001306 (RPL)APPLICANT NAME (L, F. MIL_' _�'.•
��� vS�rn'�.�"p'o„•�
ADDRESS - ,
P.O. Sox 1371
CITU/COMMUNITY/STATE/ZIP - -
La Qtainta, (A 9225E
JOB SITE ADDRESS/SPACE
78-094 Ca11e Ni rte
— - PERMIT
f 'tJ
APPLICATION ' » •AA
• ,;. City
' Department of
of La Ouinta ��
Building and Safety
C
..
_ This permit• becomes'woid 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.
' - • -
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 provisiins-of=Chapter 9 ..
' the permit is for one hundred ($100) o. less. l 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 mannersoas to become subject to the Workers'Compensation laws of
and effect. - 1 t
California.
` /
License.Class Lic. Numbererpt
Date Applicant
1MV' Date Contractor
NOTICE TO APPLICANT: It, after making this Certificate of Exemption, you should become subject to the Workers'
? /
OWNER -BUILDER DECLARATION: I hereby affirm That I amezempt fromYhe Contractor's License Lawlor 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 permit to file a signed statement -that he is licensed pursuant 16 the provisions of the Contractor's License Law..
_ 6Ihereby.certifythat no excavation live (5) or morefeet in depth into whiih a pers-on is required to descend,will be
'(Chapter 9 (commencing.with section 7000) of Oivision.3 o1 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-
.-q•therefrom and.the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for,a permit .
I demolition or dismantling thereof; will be more than thirty-six (36) feet higV(Chap 3.2, Grp 2, Art 2; Sec341. Title B,
subjects the applicant to a civil penalty of. not more than five hundred dollars ($500.): _,.
'C.A.C.) '
• . 0A as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
❑ As `owner -builder, I will not employ anyone to do work which would require a permit from the Division of
• structure is not intendedor 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 anowner of property who builds, or improves thereon, and who does such work himself or ..
+, . •• .. , • .
through his bwn,employees. provided that such improvements are not intended or. offered for sale. If, however, the
O.Division of Industrial Safety Permit No.
building or improvernat is sold within one year oficompletion.the owner-builderwill have thkburden 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
ID 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
' builos or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the
•°' SIDE',•
Contractor's License. Law.).
Lender's Address
❑ 1 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 �r ' 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, or a
' certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C:). •
Signature of Applicant or Agent = •f Date'"
Policy No. Company
,CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:' I certify I have read this application and statethat
O Certified copy is hereby furnished. ,.
u, +'the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling - r;
O Certified copy is tiled with the City Building Inspection Department or City Department.
construction, and au a'repXre ntatiye of theC City of La Ouinta Department of Building and Safety to enter
Date Applicant
upon the propert,forwhfch I ha: appliMor.thi permit'forthe purpose of making inspections..
C �[..�lyV
_
(
"
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPLICANT NAME (L, F. MIL_' _�'.•
��� vS�rn'�.�"p'o„•�
ADDRESS - ,
P.O. Sox 1371
CITU/COMMUNITY/STATE/ZIP - -
La Qtainta, (A 9225E
JOB SITE ADDRESS/SPACE
78-094 Ca11e Ni rte
CITY/COMMUNITY/STATE/ZIP -
La Quanta, CA 92.253
BOK ,
PAG
PRC
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TRAIC�J+T�158.� Cp
LOT 3
TRACT NAME Yb..�.� /'�.....7..,..... -'
L/W![3 l7Lib�.�G17� -
OWNER NAME (L..F, MI)1 7n»jy�t
CONTRACTOR -FIRM NAME-I)eXpta= ' TL,w'f S .
w'1�.1
ADDRESS 73-8��885'+��+FxW'�yJVi1.
CITY/COMMUNITY/STATE/ZI-P„�1�;,, TNe...ivi..,"1�9r 92260
�•i�
PHONE* 340-490,0 �
LICNC N
..
ARC/ENG FIRM NAME ,
ADDRESS
CITY/COMMUNITY/STATE/ZIP 1..•'” -
PHONE II7
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LICNC 4
USE OF PERMIT
SL
ZON
PFS8
`SSB
SSB
RSB•
OFC
• :ZONE ORD II.-:
LOT SZ..
,, 4'
END
•°' SIDE',•
APPL/PRMT
PWL
Permit to d nstrwt clue 6. ft. round -
spa as Per amIl rimed Plans.
Plan check 25.02
Mnst. Free 38.50
9a Flee 650
^ - TOTAL
FEE 64 O2 r
•
A.0506 3• 27
BLDG. DEPT.
VALUATION 4, 0,gooVoo
• A• a �. - •
Ah
AL
NO.
OPERATION ,TE
INSPECTOR
NO.
OP TION 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.
❑
OP'NO.
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
PSL PA
a
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final