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0323 (SATT)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 a p—riod 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. 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 provisions of the Contractor's License Law (Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefromand the -basis for the alleged exemption. Any violation of Section 7031.5by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (3500.): 0 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, acid 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 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 builds or improves thereon, 'and who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law.). CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if the permit is for one hundred ($100) o, less. I cettify that ii the performance of the work for which this permit is issued. I shall not employ any person in any manner so a s to become subject to the Workers' Compensation Laws of California. Date Applicant .NOTICE.TO APPLICANT: If, after making this• Certificate ot'Exemption, you should become subject to the Workers' Compensation provisions of the Labor. Code, you must ionhwith comply with such provisions or this permit shall be deemekrevoked. DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: 0 1 hereby certify that no excavation five (5) or more feet ir. depth into which a person is required to descend, will be made in connection with work authorized by this permit, z nd that no building structure, scaffolding, falsework, or demolition ordismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2. Grp 2. An 2, Sec 341, Title 8. C.A.C.) 0 As owner -builder, I will not employ anyone to do work which would require a permit from the Division-bf Industrial Safety, as noted above, unless such person has a permit to do such work from that division. ❑ Division of Industrial Safety Permit No.. Date Applicant CONSTRUCTION LENDING AGENCY: I hereby affirm that Uere is a construction lending agency for the performance of the work -for which this permit is issued (Sec. 3097, :iv. C.). Lender's Name Lender's Address 0 1 am exempt under Sec. B. 8 P.C. (Attached Certificate). I certify that I have read this application and state that Ine above information is correct. I agree to comply with all Date Ownercity and county ordinances and state laws relating to bLilding construction, and hereby authorize representatives of this county to enter upon the above-mentioned prop!rty for inspection purposes. 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.). Signature of Applicant or Agent Date Policy No. Company CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OFENTRY: I certify I have read this application and state that 0 Certified copy is hereby furnished. the information given is correct. I agree to comply will all state laws and county ordinances relating to buidling k�nconstruction, and authorize a'representative of the Ci.y 0 Certified copy is ffiilleed/with the' ity Building Inspection Oepa enr City Department. of La Ouinta Department of Building and Safety to enter e �1J �/ ✓ �� t o�� �1 upon the property for which 1 have applied for this permit for the purpose of making inspections. DatApplicant Signature of Applicant or Agent dint v PDODR0e Z= 700 .CITY/C M11Mti .Y/�SSyTFJZIP - A 92253 O V -6 ADDRESS/SPACER ita KA QuMm, m, TE/C P 92253 BOK PAG PAC.a''L C Patio ctvlax U0 TWIN RNG SE S TRACT L7s0 271.73 Conotx¢cian Ft__ C 3 SB 35,93 TRACT o ' tt Y\NAMEQ.s�',.•_ 'lily a OWNER NAME (L.,F, MI) ' ,CONTRACTOR -FIRM NAM 4y, , ADDRESS Po no B= 780 CITY/CO-.. MMPUNIT�V^STSATE/CZIP 92253 61�"fEYP` Cc 54 1 315 F 333762 RECEIVE® in r;z,,, OCT 13 1983 U 4!Ftl 11 1LJJ City oi La ` TOTAL ti FEE ..po ARC/ENG FIRM NAME ADDRESS CITY/COMMUNITY/STATE/ZIP PHONE II LICNC M ' USE OF PERMIT � lfr p ly II IZ11 7 BL ZON FSB SSB SS8 RSO OFC ZONE ORD II LOT SZ END .SIDE Print Applicant/Agent Name Date APPUPRMT [01 G)l DATE 1. � ,1./•� CL\,� 9 _ 17,-_ t to CJ %.s!` id.urt 1: 1 C -3—o Dml.lang 1,893 Scro Fto C- rar—�,.- 433 Sqio Ito Patio ctvlax U0 1SC71 1%o .. Plan i Ft3 271.73 Conotx¢cian Ft__ IS18000 L iCM1 oc 35,93 FU Iia 6542 P13�C")�1T _77 690 a �� �at Fz-- 450,00 F RECEIVE® in r;z,,, OCT 13 1983 U 4!Ftl 11 1LJJ City oi La ` TOTAL ti FEE ..po VALUATION=po 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 ZAAZ 40• Fire Damper 8 Vents 41 Smoke Detection Device. 9 Garage Fire Wall 42 Commercial Hood 10 Fireplace P. L. ❑ 43 Final 10A f=ireplace T.O. ❑ OP'N ADDITIONAL INFORMATION NO. 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 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 ..