0069 (SOL)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, U work has been, suspendedor 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) of Division 3 of the Business, and Professions Code, and my license is in full force
and effect.
License Class Lic. Number -
Date Contractor
OWNER -BUILDER DECLARATION: Thereby affirm that I am exempt from theContractor's License Law for the
following reason (Sec. 7031.5: Business.and,Professions Code: Any.city,orcounty 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 70(10) 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 70315 by any applicant for a,permit
subjects the applicant to a;civil penalty ofr not more than five hundred;dollars,($500.):
17 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 anowner of property who builds, or improvestheieoo, and who does such work himself or
through his own'empfoyees, provided that such,improvementsare not Intended or offered for sale. If, however, the
building or.improvemnt is sold within one year of completion, the owner -builder will have the burden of proving that
he did not build or improvefor the purpose o1 sale.).
0 1, 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
Contractors License'Law).
0 1 a exempt under Sec.
B. & P.C. (Attached -Certificate).
Date Owner
WORKERS' COMPENSATION DECLARATION: thereby affirm that I have a certificate of consent,to,self-Insure, or
certificate of,Workers' Compensation Insurance , or a certified copythereot (Sec. 3800. Lab. C.).
Policy No. Company
o Certified copy is hereby. furnished.
0 Certified copy is tiled with the.Clty Building Inspection Department or City Department.
Date Applicant
NAME
M=:1) RM:s -
hard J.
IORE
/o'-126 H a,Cisr ?sl. T, Oa}ita
CITY MMITY/STATE/ZIP-
Iza UL $ CA 9225
lER7
JO. ILSLTE ADORESWSPACE:
CITY/COMMUNITY/STATE/ZIP '
BOK
PAG
PRC
C
-
rim
ING
SE
S
TRACT
LOT
MOD
SB
TRACTNAME
gR
�{y ITI
WA TO”
ADOPESS
:)T-720 AIVC.J�p3pALCA Villa
CITY/C?
ni23IlIr rE/pp 92
LICNC
ARC/ENM FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
-PHONE a
LICNc e
'
USE OF PERMIT'
aL
ZON
1983
FSS
.SSB I
SSS
RSS
OFC
ZONE -ORD a
LOT SZ
ENO
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE: This section, need not be comp feted if
the pe(mit,is for one hundied'($100) o. less. Icertify that in the performance of the work for which.this permit is
.issued, I shall not employ any perso0n any manner so as to become subject to the Workers'Compensation awsof
California.
Date IV .� Applicant
/ J
NOTICE TO APPLICANT: 11. after making this Certificate of 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 thereby certify that no excavationtive (5) or more feet in depth Into which a person Is required to descend, willbe
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'Z Art 2, Sec341, Titlell,
CAC)
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.).
Lenders Name
Lender's Address
I certify that 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 thWcounty to enter upon the above,:mentioned property for inspection purposes:
Signature of Applicant or Agent
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION'OF ENTRY: I certify I have read this application and statethat
the information given is correct. I agree:to comply with all state laws and county ordinances relating to buidting
construction. and authorize a"representative of the:.City of La 0uinta Department of Building and Safety to enter
upon the property"for which I have applied for this peimitior the purpose of making Inspections:.
Signature of Applicant or AgentY Date
Print Applicant/Agent Name
t
APPLMRMT " "2
�J it417 .1
� �;.��[S.D
i; for 7
Solar Paned - :� an
X 7:,. it ,
Get
►7 r,.- Tank
lsa�_Inc3 -Fee
FEe'2 5
1983
Cft at La
Uinta
TOTAL
FEE •
VALUATION
Arrow Printing 250/1.83 White: Finance Canary: Assessor Pink: Applicant Tag: Bldg. Dept.
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
40
Fire Damper
8
Vents
41
Smoke Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P.L.
❑
43
1 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
P
STREET NAME
PROPERTY LINE
P/
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
'29A Grounding Wire
29B Bonding
30 Fixtures
'31 Service
32 Final