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000909 (RR)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; if work has been suspended or abandoned for a period of 180 days. . '' . J 4 1 '-CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION 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 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. ` S �,S%t�� % California. License Class I ic. N,umCber y Date Applicant Date �''—' ' Contractor ► M �� . +v`� ,.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 fr m the Contractor' License Law for the Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall LOT be deemed revoked.' following reason (Sec. 7031.5. Business and Professions Code: Any city. or county which requires a permit to MOD construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: such permit to fileasignedstatementthatheislicensedpursuanttotheprovisionsoftheContractor'sLicenseLaw -, 01 hereby certify that no excavation five (5) or more feet indepth 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 for a permit. GemMition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8. '• subjects the applicant to a civil penalty of not more than five hundred dollars ($500.): '1%,&CC.) " 0 I, as owner o1 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-Uf 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. 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 ❑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.). ! CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance �O 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.). 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 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 the above information is correct. I agree to comply with all Date Owner 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 ;'ora certified copy thereof (Sec. 3810. Lab. Q. Signature of Applicant or Agent Date Policy No. Company CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that 0 Certified copy is hereby furnished. - the information'given'is correct. I agree to comply with all state laws and county ordinances relating to buidling•. 0 Certified copy is filed with the'City Building Inspection Department or City Department. 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. Date Applicant APPLICANT NAME (L. F. MI) C.V.R00 IW W. ADDRESS P.O. Sox 125(6 - CITY/COMMUNITY/STATE/ZIP Indio' C 92201 JOB SITE ADDRESSISPACE 52-990 Eise ftmer CITU/COMMUNITY/STATE/ZIP La T ^ QW*nta 7 CA ` ,92253 BOK PAG PRC C xyf TWN- RNG SE S TRACT LOT SNffP .50 MOD SB ' TRACT NAME OWNER NAME (L. F. MI) - Ztm Caraillo CONTRACTOR -FIRM NAME �'••yOFI' ADDRESS ' CITY/COMMUNITY/STATE/ZIP ' PHONE a ' LICNC 1 ' ARC/ENG FIRM NAME ADDRESS 1 CITY/COMMUNITY/STATE/ZIP ' rte. PHONE . LICNC • USE OF PERMIT ' Re --roof BL ZON I FSB SSB SSB RSB OFC ZONE ORD . ' LOT SZ END SIDE �1 Signature of Applicant or Agent Print Applicant/Agent Name Date APPL/PRMT M n 9 ffli 8- 27-84 OLLN Permit to xyf Permit Fee 22.00 SNffP .50 4� • Ft I • P F PIN 0 Tia MOO v TOTAL FEE 22.50 BLDG. DEPT. VALUATION $ 1,875.00 5 Bond Beams 38 Compressor 6 Roof Deck 39 Appl. Clearance 7Framing 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. ❑ NPON ADDITIONAL INFORMATION 11 Exterior Lath 12 Internal Lath `% n 12A Drywall 13 Finish Grade INSULATION Thick R Value 7 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 STREET NAME �. 3 J NO. OPERATION DATE INSPECTOR NO. OPERATION DATE INSPECTOR BUfLDING.APP .ROYALS 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 7Framing 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. ❑ NPON ADDITIONAL INFORMATION 11 Exterior Lath 12 Internal Lath `% n 12A Drywall 13 Finish Grade INSULATION Thick R Value 7 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 STREET NAME �.