0088 (PLBG)PERMIT'APPLICATION
City of La Ouinta
Department of Building and Safety
This permit becomes voidtf work;not commenced, within 180 days from date o1 issuance. OR, if 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 Contractor
OWNER -BUILDER DECLARATION: 11h - ereby affirm that am exempt from the Contractor's License Law for the
following reason (Sec. 7031A.Businssand 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 applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($WO.):
IP 1, 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 notapply 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 improvemntis sold within one year of completion: the owner-builderwill have the_ burden of proving that'
he did not build or improve for the purpose of sale.).
❑ I, as owner of the property, am exculsively contracting with licensed contractors to construct the projec (Sec..
7044. Business and; Professions Code: The Contractor's License'.Law does riot apply to an owner of property,who
builds or improves thereon, and who contracts for such projects with a contractor(s)ilicensed pursuant to the
Contractor's License; law.).
❑ 1 am exempt under Sec.
B. 6 P.C. (Attached Certificate).
Date Owner
WORKERS'. COMPENSATION DECLARATION; I,hereby affirm that I have a'certificate o1 consent to self -Insure, or a
certificate of Workers' Compensation Insurance, ora cer ifiedcopy,thereof (Sec. 3801): Lab. C.).
Policy No. Company
❑ Certified copy is hereby, furnished.
o Certified copy is tiled with the City. Building Inspection Department or City Department.
Date Applicant
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CERTIFICATE OF EXEMPTION FROM, WORKERS' COMPENSATION INSURANCE; This section need not be completed 11
the permit'is for one hundred (5100) o, less. I.certify that in.the performance of the work for which,this permit is
issued. I shall not employ anyyperson 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 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 1 hereby certfty that no excavation five (5) or more feet in depth into which a person is required to descend. will be
made in connection with work authorizedby this permit, and that no building structure, scaffolding, talsework, or
demolition or'dismantlingthereof. will be more than thirty-six,(36) feet high. (Chap 3.2. Grp 2, Art 2;Sec341, Ttle8,
C:A.C.)
11 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:
p Division of Industrial. Safety Permit No.
Date Applicant
CONSTRUCTION LENDING' AGENCY: 1 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
I certify that I have read this application and state that the above information Is correct. I agree to comply with ail
city and county ordinances and state laws relatinitdbuilding 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 AUTHORIZATIONOF ENTRY: fortify I have read this application and state that
the information givemis correct: I agree to comply with all state taws 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 the' property for which I have applied for this permit'.for the purpose of, making inspections. . _
Signaturcof Applicant orAgent
Print Applicant/Agent Name.
Date
APPL%PRtT ` '_3-83
Plttifibit�
Pendt to install seepage tut per approvedi
plan
Penni , issiximioe re
$ 10.00
Seapag;-:) Fit
540
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$15.00
Arrow Printin 1250/1-83 White: Finance Cana VALUATION *1,500.00
g ry: Assessor Pink: AppliFant 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
Slali 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.
❑
NON ADDITIONAL INFORMATION
:.O
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 PROPERTY LINE
P -- - P)I
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service -
32 Final