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0309 (BLDG)e .• `=: PERMIT APPLICATION > �. • • ] Y + _ ' ir.`, Y City of La Ouirita 1 Department of Building and Safety °fir• This permit becomes void if work not commenced within 180 days from date of issuance, OR, if work -has been suspended or abandoned for a period.ot 160 days. ': ' '�'� ` • :. PAG PRC. • r: , CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be'completed it .'i LICENSED CONTRACTORS DECLARATION: I hereby 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 isA . (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force . - issued; l shall not employ any person in any mannerso asto become subject tothe Workers'Compensation Laws of and effect. . California. ' ,( License Class Lic. NumberDate Applicant: ' ' Date Contractor ' _ NOTICE TO APPLICANT: If, after making this Certificate of Exemption; you should become subject to the Workers' . • OWNER -BUILDER DECLARATION: I hereby affirm 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 �_•=' following reason (Sec. 7031.5. Business and Professions Code: Any.city.or county which requires a permit to be deemed revoked. + aa' 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 a signed statement that he is licensed pu rsuant to the—provisions of the Contractor's License Law : O I hereby certify that no excavation five (5) or more feet in depth i nto which a person i , required to descend, w illbe (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 nd building strudture, scaffolding; falsework, or w' ' therefrom and the basis for the alleged. exemption. Any yiolation 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, Sec'341. Title B, "' + • subjec the applicant to a civil penalty of not more.thanrfive hundred dollars (S500.):. C.A.C) O I, as owner of the property, or my employees with wages as their.sole compensation, will do the work, and theO As owner -builder, I will not employ2nyone 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 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. improvements intended for If, however, the - . • ❑ Division of Industrial•Satety Permit No. through his own employees,, provided that such are not or offered sale. building orimprovemntissold within one year ofcompletion, the owner -builder will have the burden of proving that • r . .Date Applicant T he did,not build or improve for the purpose of sale.).• r CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance ❑ 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 +l builds or improves thereon, and who -contracts for such projects with a contractors) licensed pursuant to the ZONE ORD N Contractor's License Law.). s Lender's Address x ' ❑ G 1 am a empt=under Sec. /1 ' B. & P.C. (Attached Certificate). D �Owner I certUydhat 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 representatives at + f ! + zr r �' L r RK DECLARATION: I he that I•have arcertilicate of consent to self -insure, or a of this county to enter upon the above=mentioneb property for inspection purposes. - •. ' WOERS' COMPENSATION eby affirm certificate of Workers' Compensation Insurance , or a certified copy thereoflSec./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 t , ❑ Certified copy is hereby furnished. t. y 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 -, r. ,- . . • . . .. upon the property for which I have applied for -this permit for the purpose of making inspections.. Date Applicant Signature of Applicant or Agent Date >. �I �%'—••�'�' APPLICANT NAM=, F, MI) t lot)ADDRESS (�• '�' •'� / . - • CITU/COMMUNITY/STATE/ZII � JOB SITE'ADDRESS/SPACE ` CITY/COMMUNITY/STATE/ZIP BOK PAG PRC. C • TWN PING SE S TRACT LOT- TOTAL FEE MOD SS TRACT NAME ' OWNER NAME (L, F. MI) r CONTRACTOR -FIRM NAME ADDRESS CITY/COMMUNITY/STATE/ZIP PHONE • ` LICNC 0 ARC/ENG FIRM NAME ADDRESS r CITY/COMMUNITY/STATE/ZIP PHONE M LICNC •. USE OF PERMIT - BL ZONFSB SSB SSB- RSB OFC . ZONE ORD N LOT SZ t END SIDE Print Applicant/Agent Name APPLIPRMT lJul"9 71 if �,�%dam ©Cif • " ��, o o. � C City of La Quintia C; V.E. ® ' TOTAL FEE u _ city of La Quinta BLDG. DEPT. VALUATION /_100 NO. OPERATION DATE INSPECTOR NO. OPERATION DATE INS'PECTOR BUILDING APPROVALS MECHANICAL APPROVALS 1 Set Back 33' Ventilation System 2 Ftgs & Frms 34 Plenums & Ducts 2A Slab Grade 35 Furnace Compact._, 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 IHood 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 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/1 STREET NAME 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service 32 Final