and county ordinances and state laws relating 10ulding construction, and hereby authorize representatives
_ % of this county to enter upon the above=mentioned piop-rty for inspection purposes.
WORKERS'' COMPENSATION DECLARATION: Ihereby affirm that I have/a certificate of consent to self -insure, or;/
' .. - - ' ' . ' '
certificate of Workers' Compensation Insurance , or a certified cop/ thereof (Sec. 3800.'Lab. C.).. ' Signature of Applicant or 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. the information given is correct. I agree to comply4itlnall state laws and county ordinances relating to buidling
construction, a`nd authorize a:representative of the Cil: of La Ouinta'Department of Building and Safety to enter
O Certified copy is filed with the City Building Inspection Department or City • Department. + r r
upon/thee prapert for which I'have applied for this�pernitt fo�hepurpose of making inspections. r,
Date Applicant i`i /o
Sign tuni of Applicant or Agent Date
i /Print Applicant/Agent Name I
APPLICANT NAME (L; F. MI) Mthy §dth-S coley '
ADDRESS '
46-441 Roadrunner Lam
CITY/COMMUNITY/STATE/ZIP
La Qiinta, CA 92253
JOB SITE ADDRESS/SPACE
sam
CITY/COMMUNITY/STATE/ZIP - -
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BOK
' PAG
PRC
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Building Bermit .1-3.00
TWN '
RNG
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TRACT
LOT
MOD
SB
TRACT NAME
OWNER NAME fL. F. Mn
CONTRACTOR -FIRM NAME applicG11V
ADDRESS a ime ,
CITY/COMMUNITY/STATE/ZIP a om
PHONE t
LICNC
-
ARC/ENG FIRM NAME -
ADDRESS
CITY/COMMUNITY/STATE/ZIP -
PHONE •
LICNC a
,
USE OF PERMIT
Add ddtt l• 200 EM SW.
Bl.
'ZON
FSB•+
SSB
SSB
RSB
OFC
ZONE ORD 1
LOT SZ.
END
SIDE
APPUPRMT
R
3-L218-85
1:1LJCCti�w1 •
Plandt to testall one 200 am service as
nex ain roved plans.
Building Bermit .1-3.00
Elect.'
25.00
TOTAL
FEE
.
35•00 1.
A 1 3 3 7 .. .5, •L8
BLDG. DEPT.
VALUATION 1 —U—
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.
❑
OP'NO.
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)
J2C 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 P)
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire..
29B Bonding
30 Fixtures
31 Service
32 Final �/ e