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0847 (BLCK)s ` PERMIT APPLICATION City of La Duinta Department of.Building and Safety "within ADDRESS ... • .' 77-450 C ".6 TE<A7E This permit becomes void if work not commenced 180 days from date of issuance, OR, it work has been suspended or abandoned for a -period of 180 days. • ' - V CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if LICENSED CONTRACTORS' DECLARATION: I hereby affirm that 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 of the Business and Professions Code, and'my license is in.full force. issued. I shall not employ any person in any manner so asto�me subject to the Workersy ompensation Laws of , and effect. California.) r 1 3 41 License Class Lic. Number Date ' ' Contractor Date I Applicant. NOTICE TO APPLICANT: If, after making this Certificate of Exemption, shouldibecome subject to the Workers' -T .liD r� U. you ✓' OWNER -BUILDER DECLARATION: I hereby affirm that I am exempf 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 be deemed revoked: - ' 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: such permit to fileasignedstatementthatheislicensedpursuanttotheprovisionsoftheContractor'sLicenseLaw" '0 1 h6reby - certifi thatno excavation five (5) or more feet in depth into which a person is required todescend.'Will be (Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) or that he is exempt 'made in connection with work authorized by this permit, and that no building structure, scaffolding, fafsework'r therefrom and the basis for the alleged exemption -Any violation of Section 7031.5 by any applicant for.a;permit demolition or dismantling thereof, willSe more than thirty-six (36) feet high. (Chap 3.2; Grp 2, Art 2, Sec341, Titleo1. subjects the applicant to a civil penalty of not more than five hundred dollars ($500.): ' CAC.) 7, •O I, as owner of.the property: or my employees with wages as their sole compensation, will do the work, and the O As owner•builder,.l will not employ anyone to do woik'which would require a permit from the Division of ' Business and Professions Code: The Contractor's License - structure is not intended or offered for sale (who Industrial Safety, as noted above, unless such person has -a permit to do such work from that division: build 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. 11, however, the _0 Division of Industrial Safety Permit No.. - - building orimprovemntissold withinone year ofcompletion, the owner -builder will have the burden of proving that. 'Date 'Date Applicant he did not build or improve forahe purpose,ol sale.). „ - '�q: CONSTRUCTION LENDING AGENCY: I hereby affirm.that there is a Construction lending agency for the performalice O I, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec. " ' ot'the work -for which this permit is issued (Sec. 3097. Civ.'C.).: 1 • b 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 contractor(s)'licensed pursuant to the Contractor's License Law.). ' Jai �4' 'Owner.""' Lender's Address have.information'is ' B.�B P./C: �(Attached Certificate).. ❑ f am exempt under Sec. (� I r�'� S ` t` I ' 1y;;"1 'tJ�'l'. � '-' 1 "'�'`�J�' (�Lr'� " I certify that l read this application and state that the above correct. I agree to comply with all city and county ordinances ano stale Iaws relating to building construction, anit hereby authorize representatives Date „ / _ . , �. T . f ' '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. or a END.. certificate of Workers' Compensation Insurance : or a certified.copy thy reof (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 application and state that ❑ Certified copy is hereby furnished. - the information given is correct. I agree to4eomply with all state laws and county ordinances relating to buidling "❑ Certified copy is filed with the City Building Inspection 'Department or City Department. construction, and authorjze•a'rleDresentative of the �ty'of La Ouinta Department of Building and Safety to enter upon the property for,wthich I have applied for this permit for the purpose of making inspectionsn Date - Applicant ( / ��/� .4� Signature ofIApplicant or Agent/ - I' Date w -- I, — Print Applicant/Agent Naml APPLICANT NAME (L', F, MI)' f •✓ - ETn�/ G E 2 , Mr s. ADDRESS ... • .' 77-450 C ".6 TE<A7E CITY/COMMUNITY/STATE/ZIP I -A qvf rA, rA 92253 JOB SITE ACORESS/SPACE - 77- 4 cAtt, 9ECATE ,.. CITY/COMMUNITY/STATE/ZIP Ui 4,vjnJTA, CA 9122A3 PAG! B�4. 1 ^r / JJ (�7 o�z ©lv�n! cCS .. TNM+, FIND SE S -T .liD r� U. LOT � 11 �jC ^ _ !� MOD SS w TRACT NAME SAaiA (AAM M- 111A /kt VX4 &A 6AAAli A NO - OWNER NAME (L, F, MI) CONTRACTOR -FIRM NAME - oWn/Ei2 ' ADDRESS •- SAME I's /cove CITY/COMMUNITY/STATE/ZIP - ,SgME Is 11r30VE PHONE • LICNC • ' ARC/ENG FIRM NAME I!' /V 0AIF ADDRESS CITY/COMMUNITY/STATE/ZIP PHONE •. LICNC • USE OF PERMIT c - 7VC-17J f , a 41 - BL ZON FSB SSB SSB •RSB OFC'. ZONE ORD # -LOT SZ - END.. -SIDE f APPUPRMTwA t •_I_ TE _ T o CoNsrRo'cr 14 0 G11JCAL IS15T o) 3'®H f�! 6 H FlZ�3i►'�E � S7v�eo �� L - ,e�i2 APPW'ZOUc� ��'vs �N p f�PP� r r��E copf�s ' BLVD o�z ©lv�n! cCS .. w R E C " CA VS7R . /7.5o 1'3 so -Q TOTAL6!29 �• OQ i 11 FEE U U—u U v VALUATION /000 I6�::.::• ' ° ..- BLDG. DEPT. ,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. ❑ NO ADDITIONAL INFORMATION Q ,/ 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 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/1 STREET NAME 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 2913 Bonding 30 Fixtures 31 Service 32 Final