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001024 (RR)PERMIT APPLICATION City of La Ouinta Department of Building and Safety This permit becomes void if work not commenced within 180 days from date of issuance, OR, if.work has been suspended or abandoned fora period of 180 days. . LICENSED, CONTRACTORS DECLARATION:.I hereby affirm that I am -licensed under provisions.of Chapter 9 (commencing with Section 7000) o1 Division 3 of the Business and Professions Code, and my license is in lull. force ' and effect. License Classy Lic. Number T Z' Dal ` �' _ . _r Y. - Contractor 9 - L 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 aligned statement that he is licensed pursuant to the provisions of the Contra ctor'sLicense Law (Chapter 9 (commencing with section 7000)of Division 3ofthe.Businessand 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.): O 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; them , r. building orimprovemntissold within one year ofcompletion, the owner -builder will have the burden of -proving that •, he did not build or improve for the purpose of sale.). 0. I, as owner of the property, am exculsively contracting with licensed contractors to.construcfthe 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 such projects with a contractor(s) licensed pursuant to the Contractor's License Law.). 0.1 am exempt under Sec. B. 8 P.C. (Attached Certificate). Date ' Owner WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a certificate of,Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. Q. Policy No. Company 0 Certified copy is hereby furnished.. 0 Certified copy is filed with the City Building.lnspection Department or City Department. Date - Applicant APPLICANT NAME (L. F. MI) Qf' i TMT ADDRESS 3 W-550 0 1 CITY/COMMUNITY/STATE/ZIP T icy. 201 JOB SITE ADDRESS/SPACE " %- F ll F.i cA Y�rxelar CITY/COMMUNITY/STATE/ZIP ,. T int A 9 9 9 S'A BOK PAG ,PRC C - TWN- RNG SE S TRACT LOT 51..00 MOD TRACT NAME OWNER NAME (L. F. MI) }• �q,.� - •.w, t% Mrs BJ�CS ' CONTRACTOR -FIRM NAME ' ate_ li:car�t ' ADDRESS above CITY/COMMUNITY/STATE/Z4IIP��MM ��,,,,��. [Al. ove ' PHONE • 34-5-3751 LICNC n 274 921 ARC/ENG FIRM NAME ' ADDRESS CITY/COMMUNITY/STATE/ZIP - PHONE • LICNC . USE OF PERMIT Re—roof BL ZON FSB I SSB SSB RSB ZONE ORD • LOT SZ END ' SIDE CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if the permit is for one hundred ($100).o. less. I certify that in the performance of.the work for which this permit is . issued, I 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: If, after making this Certificate of Exemption,you should become subject to the Workers'-- Compensation orkers';Compensation provisions of the,Labor Code, you must forthwith comply with such provisions or this permit shall - be deemed revoked. DIVISION.OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ' 0 I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with woik'authorized by this permit, and that no building structure, scaffolding, falsework, or' demolition.or dismantling thereof, will be more than thirty-six (36) feet high: (Chap 3.2, Grp 2. Art 2iSec341. Title B., C.A.C.) : t 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. 0 Division of Industrial Safety Permit No. Date Applicant CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance 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 representatives 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 and state that the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling construction, and authorize, a'representative of the City of.La Ouinta Department of Building and Safety, to enter upon`theroperty for which I have applied ffoor this permit for the purpose of making inspections. Signature of Applicant or Agent Date Print Applicant/Agent Name APPL/RRMT not 02A DATE 7.0-23- d BLDG. Pemit to tear old roof off and re= of cicm1ete house and cgwaw using 2 layers 301b felt with California S tile an top. Permit 50.50 Ra Fee •50 get2 1 TOTALe • 51..00 BLDG. DEPT. VALUATION 4,500.00 ELECTRIC -APPROVALS.' 26 Power.Pole 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 29B, Bonding 30 Fixtures 31 Service 32 Final Tank Pit L. Line REAR OF PROPERTY LINE STREET -NAME, .. 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 40Fire Damper. 8 Vents 41 Smoke Detection Device 9 Garage Fire Wall 42 Commercial-Hood 10 Fireplace P. L. ❑ 43 Final 10A fireplace T.O. ❑ NPO'N 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 ELECTRIC -APPROVALS.' 26 Power.Pole 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 29B, Bonding 30 Fixtures 31 Service 32 Final Tank Pit L. Line REAR OF PROPERTY LINE STREET -NAME, ..