001375 (BLCK)LICENSED CONTRACTORS TECLARATI
(commencing' with Section 7000) of Divi
and effect.
License Class Lic. Number -
Dater Contractor
Contractor
a
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 Contra ctor'sLicense Law'
(Chapter 9 (commencing with section7000) 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 any applicant fora permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
0 I, as owner of the property: or my employees with wages as their sole compensation,.will clothe work', and the
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License
I' 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. It, however, the
building or i mprovemnt 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.).
D 1, 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
Coniractor's.License Law.). /
0 1 am exempt under Sec. %i B. ,8 P/E. (Attached Certificate).
Date Owner w G'• "' '� t/ ''G ry s r �''
WORKERS' COMPENSATION DECLARATION: I here y affirm that I have a certificate of consent to self -insure. or'a
certificate of Workers' Compensation Insurance( ora certified copy.thereof (Sec: 3800. Lab. C.).
Policy No. Company
❑ Certified copy ishereby furnished.
O'Certified c py is filed with the City Building Inspection Department orCity Department. '.
Date Applicant
rt
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, if work has been suspended or abandoned fora period'of 180 days.'
CERTIFICATE OF EXEMPTION FROM WORKERS"COMPENSATION INSURANCE: This -section need not be completed it
ON: 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
sion 3 of the Business and Professions Code. and my license is in full force issued, I shall not employ'any person inany manner so as to become subject to.the Workers'Compensation Laws of
California.
APPLICANT NAME (L, F. Ml) Mr- & Mrs. David Vasquez
ADDRESS 51-650 Avenida Juamz
CITY/COMMUNITY/STATE/ZIP T ' 'Q �� . _ta' C . 92253
J.KL �j
JOB SITE ADDRESS/SPACE
saw
CITY/COMMUNITY/STATE/ZIP
BOK
PAG
PRC
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TWN
RNG
SE'
.S
TRACT
LOT
MOD
SB
-
'TRACT NAME
OWNER NAME (l. F. MI) �i • _ -_ & t
CONTRACTOR -FIRM NAME aPplit�ant
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP ^�M
� above
PHONE .
LICNC .
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE .
LICNC .
USE OF PERMIT '
block wall
BL
ZON
FSB
SSB.
SSB
RSB
OFC
ZONE ORD N
LOT SZ
END
SIDE
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, youshouldbecome 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 l hereby certify that no excavation five (5) or more feet 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 Z Art 2, Sec 341, Title 8, '
C.A.C.)
.0 As owner -builder, Twill 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.
O Division of Industrial,Safety 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, C.).
Lender's Name
Lender's Address
certify 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 to -building 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
up n the pr(6perty for which1have applied for this permit for the purpose of king inspectio
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPL/PRMT it fl i F � 'S eDAb-"� BU)G•
Pe rli-t to oonstnict 37 lin. ft- &f 6 fth
high block wall aril 146 lin. ft. of•6 Et.
high re&yood fence as per approved flans(
Plan Cock 25.02
Permit Fee 38.50
SMI Fee •50
1
a :
TOTAL
64.02
-A, 0 0 3 5 1 3
VALUATION 2166.00
BLDG. DEPT.
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION DATE INSPECTOR
BUILDING APPROVALS
MECIiANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
5
34
Plenums & Ducts
2A
Slab Grade
35
Furnace Compart.
3
Steel
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
Tv&t
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'N
NO.
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
t2 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick Vaalulu e
7A Walls (Batts)
126 Ceiling (Batts)
12C Ceiling (Blown)
14 Final G -
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/L
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
298 Bonding
30 Fixtures
31 Service
32 Final
FA