001241 (PAT),APPLICANT NAME (L. F. MI) Tara mark - •. -
.
PERMIT APPLICATION ' • '4• /
. ..- .• . .•
V J
City of La Ouinta
Department of Building and Safety
;. This permit becomes void if work not commenced within 180 days from date
s
of issuance, OR: if work has been suspended or abandoned for a period 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 in the performance of the work for which this permit is '
' (commencing with Section 7000) of Division Sof the Business and Professions Code, and my license is in full force '
:Y issued. I shall not employ any person inany manner so as to become subject to the Workers'Compensation Laws of
and effect.„
California.
License Class Li, -Number— n e
Date Applicant
:•r_Date : - Contractor ” � -
.. NOTICE TO APPLICANT: IL after making this Certificate of Exemption; you.should become subject to the Workers',
"* OWNERikOER DECLARATION:' I hereby affirm that] am exempt from the' Contractor's License,L•aw for the '.
• . Compensation provisions of the Labor Code, you must forthwith comply.with such provisions or this permit shall
'be t
following reason (Sec: 7031.5. Business and Professions. Code: Any city or county which requires a'perrnit to
:fes . , deemed revoked:
construct, alter, improve, demolish, or repair any structure, prior to its'issuance, also requires the applicant for
- : :• DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:, -
suchpermittofileasignedstatementthatheislicensedpursuanttotheprovisionsoftheContractor'sLicenseLaw
'3
d Iherebycertify thatnoexcavation five (5) or morefeetindepthinto which aperson isrequiredto des cend,willbe
(Chapter 9 (commencing with section 7000) of Divisionof 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 applicant for a permit
, demolition or'dismantling thereof, will be more than thirty-six (36):feet high. (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8,
' subjects the applicant to a civil penalty of not more than five hundred dollars (5500.):
C.A.C')
0 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
' '•. I7'As owner -builder, I will not employ anyone to do work which would require a permit from the Division of e
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License '
'Industrial 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
9,Division of Industrial Safety Permit No.
building or improverunt 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.).•: * •
' ' CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
0 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, Civ. C.). ' - - • -• ..
7044. Business and Professions Code: The Contractor's License Law does not applyto 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 .
.; ZONE ORD .
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 building construction, and hereby authorize representatives
of this county to enter upon the' above-mentioned property for inspection purposes.
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. Q.
Signature of Applicant or Agent Date
,Policy No.. Company
• CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify l have read thisapplication and state that
❑Certified.copyis hereby furnished..
the information given is correct. l agree to comply with all state laws and county ordinances4elating wbuidling,•
0 Certified'co is filed with the Cit Building Inspection Department or Cit De artment.'
DY Y 9 p D Y D
construction, and authorize a'represem Ii of the City of La Ouinta Department of Building and Safety to enter
o• 6
the"p4ppeertty for A. lie is for the'purpose inspections.
-
Date Applicant
upon Rhave a permit of making
i i
Signature of Applicant or Agen Date
Print Applicant/Agent Name +
,APPLICANT NAME (L. F. MI) Tara mark - •. -
ADDRESS P.O. `g= • 1900
CITY/COMMUNITY/STATE/ZIP La i>:Jirl a, C • 92253
JOB SITE AOORESS/SPACE 8-168 (a]�e' •'
CITY/COMMUNITY/STATE/ZIP J8 Qtlinta] CA 92253 • • ' .
BON
PAG
PRC
,C C.
Plan Check
TWN
PING
SE.
S,
TRA1':7 16 / —
LOT
3
MOD
SB
TRACT NAME La ujta
7�Dum
.OWNER NAME (L. F. MI) Applicant
CONTRACTOR -FIRM NAME _S✓�ij=t ..
ADDRESS abme'• ...
CITY/COMMUNITY/STATE/ZIP aloolle -
PHONE 4 '
LICNC I
'
ARC/ENG FIRM NAME •. :.
ADDRESS -
CITY/COMMUNITY/STATE/ZIP - - -
PHONE .
TOTAL
FEE
LICNO 1
USE OF PERMIT Patio* n' /'L.. er-
IJVGSJSB'.
BL
ZON
FSB
, SS8'
RSB
.OFC
.; ZONE ORD .
LOT SZ
.END
SIDE
•APPL/PRMT n nl A^ p
2,0120-85 77i8J1I• ,
Pe dt to =istmict patio cover as- Per
approved platy..
Plan Check
25.02
Const. Fee
38.50
SU Fee
:50
AR
.. a _
TOTAL
FEE
• VALUATION L,6UUI.UU
BLDG. DEPT.
ih
r
NO.
OPERATION I L7 I E
INSPECTOR
NO.
OP -I ION I 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
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 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