0371 GradingPERMIT. APPLICATION
City of La Ouinta
Department of Building and Safety
This permit becomes void it work not commenced -within 180 days from date of issuance.:OR, i8work has•been suspended or abandoned for a period at180 days.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that 1 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
'Dale — -Contractor
OWNER -BUILDER OECLARA�ION_ : 1 heieby affirm, that Iram'exempt from the Contractor's License Law forthe
following reason (Sec. 7091.5. 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 permittofile asigned statement thatheislicensed pursuant tothe provisions oftheComra .VsLicenseLaw
(Chapter 9 (commencing withsection 7000);of.Division 3 of the Businessand,Professions Code) or that he is exempt
therefrom and the bareis'for the -alleged exemption. Any'violation of Section 7031.5 by any applicentfor a permit -
subjects the applicant'to a civil penalty of not more than five hundred dollars (5500.):
OI. as, owner of the property, or my employees with wages as their sale compensation, will do the work, and the
atructure is. riot Intended or offered,for sale (Sec, 7044, Business and Professions, Code: The Contractor's License
Law does notapply.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.).,
❑ 1, 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.
❑ tam exempt underSec. B.:B P.C. (Attached. Certificate):
Date Owner
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.)... .
Policy No. Company
13. Certified copy is hereby furnished,
❑ Certified copy is fit I the City out in Inspection o pa nt or Cily�' De0.artment.
Plrant ! %
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TRACT NAME .
OWNER NAME (L. :, W)
TOR -FIRM NAME -
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CITY/COMMUNITY ATE/ZIP
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ARC/ENO FIRM NAME .
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CITY/COMMUNITY/STATEMP
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111PUM1111111.
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Cit of La int T�
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SIDE '
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE:, This section need not be completed d
the permit's for one hundred ($100) o, less. i:cerbfy that irrthe performance of the work for which this permit is.
issued, I shall noCemploy any person In any manner so asto become subject to the Workers' Compensation Laws of
California.
-Date Applicant
NOTICE TO APPLICANT: It. after making this Certificati of Exemption, you should become subjectdo 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:
0 1 hereby oertify that no excavation live (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 buildingstructure, scaffolding, falsework; or
demolition or•dismantling thereof; will be more than thirty-six j38) feet high. (Chap 92 Grp Z Art2' Sec34i; Titlek
C.AiC.)
04As.owner-builder; I will hot employ,anyone•to do work which would require a permit from the Division of:
Industrial' Safety, as noted above, unless such persomhas a permit to, do such work from that division.
¢ Division ol,lnduslrial Safety Permit No.
Date—Applicant '
CONSTRUCTION LENDING AGENCY: I hereby affirm that Mere is a construction lending agency for the performance
o1 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. I agree to comply with alt
city and',counly, ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above-fientioned property for inspection purposes.
Sigriitura;of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I cerhlyl have read thisapplication 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' representalive.cf4he City of La Ouinta Department of Building and Safety to enter
upon tho!priapo for.whicry .1have applied for this,permH,for the purpose of makin inspections: 1
Signature of Applicant or'Agent Dale
Print Applicant/Agent Name
APPL/PRMT DATE
a. vee%
Am Will
111PUM1111111.
ip) ax i
i ni--
DEGI 1983
Cit of La int T�
BLDG. DEPT.
VALUAT#N �$?O� 0 0
. -i
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.
❑
NON
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick „Ru
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 P)
STREET NAME:
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final