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001152 (MECH)PERMIT APPLICATION Q Q City of La Ouinta /J 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 . • • . I I r ., • - CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed it -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, I shall not employ any person in any manner so as to.become subject to the Workers Compensation Laws of and effect. California. i 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 Contractors 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 L alter,improve, demolish, or repair any structure, prior to its issuance, also requires.the applicant for DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: lconstruct, such permit to file a signed statement thathe is licensed pursuant to the provisions of the Contra.cto(s License Law 01 hereby certify that no excavation 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 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 fora permit demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec341, Title B. subjects the applicant to a civil penalty of not.more than five hundred dollars ($500.): - 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 . I 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. . I Law does not apply to an owner of property who builds, or improves thereon, and who does such work himself or r 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.). 1. '; • CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance Y 9 A Y 0 I, 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:).' 7004. 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, A. & P.C. (Attached Certificate) .. I. certify that I have read this application and state that the above information is.correct. I agree to comply with all Date Owrier 'x'" ` a :.. c z,� R' L 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. 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 .):Policy No. - Company 0 Certified copy is -hereby furnished.: 0 Certified copy is filed with the City Building Inspection Department or -City Department. Date - • Applicant - u APPLICANT NAME (L, F. MI) l/ James Schnell ADDRESS . 52-293 Eisenhower ' CITY/COMMUNITY/STATE/ZIP La Quinta, CA 92253 JOB SITE ADDRESS/SPACE Same CITY/COMMUNITY/STATE/ZIP Same )) 8173 P.Al+G6C J PUl3 C ,� � TWN RNG SE .�• S .TRACT LOT2MOD :F p Iuc� r - ..TOTAL . ' FEE SB TRACT NAME None OWNER NAME (L. F, Mn Applicant - CONTRACTOR -FIRM NAME Applicant ' ADDRESS above CITY/COMMUNITY/STATE/ZIP above - PHONE II 564-5475 "°"°" ARC/ENG FIRM NAME ADDRESS CITY/COMMUNITY/STATE/ZIP PHONE . LICNC USE OF PERMIT Wall ,Furnace. BL ZON FSB SSB SSB RSB OFC , ZONE ORD 0 LOT SZ END • . SIDE •• Signature of Applicant or Agent Date CERTIFICATE OF COMPLIANCE AND•AUTHORIZATION OF ENTRY: I certify I have read this application and state that theinformation given is correct. I agree to comply with all state laws 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. Signature of Applicant or Agent Date Print Applicant/Agent Name APPL/PRMT S 1 2DA EO -84 Mech. Permit it install wall furnace, not to be installed in any bedroom or sleeping area. Mech. Fee 9.00 :F p Iuc� r ..TOTAL . ' FEE 9.00 VALUATION 750.00 BLDG. DEPT. 26 Power Pole 27 Conduit 28 Service Entrance, 29 Wiring 29A Grounding Wire 29B Bonding 30• Fixtures 31 Service 32 Final STREET NAME 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 1 Fire Damper 8 Vents 41 Smoke Detection Device. 9 Garage Fire Wall 42 Commercial Hood 10 Fireplace P. L. ❑ 43 Final 10A f=ireplace T.O. ❑ NPON ADDITIONAL INFORMATION r . SEWAGE SYS.TEM'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 h ' PLUMBING APPROVALS. 15 Ground Plumb 16 Water Piping 17 Rough Plumb 18 Vents 19 Sewage Disposal_ 20Sewer 21 Water Heater 22 Water Softener 23 Water Service 24 Gas Test 25 Final Tank Pit L. Line ELECTRIC APPROVALS REAR OF PROPERTY LINE 26 Power Pole 27 Conduit 28 Service Entrance, 29 Wiring 29A Grounding Wire 29B Bonding 30• Fixtures 31 Service 32 Final STREET NAME DEPARTMENT OF BUILDING & SAFETY COUNTY OF RIVERSIDE CONSTRUCTION ESTIMATE Dbl NO. ELECTRICAL FEES NO. PLUMBING FEES $ Dbt UNITS Dbl 1ST FL. S0. FT. ® ❑ $ Dbl $ YARD SPKLR SYSTEM 2ND FL. S0. FT. ® POR. SO. FT. ® M0131LEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P. 80. FT. ® DRAINAGE PIPING WALL $0. FT. ® DRINKING FOUNTAIN 80. FT. ® URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENTSYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM B.Y.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT ® c BATH TUB SO. FT. ® ¢ WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO.FT.RESID ®11/4¢ SEWAGE DISPOSAL SO.FT.GAR ® Va¢. HOUSE SEWER GAS PIPING PERMIT FEE 3 00 PERMIT FEE PERMIT FEE TOTF7-1AL FEES MICRO FEE MMEECH. FEE PL. CK. FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE MICRO FILM FEE jCopj $ MECH. FEE PL. CK. FEE CONSTRUCTION FEE ELECTRICAL FEE SMI FEE PLUMBING FEE Dbl $ ❑ $ Dbt S Dbl $ ❑ $ Dbl $ TOTAL FEES M.O.❑ N.C.❑ CASH RECEIVED BY TREES REQUIRED SEWAGE SYSTEM T LL SEWER DISTRICT FORM 284-58 (REV. 8/79) PLAN CHECK PLUMBING ELECTRICAL STRUCTURAL FIRE MARSHAL $ 9 1 00 AUDIT CHECK ❑ C R T DATE NOTAPPROVED COMMUNITY OWNER c_S c c- VALUATION F.C.C. GROUP TYPE DATE ISUPP.TOPERMIT DATE APPROVED CLEARANCE REO'D ❑ JOBADDRESS ❑ ROAD DEPT ❑ USE OF PERMIT ❑ PLANNING DEPT ❑ PLAN NO. PLAN CHECKER PLAN CHECK PLUMBING ELECTRICAL STRUCTURAL FIRE MARSHAL $ 9 1 00 AUDIT CHECK ❑ C R T DATE NOTAPPROVED COMMUNITY OWNER c_S c c- VALUATION F.C.C. GROUP TYPE DATE ISUPP.TOPERMIT DATE APPROVED CLEARANCE REO'D ❑ GRADING ❑ ROAD DEPT ❑ HEALTH DEPT ❑ PLANNING DEPT ❑ LAND USE REMARKS: W (Z)U— \ vQU�1C i P