Loading...
0370 (RPL)PERMIT APPLICATION -1 City'01 La ouinta' ' - Department of Building' and Safety ' This permit becomes void it work not commenced within 380 days from date of issuance; OR,.if,work has been suspended or abandoned fora period of 180 days:. ' JOB SITE ADDRESSISPACE ,r-•' CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if, ' t. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am, licensed. under. provisions of Chapter .9 . < the permit is for one hundred (8100).o, less, I certify that in the performance of the worktor which this permit is. ' (commencing with Section 7000) of0ivision 3 of the Business and Professions Code, and,my license is in lull force issued: I shall not employ any person in any mannerso as to become subject to the:Workers'Compensation Laws of and effect./± t I5 3°5 54 California. • - '_�• - License Class Lic. Numbers Date' Applicant: ' Date - h;3 Contractor 'NOTICE TO APPLICANT: If, after.making•this Certificate of Exemption; you should become subject to the Workers' OWNER•BUILDER DECLARATION: '1 hereby affirm that I am exempt from the Contracfor's.LiCense.Law.tor 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 construct; after, improve, demolish, or repair any structure, prior to its issuance, also.requires the applicant for. DIVISION, OF INDUSTRIAL SAFETYPERMIT. CERTIFICATION: - , such,permittofile asigned statement thalheislicensed pursuanttotheprovisions ofthe Contra ctor'sLicense Law 0, 1 hereby certify,that h6 eicavation five (5) or more feet in depth into whicha person is required to descend, will be .Y (Chapter:9,(commencing with section 7000) o1 Division 3 of the Business and.ProfessionsCode) 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 .appficanl4or a permit, demolition or dismantling thereof, will be more than thirty-six (36).feet high. (Chap 3.2, Grp 2, Art -2, Sec341:Titlell, - = 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 ❑ 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 olfered for sale (Sec. 7044,Business and Protessions.Code: The Contractor's License Industrial Safety, as noted above; unless such person has a permit to do such work from that division.; --r''• , Law does not apply to an owner of property who builds, or improves thereon, and who does such work himself or . rr . 0 Division of Industrial Safety Permit No. ' through his own employees, provided that such'improvements are not intended or offered for sale. II, however, the building orimprovemntissoldwithinone year ofcompletion„lheowner-builder will havetheburden ofprovingthat. - Date Applicant he did.not build or improve for the purpose of sale,)... :';+ CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance O I, as owner of the property, am' exculsively.contracting with licensed contractors to construct the project (Sec: of the work'lor which this permit is issued (SecAO97, Civ :C.). •. i 4044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Lender's Name ” 'builds or improves thereon; and who'contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.). Lender's Address O 1 am exempt under Sec. B. 8 P.C.,(Attached.Certificate). I certify that I have read this application and statethat the above information is correct. I agree to comply with all, " Date Owner. ': 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. ti . WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of.consent to self -insure, ora certificate of.Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C:)2,,, Signature of A'p"plicant or Agent Date, Policy No. Company CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify,Fhave read this application and stafethat O Certified copy is hereby. furnished. the information given.is correct. I agree to complywith all state laws And county ordinances relating to buidling • • _ -, O Certified copy is filed with the City Building Inspection Department or City Department.. conW,uction,,and authorize a'representative of the City of La Ouinta Department of.Buifding and Safety, to,enter • .T upon the property for which I have applied for this permit for the purpose of making- inspections: Date Applicant. Signat&Cof-Applicant or Agent Date . Print Applicant/Agent Name APPLICANT NAME (L, F. MD ADDRESS -� - CITY/COMMUNITY/STATE/ZIP - JOB SITE ADDRESSISPACE CITY/COMMUNITY/STATE/ZIP ^ ... ' BOK PAG PRC C. - TWN RNG SE S TRACT ,' LOT MOD SB - TRACT NAME OWNER NAME (L. F. MI( 412 ^ /•1 I /© T!', S CONTRACTOR -FIRM NAME ADDRESS CITY/COMMUNITY/STATE/ZIP. PHONE • .LICNC • ARC/ENG FIRM NAME ADDRESS CITY/COMMUNITY/STATE/ZIP PHONE N LICNC • USE OF PERMIT -. =ZONE FSB SSB.. •'SSB' -'RSB OFC • ORD �. - ,:�- LOT SZ- =;END 'SIDE:- APPUPRMT � `�,y. ■. DATE /� // ^ +ry• ` Pf,e/;1 /% 1-0 _—Z V 7,44 6 A00Z 5 /fit 4 5 FEE VALUATION i BLDG.DEPT. ':.TOTAL • ' � DD . . FEE VALUATION 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.-ED 43 Final 10A Fireplace T.O. ❑ NO ADDITIONAL INFORMATION �y� /�/✓J/O / T�� ll SEWAGE SYSTEM SIZE & LOCATION 11 Exterior Lath 12 Internal Lath t2A 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 PAI STREET NAME 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service 32 Final