001242 (PAT)a` -
APPLICANT NAME (L, F, MI) landrark
ADDRESS P.O. BDQS 1000 '
CITY/COMMUNITY/STATE/ZIP 'La
A„j nt ,VCA 92253
J08 SITE ADORESS/SPACE 7$=114 calle:Norte
PERMIT APPLICATION ° T -
T•
011a;0i
4 . 7t:,City rr
/ Department of Building and Safety y
PAG
PRC
This permit becomes void'if work not commenced, within 180 days•from date of issuance,
OR, if work has-been suspendey-or abandoned for a period of 180 days. •• . -
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-CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed it. ,.I
• 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
issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of
and effect. 4
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California. —
License Classy Lit. Nu"'ber `
Date Applicant
-Date 1Contractor.•=/ ` ' —
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers;•,:.;a,
-OWNER-BUILDER DECLARATION: I'hereby affirm Ifiat`I am exempt from the Contractor's License Law for the
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
_
following reason (Sec. 7031.5. Business and Professions. Code: Any city or county which requires a permit to
; be•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:
such permittotileasignedstatement that heislicensed pursuant tothe provisions ofthe Cont ractor:sLicense Law . ,
p 1hereby certitythat noexcavation five(5)ormore feet indepth into which aperson isrequiredtodescend, will be
. (Chapter 9 (commencing with seclion7000) 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 ndbuilding structure, scaffolding, falsework, or
therefrom and the basis for.the,alleged exemption; Any violation of Section 7031.5 by any.applicent for a permi4:
demolition or dismantling thereof, will be'inore than thirty-six'(36) feet high. (Chap 3.2, Grp 2. Art 2, Sec 341, Title8.:, i..
. subjects the applicant to a civil penalty of not more than five hundred dollars ($500.): ••
' C.A.C.) `
❑ I, as owner of the property, or my employees with wages as theirsole compensation, will do the work, and the..
O-'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•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 improvesch thereon, and who does sub work himself or
-
through his own employees, provided that such, improvements are not intended or offered for sale. If, however, the
p Division of Industrial Safety Permit N.
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building orimprovemntissoldwithinoneyearofcompletion,theowner-builder,willhavetheburdenofprovingthat
Date Applicant
he did not build or improve for the purpose of safe.). ^� -
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 for which this permit is issued (Sec. 3097, Civ. 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
:,- 0A am exempt under Sec. B. 8 P.C. (Attached Certificate).
I certify that I have read this application and slate 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.,• -A.-
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
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`certificate of Workers' Compensation Insurance: or a.certified copy.thereof (Sec: 3800: Lab. C.).
Signature of Applicant'or Agent Date
Policy No. Companyr
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CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify l have read this application and state that
❑:Certified copy is hereby furnished. r
the'information given is correct. I agree to 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. •
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construdiori� and'authofize a4epresentative of the City of La Ouinta Department of Building and Safety to enter
upon the.prropeerrt=y forch Lhave.applied this permitfor the purpose of making inspections. 1
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Datepplicant
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APPLICANT NAME (L, F, MI) landrark
ADDRESS P.O. BDQS 1000 '
CITY/COMMUNITY/STATE/ZIP 'La
A„j nt ,VCA 92253
J08 SITE ADORESS/SPACE 7$=114 calle:Norte
CITY/COMMUNITY/STATE/ZIP eta;. CA • 92253
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TRACT NAME T1,..... T... Qu nt
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OWNER NAME (L. F. MI)
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CONTRACTOR -FIRM NAME t�. p lcan{t
Applicant
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ADDRESS
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CITY/COMMUNITY/STATE/ZIP_
above ?, }
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ARC/ENG FIRM NAME -� • • ... _
ADDRESS- - - • +. - ..
CITY/COMMUNITY/STATE/ZIP - -
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USE OF PERMIT Patio Ower'
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Signature of Applicant or Agent / Date
Print Applicant/Agent Name /.
APPL/PRMT^��.
OLT.E28-8'S .'i3Li./V•�--.1
DC.rm it t• o «7Ai7 t xuct patio cmex as .per
apmcwd Plans.
Plan Check
25.02
Const: Fee
38.50
...SMI Fee
.50
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£:..
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TOTAL
FEE •
Yl�f. w U6r
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.VALUATION _
�`, . BLDG. DEPT. r
NO.
OPERATION ITM rE
INSPECTOR
NO.
OP ION 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
P/L 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