001039 (GRES)PERMIT APPLICATION
J City of La Ouinta
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.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with.Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
and effect. -
License Class, Lic. Number
Date Contractor
OWNER -BUILDER DECLARATION: A hereby affirm that I am exempt from the Contractor's License Law for the
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
such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor'sLicense Law ,;
(Chapter 9(commencing with section 7000) of Division 3 o1 the Business and Professions Code) or that heis exempt ..
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.): , : .
0 I. as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License
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
building or improvemnt is sold within one year of completion, the owner -builder will have the burden of proving that
he did not build or improve for the purpose of sale.).
❑ I, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec. -
7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.). J,/
❑ 1 am exempt under'Sec. ' ' B.aB C! Attachedd_Certilicate).
`D to Owner t7 ' l• /'Ti P /
)WORKERS' COMPENSATION DECLARATION: I hereby affirm thal'lhave a certificate of consent to self -insure, or a
certificate of Workers' Compensation Insurance , or a certifie6,copy thereof (Sec. 3800: Lab. C.).
Policy No. Company !� i
W
❑ Certified copy is hereby furnished.
O Certified copy is filed with the City Building Inspection Department or City Department.
Date Applicant
APPLICANT NAME (L, F, MI)
ATWIY xsiann
ADDRESS
!;A,- A��- 7 7-ySv G°u11c
CITY/COMMUNITY/STATE/ZIP
La Otinta. M 92253
JOB SITE ADORESS/SPACE '
Sam
CITY/COMMUNITY/STATE/ZIP
abom
BOK•�/y JP/AG
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TWN
RNG
SE
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TRACT
SMI Epee
LOT
Elect.
MOD
SB
TRACT NAME '
OWNER NAME (L. F. MI) applicant
CONTRACTOR -FIRM NAME ' '
mplw,,,,,,�t
ADDRESS w
abom
CITY/COMMUNITY/STATE/ZIP '
1 bme
PHONE •
345-4427
LICNC •
'
ARC/ENG FIRM NAME '
ADDRESS
CITY/COMMUNITY/STATE/ZIP -
PHONE •
LICNC •
'
USE OF PERMIT �.
I 1 RtM,.,�-)ct aaa m
BL
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FSB SSB
SSB RSB
OFC
ZONE ORD V
LOT SZ
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
the permit is for one hundred ($100) o. less. I certify that in the performance of the work for which this permit is
.-issued, I shall not employ any person in any mannerso asto become subject to the Workers'Compensation Laws of .
California.
Date Applicant
NOTICE TOAPPLICANT: If, after making this Certificate of Exemption, you should become subjecl'to the Workers'
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
be deemed revoked. "
DIVISION OF. INDUSTRIAL SAFETY.PERMIT CERTIFICATION:
O l hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
- demolition of dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2. Art 2, Sec341, Title 8,
C.A.C.)
❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of
Industrial Safety, as noted above, unless such person has a permit to do such work from that division. -
O Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
I certify that I have read this.application and state that the above information is correct. l agree to comply with all
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.
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND'AUTHORIZATION OF ENTRY: •1 certify I have read this application and state that
the information given is correct. I -agree to comply with all state laws and county ordinances relating to buidling
construction, and authorize a'representative of the City of La Ouinla Department of Building and Safety to enter
upon the property for which Ihave applied for this permit for the purpose of making inspections.
Signature of Applicant or Agent
Print Applicant/Agent Name
Date
APPL/PRMT "� ' � � � � � %�
7
DATE
NM. 7 / EU)G
Pp-rm Lt to nmstrmt
975 ea. ft. of
image as Per approved plans &
applicable code and ordinanoes.
Permit
92.50
Plan check
60.12
SMI Epee
.81
Elect.
9.56
TOTAL
FEE
BLDG. DEPT.._ t+
VALUATION 11,025.00
10A
Fireplace T.O.
❑
NON . ADDITIONAL INFORMATION
11 Exterior Lath
40 t -
'Zp-.tiK'
NO.
OPERATION DATE INSPECTOR
NO.
OPERATION DATE
INSPECTOR
Bonding
INSULATION
BUILDING APPROVALS
7A Walls (Batts)'
MECHANICAL APPROVALS
128• Ceiling (Batts)
1
Set Back
33
Ventilation Systeme
F
2
Ftgs & Frms
34
Plenums & Ducts
17 Rough Plumb
2A
Slab Grade
35
furnace Compart:
20 Sewer
,3
Steel
36
Inlets,&.Outlets
~'
4
Grout Blocks
37
Combustion Air
5
Bond Beams.
38
Compressor
6
Roof Deck
4
39
Appl. Clearance
7
Framing
!
40
Fire Damper
ya .
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
11 Exterior Lath
Service Entrance
12 Internal Lath
Wiring.
12A Drywall
Grounding Wire
13 Finish Grade
Bonding
INSULATION
Thick R
Value.
7A Walls (Batts)'
Service
128• Ceiling (Batts)
Final
12C' " Ceiling (Blown)
14 Final
<�
PLUMBING AP ROVALS
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 1 Final
26
Power Pole
27
Conduit
28
Service Entrance
29
Wiring.
29A
Grounding Wire
29B
Bonding
30
Fixtures
31
Service
32
Final
•SEWAGE SYSTEM SIZE &LOCATION.
Tank Pit - L. Line
ELECTRIC APPROVALS REAR -OF PROPERTY LINE
. _ STREET NAME.