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0639 (RPL)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 Iona f eriod of 180'days:. APP NAME-(L/i�FN` L�� •... CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSA-'ION.INSURANCE: This section need not be'completed if ' LICENSEO'CONTRACTORS DECLARATION:- 1 hereby. affirin that I am licensed .under provisions of Chapter 9 the permit is for one hundred (8100) o;'less. I certify that i -i the performance of the work.for which this permit is (commencing with Section 7000) Qf Division 3o1 the Business and Professions Code• and my license is in full force issued; I shall not employ any person in anymannerso as tr,become subject to the Workers'CompensationLaws of and effect. California. License Class Lic: Number Date Applicant • Date Contractor NOTICE'TO APPLICANT: If, after making this Certificate of.Ezemption, you should become subject to.the Workers:.,.: n: • -' - - OWNER -BUILDER DECLARATION: - I hereby affirm that I am exempt from the Contractor's License Law 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 s 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 pursualt to the provisions of the Contractor's License Law -'❑(hereby certify that no excavationfive(5)ormorefeetindepthintowhich'apersonisrequiredtoIdescend,willbe: ' (Chapter -9 (commencing;with section 7000) of.Division 3 of the Business and Professions Code)or that he is exempt 'made 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 of Section 7031,5 by any applicanLfor a permit . - demolition or dismantling thereof, will be more than thirty -six -(36) feet high. (Chap 3.2. Grp 2, Art 2, Sec341, Title 8, ' subjects the applicant wa:civil penalty of not more than five hundred dollars (8500.): C.A.C.) ❑ I, as owner.of the property, or my employees with wages as their sole compensation, will do the work, and the - O As dwner-builder, I will not employ anyone to do wcrk 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 -sucli person has 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 a.. O Division of Industrial Safety Permit No. ? building orimprovemntissoldwilhinoneyearofcompletion. the owner -builder will have the burdenotproving that •. Date Applicant-• he did not build or improve for the purpose of sale.). r" CONSTRUCTION LENDING AGENCY: I hereby affirm:that th--re is a.consiruction 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; C v. C.). 7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Lender's Name builds or'improves'lhereon, and who contracts for such projects with a contractor(s) licensed pursuant'to the 'SSB Contractor's License Law.). _ .. Lender's Address O 1 am exempt under,Sec. A. & P.C. (Attached Certificate). .. I certify that I'have read this application and staleahat th.: above information is correct. I agree to comply with all . Date Owner "" city and county, ordinances and state laws relating to builling construction• and hereby authorize representatives . . of this county la enter upon the above=mentioned propetfy for inspection purposes.. WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell -insure: or a ' certificate of Workers'Compensation' Insurance , or ecertified. copy thereof'(Sec.'3800. Lab. C.). "Signature of Applicant or Agent Date Policy No. Company CERTIFICATE OF'COMPLIANCE AND AUTHORIZATIONOF EATRY: I.certify l have read this application and state that, ❑ Certified copy is hereby furnished. - ; : • - : `\w the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling construction„and authorize a'representative of4he City �f LaOuinta Department of Building and Safety to enter O Certified copy is I I d withothe City Building Inspection Department or_City - Department. �1 (,T/, �_ J Bii;^'�� �' ! upon the property for which I have applied for this perp it for the purpose of making'inspections. Date Applicant APP NAME-(L/i�FN` L�� •... aLICOT A� 2F ��O/ ci A�� ///. .. % .CIT V,%C.OMMU�NVIT_Y/STATEJZIP-JOB � C..G�Jn©>A� /T TE,AIp�pJ/R .R/•/A10EdZ C_ /7 G `ITY/COMMUNITY/STATE/ZIP . ' BOOK PAG PRC .0 TWIN' PING SE S /ATc�6 : LOT; J - MOD se TRACT NAME OWNER NAME (L. F. MI) ' CONTRACTOR -FIRM NAME •• 'ADDRESS - CITY/COMMUNITY/STATE/ZIP '. � / & `^ D 7 LION 7 7 `�7 . ARC/ENG FIRMNAME- ADDRESS CITY/COMMUNITY/STATE/ZIP •• PHONE II LICNC • - .• USE OF PERMIT BL ZON FSB 'SSB SSB RSB OFC .•-. ZONE ORD • % LOT SZ END SIDE Signature of Applicant or Agent Date Print Applicant/Agent Name APPL/PRMTn L �t..t 9T .+go ���� y/ , �,O/v /r ro l`11��/ ' t TOTAL FEE VALUATION BLDG. DEPT. W 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. ❑ NON ADDITIONAL'INFORMATION / / r 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 PSL 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