001064 (RR)PERMIT APPLICATION
City of La Quinta
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. for a. period of 180 days.
ADDRESS
78-550 Darbv Rd.
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),o, less..) certify that 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 -as ,o become subject to the Workers'CompensationLaws of
and effect.
License Class. I (� Lic. Number 1 r� y 2
California. �� -
Date Applicant
Date ' Al � � 7/ " Contractor �� ;'
NOTICE -TO APPLICANT:, If, after making this Certificate o -'Exemption, you should become subject to the Workers'.
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 t&.-thwith comply with such provisions or this permit shall
be deemed revoRed.
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. ..
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATI07:
such permit to file a signed statement that he.is licensed pursuant to the provisions of the Contractor's License Law
0-1 hereby certify that no excavation five (5) of more feet i i depth into which a person is required to descend, will be
(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, lalsework, or
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
'demolition or dismantling thereof, will be more than thirty -.six (36) feet high. (Chap 3:2, Grp 2, Art 2, Sec341, Title8.
subjects the applicant to a civil penalty of not more than five hundred dollars (S500.)>
O 1. as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
0 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
Industria l' Safety, as noted above; unless such 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
PHONE •
through his own employees. provided that such improvements are not intended or offered for sale. If, however, the
❑ Division.of Industrial Safety Permit No.
building or improvemnt is sold within one year of completion, the owner -builder will have the burden of provingthat
Date Applicant
he',did not build or improve for the purpose of sale.). !A1. -
CONSTRUCTION LENDING AGENCY: I hereby affirm that.th:re is a constructionlending agency for the performance
❑ 1, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec:.
of the workfor which this permit is issued (Sec. 3097, Cw. 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 thereon, and who contracts for such projects with a contractor(s) licensed pursuant tothe-.
-- .
Contractor's License Law.).. _..
Lender's Address
❑ 1 am'exempt under Sec. 8. .& P.C. (Attached Certificate):
I certify that I have read this application and state that the above information is correct. I agree to comply with all
DateOwner °'
city and county ordinances and state laws relating to building construction, and hereby authorize representatives .
of this county to enter upon the above-mentioned proper 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. 3801. Lab. C.).-
Signature of Applicant or Agent Date
Policy No. Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF Eh76; I certify l have read this application and state that
O Certified copy is hereby furnished.
the information given -is correct:•I agree to comply with all state laws and county ordinances relating to buidling
❑ Certified copy is filed with the City Building Inspection Department or City Department.'
construction, and authorize a representative of the City all La Quinta Department of Building and Safety -to enter
-this
upon the property for w fdh I have applied for -perm t for the purpose of making inspections.
Date Applicant
ADD
^/_ ?e
fY Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPLICANT NAME (L.'F, MI) -• -
Custom Roofing
ADDRESS
78-550 Darbv Rd.
CITY/COMMUNITY/STATE/ZIP -
Indio, CA 92201
JOB SITE ADDRESSBPACE
53-967 Navarro
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
BOK/PAG /PRC f , C
W� //7
layers 15 lh felt,
TWN
RNG
SE
S
TRACT
LOT/
•Permit fee
MOD
SB
: 50
TRACT NAME
OWNER NAME (L. F. MI)
La Quinta Realty
CONTRACTOR -FIRM NAME
Aml.icant
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP, -
above
PHONE aLICNC
345-3751
274 921
-
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP •'
PHONE •
LICNC •
,
USE OF PERMIT -
Re -roof
BL
24.00
ZON
FSB
SS8 - SSB
RSB
OFC
ZONE ORD N
LOT SZ
-
END
SIDE. ,
APPL/PRMT - 7007 N4
YY-€ _304 BLDG.
Permit to clean rock off roof and
re -roof complete
house using 1 laves
30 lb felt with 2
layers 15 lh felt,
small crushed rock and coated white
•Permit fee
23.50
SMI ' Fee
: 50
'TOTAL
FEE
24.00
BLDG. DEPT. VALUATION 1,400.00
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION DATEINSPECTOR
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.
❑
OPEN
NO.
-1 ADDITIONAL INFORMATION
V� 42 f0 Y l /
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/l
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service -
32 Final