000968 (AR)PERMIT APPLICATION Cj I b
City of La Ouintaf
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.O. Box 2998
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPEN° ATION 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 ($100) o, less. I certify th:_t in theperformance 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 inany manner soas to become subject tothe Workers'Compensation Laws of
and effect. I / f
( California.
..License Class Lie. Number a
• Date 4 _LA 'Contractor —� >���+ %�' lX �• � ✓� �'-� �/
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate :)I Exemption, you should become subject to the Workers' .
% /. ` . '•
OWNER -BUILDER DECLARATION: I hereby affirm that I a yexempt from the Contractor's License Law for the
Compensation provisions of the Labor•Code, you must torthwith comply with such.provisions or this permit shalla '
be deemed revoked.
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to
TRACT
construct, alter•, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATON: ,
such permit to file a signed statement that he is licensed pursuant to. the provisions of the Contractor's License Law
01 hereby certify that no excavationfive(5)ormorefeetindepthintowhichapersonisrequiredtodescend,willbe
.(Chapter 9(commencing with section 7000) of -Division 3 of the Business and Professions Code) orthat he is exempt
made in connection with work authorized by this permit and that no building structure, scaffolding,'falsework, or
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
demolition or dismantling'thereol, will be more than thirly: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.):
'C.A.C.)
0 Las owner of the properly, or my employees with,wages as their sole compensation, will do the work, and the
0 As owner -builder -,-,l 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 las 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
ARC/ENG FIRM NAME '
through his own employees, provided that such improvements.are not intended or offered for sale. If, however, the
0 Division, of Industrial Safety Permit No.
building orimprovemntissold within one year ofcompletion. the owner -builder will have the burden of proving that
Date Applicant
he did not build or improve for the. purpose of sale.). I..
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
O 1, as owner of.the property, am exculsively contracting with licensed.contractors to construct.the, project (Secy
of the work for which this permit is issued (Sec. 3097, :iv. C.).
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
SSB
Contractor's License Law.).
Lender's Address
0 1 am exempt under Sec. B. 8 P.C. (Attached'Certificate).
I certify that I have read -this application and state that Ill a above information is correct. I agree to comply with all
Date Owner "r
city and county.ordinances and state laws relating to bu tding construction, and hereby authorize representatives
LOT SZ
of this county to enter upon the above-mentioned proprry for inspection purposes.
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. C.).
Policy No. Company.
❑ Certified copy is hereby furnished: ,.. .
O Certified copy_ is fited with the City Building Inspection Department or City Department.
Date Applicant
APPLICANT NAME'(L: F. MI) Latif ren Construction
ADDRESS-
P.O. Box 2998
CITY/COMMUNITY/STATE/ZIP
Palm Desert, CA 92261
JOB SITE ADDRESS/SPACE
51-910 Avenida Villa
CITY/COMMUNITY/STATE/ZIP '
La QuinBa,' CA 92253
BOK.
7b
'PAG
183
PRC
007
C
Elect. Fee 3.00
T. ..RNG
SE
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TRACT
LOT
.r- TOTAL
FEE
MOD
SB
TRACT NAME
OWNER NAME (L. F. MI) CM, Mi • '
ee�wiv
CONTRACTOR -FIRM NAME
Alhgrm Oxistrtici ilon
ADDRESS
above.
CITY/COMMUNITY/STATE/ZIP ,
'.
abom
PHONE 6
345-3059
349774
ARC/ENG FIRM NAME '
ADDRESS
CITY/COMMUNITY/STATE/ZIP -
PHONE 11
LICNC M
USE OF PERMIT ,
Ppom Ata, Ution
BL*
ZON
FSB
SSB
SSB
RSB
OFC .:
'ZONE ORD .
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END
SIDE
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify 1 have read this application and state that
the information given is correct. I agree to comply+with Ill state laws and county ordinances relating to buidling
construction, and authorize a'representative of the City -of La Duinta Department of Building and Safety to enter
upon the property for.which I have applied for this permit for the purpose of making inspections.
Signature of Applicant or Agent Date '
Print Applicant/Agent Name
APPUPRMT1 i n n ! . u .=DATE
Permit to construct 168 sq. ft. of
room addition as per approved plans.
Plan Check Fee 40.62
Permit Fee 62.50
SNI Fee .50'
Elect. Fee 3.00
0” n C9
.r- TOTAL
FEE
106.62
BLDG. DEPT.
J
\.ALUATION 6.888.00 .
On
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
7
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.
❑
NON
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath f 0
12 Internal Lath
12A Drywall �D
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