001343 (BLDG)PERMIT 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, it 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 Sectidn' 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: .I 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's License Law
(Chapter 9(commencing with section 7000) of Division 3 of the Business and Professions Code) or that he is exempt
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant fora permit,
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
❑ 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 properly, 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 sucVprojects^with'a cogtiactor(s) licensed pursuant to the
Contractor's License Law.').-/(�! ,�
❑.I am exenlpt.urider Sec: 4 / (A• ' �� B. 8 P.C. (Attached Certificate).
Date Owner
r
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
certificate of Workers"Compensation Insurance I, or a certified copy thereof (Sec. 3800.;Lab. C.).
Policy No. Company
O 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. Ml) 8l.JfI:::k'
ADDRESS 77-687 Calle Aohora
CITY/COMMUNITY/STATE/ZIP
Lia 6dtiiinta,CA 92253
JOB SITE ADDRESS/SPACE
same
CITY/COMMUNITY/STATE/ZIP •' '
La Quinta, CA 92253
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FIND
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LOTMOD
SB
15.00
TRACT NAME •'
OWNER NAME (L. F. MI)
Applicant
CONTRACTOR -FIRM NAME tcwfi_ ..
r�plica nt
ADDRESS ^�.,,.��
G3iJam
CITY/COMMUNITY/STATE/ZIP
above
PHONE •
LICNC 0
-
ARC/ENG FIRM NAME+
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE a
LICNC N
-
USE OF PERMIT
fexce-
BL
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FSB SSB
SSB
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ZONE ORD N - 3
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-END
-SIDE '
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section'need not bEcompleted if
the permil.is for.one hundred ($100)o, less. I certify -that in the performance of the work for which.tiis permit is
issued, l shall not employ any person in any manner -so as to become subject to the Workers: Compensation Laws of
California. -
Date Applicant
- . NOTICE TO APPLICANT: It; after making this Certificate of Exemption, you should become subject to he•Workers'
;Compensation•p!gvisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
be deemed revoked. ;
DIVISION OF INDUSTRIAL,SAFETY PERMIT CERTIFICATION:
❑ 1hereby certify that noexcavationfive {5) or more feet in depth into which a person is required todes•end;will be
made in connection with work authorized by this permit; and that no building structure, scaffolding,131sework, or
demolition ordismantlinq tfiereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp z Art 2, Sec341, Title B,
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.
❑ Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending'agencyfor the Ferformance
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.I agree to comply with all
city and county ordinances and state laws relating to building construction; and hereby authorize rep. esentatives
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 I have read this application aid state that
the information_ given is correct. I agree to comply with all state laws and county ordinances relating to buidling'
construction, and`authogze a representative of the City of La Ouinta^Department of Building and Saety to enter
upon the propertyfor•which'I have applied^for thislpermit for the purpose of making inspections.
Signature of Applicant or Agent / Date
Print Applicant/Agent Name f
APPUPRMT i i /f A -1D9 E85 BLDG.
...
Pezmit to build 96 lmn. ft. of 4 foot
high chain link fence as per approved
plans.
Qanst. Fee 15.00
-TOTAL-
FEE
15.00
A 0 7 6 5
BLDG.DEPT.
4 19
VALUATION 657.00
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 R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 J 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/l
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance.
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final