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001181 (SFD)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 for a period of 180 days. ADDRESS P.0•k1040 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section neednotbe completed if 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 is (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 inany mannerso asto become subject to the Workers'Compensation Laws of and effect. California. License Class Lic. Number Date 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 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 file a signed statement that he is licensed pursuanttothe provisions oftheContractor'sLicenseLaw 01 hereby certify that h6e"xcavation 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'Professions Code) or that heis exempt made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or -therefrom and the basis ler 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, Titfe8, subjects the applicant to a civil penalty of not more than five hundred dollars ($500.): "' '3` C.A.C) 0 I. as owner of the property.,or my employees with wages as their sole compensation, will do the work, and the 0 As owner-builder;'I will not 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 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 suchworkhimself or - e through his own employees. provided that such improvements are not intended or offered for sale. If, however, the ' ❑Division of Industrial Safety. Permit No. building or improvemnt is sold within one year of completion, the owner -builder will have the burden of proving that Date Applicant he did not build or improve for the purpose of sale.). CONSTRUCTION LENDING AGENCY: 1 hereby affirm that there is a construction lending agency for the performance 0 1, 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.). k 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.). Lender's Address 0 1 am -exempt under Sec. '` ✓ . B.,BzP.0 �Attached�Certilicate) y I certify that I have read this application and state that the above information is correct. I agree to comply with all „r " l G city and county ordinances and state laws•relatirig`to building construction, and hereby authorize representatives + Date Owner, �f 1. of this county,ig^ente yuporieCabovezmeniione ptopeity_for inspection purposes. " x ^' WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, ora °^ 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 application and state that 0 Certified copy is hereby furnished. the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling 0 Certified copy is filed with the City Building Inspection Department of City Department: construction, and authorize a representativeoof the City of La Ouinta Department of Building and Safely to enter upon the pr ryylfor which I�have appliedlioP thispepriit faJ,the purpose of making inspections. Date Applicant Z11 Sign�tuje of Applicant oPAgent. s.g __i)© ry Date APPLICANT NAME (L, F. MI) Brian Lknroe ADDRESS P.0•k1040 CITY/COMMUNITY/STATE/ZIP JJaQ`2:ir1ta, CA 92253 JOB SITE ADDRESS/SPACE 53-575 Avwdda Diaz CITY/COMMUNITY/STATE/ZIP T s Quint , -C 92253 ' iiCi 1Guiitl.Gi 4[7• BOI,K74 PAGj 1 • • • C1 V1J Elect. Fee 43.13 SMI Fee 6.65 TWN • FIND SE S TRACT LOTj •711w - MOD SB TRACT NAME ie OWNER NAME (L. F. Mq A*licaft , CONTRACTOR -FIRM NAME T].', .,.L. * Johnson. ' Clot VBilli�l Jll W222278�8• ADDRESS P.O. CITY/COMMUNITY/STATE/ZIP ,iYILAAlO, /yL 922A2 V PHONE • 347-7171 , -t`1 i - ARC/ENG FIRM NAME ' ADDRESS CITY/COMMUNITY/STATE/ZIP ' PHONE 0 LICNC USE OF PERMIT single fl�ly &j1 l inn BL' ZON FSBSSB SSB RSB�••+�•A+� OFC ZONE ORD It, r -� LOT SZ .END SIDE Print Applicant/Agent Name APPUPRMT ft t� SPE16-85 S.F.D, Permit to costs.+ 1592 sq. ft. of S.F.D. 91 sq. ft. of parch and 430 sq. ft. of garage as Per appy Plans. Mach. Fee 22.00 Plan (heck Fee Const. Fee 8 (�v Elect. Fee 43.13 SMI Fee 6.65 Plurbmnlg Fee 50.50 Prop. Dev+el. Fee 450.00 (250.00) PD 12/14 TOTAL FIF V_ FEE • /� 6,6:, BLDG.DEPT �n VALUATION ��i ���r + .• 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 a s . 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. ClNON ADDITIONAL INFORMATION 4/ SEWAGE SYSTEM SIZE & LOCATION 11 Exterior Lath -774 12 .Internal Lath�� 12A Drywall 13 Finish Grade INSULATION Thick R Value 7A Walls (Batts) i 126 Ceiling (Batts) 12C Ceiling (Blown) 14 Final PLUMBING APPROVALS 15 Ground Plumb 16 Water Piping 17 Rough Plumb 18 Vents 19 Sewage Disposal s 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/I STREET NAME 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 296 E onding _. 30 Fixtures 31 Service 32 Final