001028 (BLDG)ti
LICENSED CONTRACTORS-DECLARA
(commencing with Section,7000) of 0
and effect.
License Class - Lic. Number
Date Contractor '
OWNER -BUILDER OECLARATIONr I, hereby affirm that I am exemptfrom.the Contractor's License Law for, the'
following• reason.(Sec. Mi.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 theContractor'sLicense Law
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code)or that he is exempt
therefrom and the bisis;.forthealleged exemption. Any violation of Section 7031:5 by anyapplicantfor a permit .
subjects.the'appficant to a civil penalty of not more than five hundred dollars -(5800:):
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. 7144„ Business and Professions Code: The Contractors License
Law does not apply to an owner of properly who builds, or improves thereon. and who does suoh work himself or
through his own employees;, provided that such improvements are not intended or offered for sale. If, howism; the
building or improverint is sold within one year of completion, the owner -builder wilL Ove the burden of proving that,
hedid,not build or improve for the purpose of sale.). y•,
0 1, as owner of the property,am exculsively contracting with licensed contractorsto construct the project (Sec:
7044• Business and Professions Code: The Contractor's License1aw does not apply to an.owner;of property whor
builds or improves thereon, and who contracts for such projects with'a.contractor(s) licensed pursuant to the
Contractor's License Law:).
0 I am exempt under Sec.- n B. 6 P.C. (Anached'Cortificate), .
Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby, irm that I have a certificate of consent to self -insure, or a. .
certificate oI Workers' Compensation Insurance , ora certified copy.thereof (Sec. 3800: Lab. -C.).
Policy No. - Company.
O Certified copy is hereby furnished. a -
0 Certified copy, is filed with 'the CityBUilding Inspection Department or City Department.
Date Applicant
PERMIT APPLICATION
City of Le Ouinta
Department of Building and Safety
'29- 66 a eeulii
This permit becomes void if work not commenced within 180 days from date of issuance. OR, it work -has been suspended or'abandoned for a period of 180:days.
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not becompleted if
TION: - hereby, affirm that I am licensed under provisions of Chapter 9 . , the permit is for.one hundred ($100) o, less: I,certifythatin rin
the perfornce.of the work for which,this permit is
ivision 3 of the .Business: and Professions Code. and my license is in full force issued, I shall not employ any person in any mannersoasto become subject to the Workers' Compensation Laws of
California.
APPLICANT.NAME0.. F. MI) .. -
Jim Patterscm
ADDRESS ..- 79-660 Cnintez
CITY/CO1101MUNITY/STATE2IP
Indips CA 92201 Indian inns
JOB SITE ADDRESSWACE _
CITY/COMMUNITY/STATE/ZIP - -
BOK
PAO
PRC
C .
TWN . -
=RNO-
SE
S
TRACT.
LOT
16.00
SMI Fee
Moo
so
TRACT NAME .
OWNER NAME (L. F. MI) - -
Jim pattexs=
CONTRACTOR -FIRM NAME -
ortner
ADDRESS -
CITY/COMMUNITY/STATE/ZIP
PHONE a
LICNC e -
ARC/ENO FIRM NAME -
ADDRESS
CITY/COMMUNITY/STATE/ZIP -
PHONE. a
-LICNC e
USE. OF PERMIT
vkcd and Chpin Lir& fence
SL
16.50
ZON
Fee
I SSB
SSB
RSB
OFC •,.
ZONEORD, e. •
LOT SZ
END
SIDE:
Date Applicant
NOTICE TO'APPLICANT, If„after making this Certificate of Exemption, you should become subjectto.the Workers'
Compensation provisions of the, Labor Code, you must forthwith comply with such provisions oethis permit shall
be'deimed rocaked. '
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
0 1 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 ordisman Uing thereof. Will be more than thirty-six (36) feet high. (Chap 32 Grp -2, Art 2, Seca41, Title S.
C.A.C.) ;
0 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.
0 Division. of, Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm thatthere is a construction lending agency for the performance
of the. Work for, which.this'permit is'Issued (Sec. 9097, Civ. C.).
Lender's Nime•
Lender's Address
I certify that I havoread'this application and state mat the abovainformation is correct. l.agree to comply with all
cityand county ordinances and state taws relating to building construction, end 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;, I certify l 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 Ouinta Department of Building and Safety to enter
upon the property for which I have applied for this permit for the purpose of making inspections.
Signature of Applicant or Agent Date
Print Applicant/Agent Name
VALUATION 885.00
BLDG. DEPT.
Plemit to constnict 90 ft of cedar fence
6° ligh and 30
ft of 6- high chain
ling as per approved
plans.
Pemit
16.00
SMI Fee
.50
ask
TOTS
16.50
VALUATION 885.00
BLDG. DEPT.
na
NO.
OPERATION I DATE
INSPECTOR
NO.
OPERATION 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
f=ireplace T.O.
❑
NPON
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick 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
296 Bonding
30 Fixtures
31 Service
32 Final