001364 (PLBG)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 for a Deriod of 180 days
;., . 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: I certify that n 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,as0..become subject to the Workers'Compensation Laws of.
and effect. _ - California.
License.Class I iicc,Nuniherr - r Date Applicant
Date ` Contractor^ / •"•�- f �= `-t/ NOTICE TO.APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers:
• I, Compensation. provisions of the Labor Code, you must foMhwith comply with such provisions or this permit shall
OWNER -BUILDER DECLARATION: I hereby affirm Ihafam exempt from{he Contractor's.License'Law for the be deemed revoked. -
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 CERTIFICATIOA::
such permit to file-asigned statement that he is licensed pursuaritto the provisions of the Contractor's License Law 01 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend,will be
(Chapter 9 (commencing with section 701X)) of Division 3 o1 the Businessand Professions Code)orthat he is exempt made in connection with work authorized by this permit, aid that no building structure, scaffolding, falsework, or
therefrom and the basis for.•the alleged exemption: Any violation oLSection ,7031.5 by any applicant for a permit in
or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec341, TitleB:
subjects the applicant to a civil penally of not more than five•hundred dollars ($500.): C. C.)
❑ 1. as owner of the property, or my employees with wages as their sole compensation, will do the work, and the O As owner -builder, I will not employ anyone to do wck 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 Induslrial'.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 •
through his own employees.:provided that such improvements are not intended or offered for sale. If, however, the. O"Division of Industrial Safetylermit No.
building or improvenint is sold within one year of completion, the owner -builder willhave the burden of proving that Date Applicant
he did not build.or improve for.the purpose of sale.).
.. ,. s + CONSTRUCTION LENDING AGENCY: I hereby affirm that th.re 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 far -which this permit is issued (Sec. 3097, Ci/: 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 to the- - -
Contractor's License Law.).. 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 the above information is correct.I agree to comply with all
Date Owner city and county ordinances and state laws relating to buifdAg construction, and hereby authorize representatives
of this county to enter upon the above-mentioned propery for inspection purposes.,
WORKERS' COMPENSATION DECLARATION: I hereby.affirm that.l 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 OF ENTRY: I certify I have read this application and state that
O Certified copy is hereby furnished. the information given is correct. I agreeto comply with all state laws and county ordinances relating to buidling.
O Certified copy is filed with the City Building Inspection Department or City Department. construction, andauthorizea'representative of the,City cl La Ouinta Department,of Building and Safety.to enter
upo�njthe praperi for -which I have applied for this perm.a for the: purpose okmaking inspectionCs.
Date Applicant
° Signature of Applicant or Agent Date
Print Applicant/Agent Name
'APPLICANT NAME (L. F. MI)
AffexicmIn&_a1
L��
ADDRESS 2770 S• Harbor Blvd. #A
CITY/COMMUNITY/STATE/ZIP
Santa Ana, CA 92704
JOB SITE AOORESS/SPACE -
53-960. Ave..nida. Navw=o
CITY/COMMUNITY/STATE/ZIP -
La Quinta, CA 92253
BOK
PAG .
PRC
C
TWN
RNG
SE
S
TRACT, - I
I LOT.
MOD
SB
-
'TRACT NAME - -
OWNER NAME (L. F. Ml) l
3i
CONTRACTOR -FIRM NAME '. ` q..
Awlicant
ADDRESS M .
abom
CITY/COMMUNITY/STATE/ZIP
r �y,�,�,�
PHONE •
. '-714 966-212,1
' •
LICNC •
ARC/ENG FIRM NAME - ..
ADDRESS ..
CITY/COMMUNITY/STATE/ZIP -
PHONE N
LICNC N
USE OF PERMIT
Sial r Lester Heatim SW_ atm
BL
ZON
FSB
SSB,
'SSB
RSB
I OFC
,ZONE ORD.•.
LOT SZ.
END, I SIDE .
•APPL/PRMTSATE
i 364,5r2-85 P1�iru*-
_.
Permit to bistall a solar hot 'l1%abCL systan
as per approved Plans.
Plumbim 20.00
TOTAL
FEE •
20.00
A 0 9 0 3 5 2
BLDG. DEPT. -
VALUATION 5.200.00
•
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.
❑
NPON
ADDITIONAL INFORMATION
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
PI PiI
STREET NAME
26 Power Pole
27 Conduit
28, Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final