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0559 (SFD)PERMIT APPLICATION • City of La Quinti Department of Building and Safety This permit becomes void if work not commencedwithin 180 days from date of issuahce.'OR, if work has been suspended or -abandoned for a period of 180 days • . • -• • T •' _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if LICENSED CONTRACTORS- DECLARATION: I'hereby. affirm'lhat I am licensed under provisions of Chapter -9' the permit- is for one hundred (5100) o, less. I certify that in the performance of,the work for which this permit is (commencing with Section 7000) of Division 3 o1 the Business avid Professions Code, and my license is in full force issued: I shall not employ.any person inany manner so as to'become subject tothe .Workers Compensation Laws of and effect. California. , License Class Lic. Number Date Applicant Date - - '=• - •` % Contractor • . • NOTICE TO APPLICANT: It, after making this Certificate of Exemption, you shpuldbecome subject to.the Workers' - •� OWNER -BUILDER DECLARATION: I hereby aflirrn that'I am exempt�from-the Contractor's License Law for the Compensation provisions of the Labor Code., you must forthwith comply with such provisions or this permit shall, deemed revoked. ' following reasbn'(Sec.n7031.5. Business and'Professions Code: Any.city'or county which requires.a permit to .be „ . • construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for DIVISION OF, INDUSTRIAL SAFETY PERMIT CERTIFICATION: such permit to• file asigned.statementthat heislicensed pursuant totheprovisions oftheContractor'sLicense Law " • ❑ Ihereby certify that noexcavation five (5)ormore feet indiipth'into Which iperson isrequired tode'scend,will be •'i, (Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) orthat he is exempt ', made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or q,'..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: - x1sublects the applicant to a civil penalty of not more than five hundred dollars (S500:): C.A.C:) • O I, as owner of the property _or my employees with wages as their sole compensation, willdo the work, and the O' As owlier•ouilder, I will riot employ anyone to do work which would require a permit from the Division of ' structure is not intended or offered for sale (Sec. 7044. Business and Professions Code: The Contractor's License Industrial Safety, as nbted-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 a .. . . 1. through his own employees, provided that such improvements are not intended or•otfered for sale: If, however, the .O Division of Industrial.Satety Permit No. building or improvemnt is soldwithin one yearof completion, the ow.ner-4uilder will havethe burden of provingthat 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. C.). 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who '- Lender's Name " builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuani'to'the. - - - Contractor's License Law.). Lender's Address O 1 am exempt under Sec. B. d P.C. (Attached Certificate). I certify that I have.read this application and state that the above information is correct. I agree to comply with all Date Owner ' +n' city and county ordinances and state laws relating to building'construction, and hereby authorize representatives of this county to enter upon above=mentioned property for inspection purposes. WORKERS' COMPENSATION DECLARATION: I hereby affirm that l have a certificate of consent to self -insure, or a .. . ' certificate of Workers" Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab: C,). Signature of Applicant or Agent Date • Policy No. " Company CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read -this applicationand state that ' O Certified copy is hereby, furnished; '. - t \ the' information given is-correct.I agree to comply with all state laws and county ordinances relatinoo buidfing O'Certilied copy is filed with the City'Building Inspection De�par_tm—enrt or City. Department. construction, and authorize a representative of the City of La Ouinta Department of Building and Safety. to enter �""""'e"'• upon the property for which I have. applied for this permit for the purpose of making inspections. Date Applicant APPLICANT NAME (l. F. MI) - - - bl; kl, johns it A400 N. `Astin, ate 231 CITSanta Y/COM�UNITAVMS^AfE/LI� 92?05 4RADDDRR'E31SS//SLPACE JOB,SI - A eu LAIle 5exams C)TY/CGM,-_MUNITV�STA�E/LIP• CA 92253 BOK •- FAG PRC I C Plumbing Fee 58,50 TWN FIND SE S Ti"3640-3 3l MOD Lt7f liI' sB TRACT NAME Lagum De La P=, Ltd. OWNS EM M� F. MI WANe CONTRACTOR -FIRM NAME - ADDRESS .. CITY/COMMUNITY/STATE/ZIP.- PHONE It - (77.4) 558,,3766 ^ "LICNC 8 '• ARC/ENG•FIRM NAME ADDRESS CITY/COMMUNITY/STATE/ZIP - PHONE • LICNC'n USE OF PERMIT \ BL I I ZON FSB SS8. SSB '• RSB OFC .. •' ZONE ORD •- LOT SZ END. .SIDE Signature of Applicant or Agent Date Print Applicant/Agent Name APPL/PRMT Sq Pe=dt to CMSt =t 1,662 Sq; Ft: of S/F/D with 400 Sq. Ft. of Garage Per Approved Plans N10C.rl cal Fee $ 18.00 Plan Check Fee- _ Paid Cbnstruc.'t� Fee 412.00 Electrical. ` Fee 31:77 ;SMI Fee 6.48 Plumbing Fee 58,50 Pxapertx Development Fee 450,00 • ft1K • N t- t 8 b '1983 aty v'7 MLLiJ r TOTAL FEE $ 976.75 BLDG. DEPT. VALUATION $ 92,461.20 • r1 NO. OPERATION DATE INSPECTOR NO. OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS 1 Set Back 33 Ventilation System 2 Ftgs & Frms _ —�`� fi 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 77—G, 10A fireplace T.O. ❑ OP'NO. 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 Final 19 -!S 7y PLUMBING APPROVALS 15 Ground Plumb ^ / — (.( g 16 Water Piping 17 Rough Plumb 18 Vents AND 19 Sewage Disposal• 20 Sewer 21 Water Heater 22 Water Softener 23 Water Service 24 Gas Test 25 Final ��Gf�aS— G Tank Pit L. Line ELECTRIC APPROVALS REAR OF PROPERTY LINE P/L P/I STREET NAME 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service 32 Final