001145 (BLCK)PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
This permit becomes void it wort not commenced within 180 days from date of issuance, OR, it work has been suspended or abandoned for a period of 180 days:
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions=of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
and effect.
License Class Lic.,Number.
Date!-- --\1 - I , "If 1A.
Contractor
Y
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 a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law -
(Chapter 9 (commencing with section 7000) of Division.3 of the Business and Professions Code) or that he is exempt
therefrom and the basis for the.alleged exemption. Any violation of. Section 7031.5 by any applicantfor a permit.
subjects the applicant to a civil penalty of not more than five hundred dollars (5500.):
0 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, the
building or i mprovemnt is sold within one year of completion, 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 construct the 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 I 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 certitieWcopy thereof (Sec. 3800. Lab. C.).
Policy No. Company,
0 Certified copy is herebyfurnished.
0 Certified copy is filed with the City Building Inspection DepartmEnt or City -Department.
Date Applicant.
APPLICANT NAME (L; F, tichael Head'
ADDRESS
P.O. BOX 123
CITY/COMMUNITY/STATE/ZIP Quinta,, CA 92253
JOB SITE ADDRESS/SPACE-
54-202 405 Avenida Diaz
CITY/COMMUNITY/STATE/7l1 a Qdil nta , CA 92253
so4
PA 3 3
Pi,�Cjlr
C
TWN
PING
SE''
S
'TRACT
LOT
Plan Check
[MOD
so
11.50'
TRACT NAME None
OWNER NAME (L. F, MI) Applicant
CONTRACTOR -FIRM NAME
Applicant
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
above
PHONe! .564-408`5
Llcluc.
ARC/ENG FIRM NAME - -
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE .
-
LICNC .
I
USE OF PERMIT '
Cedar Fence
BL
ZON
FSB
SSB
SS8.
RSB
OFC
ZONE ORD N _
LOT SZ
..
TOTAL
FEE
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATIONINSURANCE: This section need not be completed it
-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 Certificateof Exemption, you should become subject to the Workers'
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, w ill be
made in connection with work 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 2, Sec341, Title B,
C.A.C.) a. •
O As owner -builder, I -will not employ anyone to do work which, would require a permit from the Division of
Industrial Safely, as noted above, unless such person has a permit to do such work from that division.
❑ 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
.):Lender's Name
Lender's Address
Icertify 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.
Signaturpof 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 .1 rrrect'1 agree to comply with all state laws and county ordinances relating to buidling
construction; and authorize a'represenl'ative of the City of La Ouinta Department of Building.and.Safely to enter
upon,the,prro/op``erty'fo�, which'I hhave applied y(<or this permit for.the purpose of making inspections.
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPL/PRMT N1140.
`{ 11-i140
12 1AT
8/ D 4
BLDG.
Permit to install 82' ft
of 6' high
dogearred Cedar -Fence as
per approve
plans.
Plan Check
7.47
Const. Fee
11.50'
SMI FEE
.50
I
..
TOTAL
FEE
19.4 7
BLDG. DEPT. VALUATION 600.00
ELECTRIC APPROVALS
26
Power Pole
27
Conduit
. a
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION I DATE INSPECTS1ir ?
29B
Bonding
BUILDING APPROVALS
-Fixtures
31-
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.
❑
OP'N
'
ADDITIONAL. INFORMATION
NO.
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
SEWAGE SYSTEM SIZE &LOCATION =
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
P/L P&
STREET. NAME