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0577 (SFD)APPLICANT NAME (L -J. MI) - iije be cYCiil3Rti�Q1 A4USS U N. matin Avenue, Suite 231 • PERMIT APPLICATION - City of LaQuinta" Department di Bu(ding'and Safety • . r PAG This permit becomes void if work not commenced within 180 days from date of issuance. OR, if,work has been suspended of abandoned for a'period'of 180 days. • " - + �;•str CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if LICENSED CONTRACTORS DECLARATION: I'herebV. affirm'that I am licensed under' provisions of Chapter 9- - the permit is for -one hundred ($100) o, less. I certify that in,the performance of'the.work for which this permit is '•;:(commencing withSectidn'7000) of Division 3 of the Business and Professions Code,and my license is in full force issued,'Ishallnot.employanypersoninanymanner-soastobecomesubjecttotheWorkers'CompensationLawsof. and effect. California. License.Class Lic. Number Date .Applicant Date Contractor NOTICE TO APPLICANT; It, after making this Certificate of Exemption, you should become subject to the Workers'-' t:o OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt frm the Contractor's License Law for the , Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall • ' "be following reason (Sec. 7031.5, Business and Professions Code: Any city or -county which requires a.permit to deemed revoked. - f construct, alter: improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: . such per mit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law. O l hereby certify that'no excavation five (5) or more feet in depth into which a person is required to descend, will be' (Chapter 9 (commencing with section 7000) of Division 3 of the Business and ProfessiansCode) orthat he is exempt made in connection with work authorized by this permit: and that no building structure, scaffolding, falsework, or therefrom and the basis for the alleged exemption: Any violation of Section 7031.5 by any.applicant for a permit demolition or dismantling thereof; will be more than thirty-six (36) feet high. (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.) ` I^ O I. as owner o1 the property, or my employees with wages as their sole compensation, will do the work, and the O As owner -builder, I will 'not employ anyone to-do.work which would require a permit from the Division of la„ structure is not intended or 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 an owner of property who builds, or improves thereon, and who does such work himself or rc through his own employees, provided that such improvements are not intended or offered for sale. It, however, the - ' O Division of Industrial Safety. Permit No. building or i mprovemnt is sold within one year of completion, the owner-builderWill have the burden 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 O 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. Q. '7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Lenders Name builds or improves thereon, and who contracts for such projects with a contractor(s)'licensed pursuant to the - Contractor's License Law.). _ Lenders Address - 0.1 am exempt under:Sec: B. &-P.C. (Attached. Certificate)' ,1 certify that'l have read this application and.state that the above information is correct. I agree to comply with all "'-• Date i 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, ora '.,certificate of of Workers' Compensation Insurance ..or a certified copy thereof (Secr3800. Lab. C.).• .> Signature of Applicant or Agent Date Policy No. Company „ CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:Icertify Ihave read this application and state that O Certified copy is hereby. furnished. , the'information given is correct. I agree to comply with'all state laws and county ordinances relating to buidling - O Certified copy is filed'with the City Building Inspection Department or City- ^ Department. construction,.and authorize a'representative of the City of La Ouinta Department of Building and Safety to enter • .'-� uponthe property for which I have applied for this permit for the purpose of making inspections. Date Applicant ' Signature of Applicant or Agent Date Print Applicant/Agent Name APPLICANT NAME (L -J. MI) - iije be cYCiil3Rti�Q1 A4USS U N. matin Avenue, Suite 231 CITY/COMMUNITY/STATE/ZIP l`g*��-�,Cn • 92705 C]]ii KK�� .i'S J09 SITE AD y-• " R;i. w toJ.ti'aerc nas CIT,Y/COMMUNITY/STATE/ZIP La eta, cit. 92253 BOK PAG PRC •, C Plan check Fee • - TWIN RNG SE S TR1J640-2, J 1 (Y� L49 �.78 P1Wb1M Fee 4OD . SB 4509'00.. TRACT NAME Ldgme Dee La Paz, Ltd. OWNER_NAME-((LL.-F, �MI))aly�f� ^ a W CONTRACTOR -FIRM NAME ADDRESS O. CITY/COMMUNITY/STATE/ZIP PHONE -• (!14)558-3766 N�FT FEB' LICNC • . . ARC/ENG FIRM NAME ADDRESS - CITY/COMMUNITY/STATE/ZIP r . PHONE • $ 925.6 LICNC II . . USEOF PERMIT F (Co{asilA:f,�.��.�[1i) BL- ZON FSB SSB SSB RSB -.. OFC' ZONE ORD • • . t. LOT SZ END SIDE APPI/PRMT ' DATE.4 Cmdo Pent to construct 1,466 Sq. Ft,' aQ SIF /D with 400 Sq. Ft. of Garage per a0praliied Pte= Mechanx—ml Fee $ 18;00 Plan check Fee • - Paid QonstXullat iaaz Fee 382.00 '382.00 1 Fee cal 29.32 .: SMI Fee �.78 P1Wb1M Fee • 40.50 PrgDerty Developaant Fee 4509'00.. N�FT FEB' - a • 6 1983 City ct Lr. rti. 1 .. nT• TEFF $ 925.6 4824,1610bit!: VALUATION A NO. OPERATION vATE INSPECTOR NO.... 0P KTION DATE INSPECTOR BUILDING APPROVALS MECHANICAL PPROVALS 1 Set Back 33 Ventilation System ok- 2 Ftgs & Frms 34 Plenums & Ducts IV t— 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 M SEWAGE SEWAGE SYSTEM SIZE & LOCATION 11 Exterior Lath 12 Internal Lath 12A Drywall 13 Finish Grade INSULATION Thick V al 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 P/L P/I STREET NAME 26 Power Pole 27 Conduit 28 Service Entrance i • 29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service 32 Final e7r