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0420 (SFD)PERMIT APPLICATION + City Department of La Ouinta Building Safety • „ ,;, , _ of and , . + . , r �• • This permit becomes void if work not commenced within. 180 days from date �. i; 1. • L of issuance, OR; -if work. has been suspended orabandoned;for a period,of 180 days. :+ ..:: • f .•-: -. .. ,. i ,, , _ • • •:r, , - 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. l 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 lull force- ; issued, l shall not employ any person inany,mannerso. s to become subject to the Workers' Compensation Laws of ; and effect. California. , License Class Lic..Number Date Applicant Date Contractor " ^- NOTICE TO APPLICANT: It, after making this Certificate of Exemption, you should become subject to.the.Workers d OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the Compensation provisions of the Labor Code; you musliorthwith comply with such provisions or this permit shall , ri be deemed revoked. ' ,. following reason (Sec. 7031.5: Business and Professions Code: Any city or county, which requires a permit to . - construct, alter, improve, demolish, or repair, any. structure, prior to its imance,.also requires the applicant for DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: „. r ; such permit to file a signed .statement that he is licensedoursuantlgthe.provisionsofthe Contractor's License Law . •' O 1 hereby'c0tify that no excavation five (5) or,moire feEl indepth into which,a person is required to descend; will be - �f a (Chapter 9(commencing with section 7000) of -Division 3 of the Business and ProfessionsCodejor that he is exempt 'made in connection with work authorized by this permi , and that 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•thereof,:will%be more than thi Ity-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 hundreddollars ($500.): , - C.A.C.),- • ' - ° Y'a%�=�•- _, _ •.. ❑ I, as: owner of the property, or my employees with wages as their sole compensation, will do the work, and.the . 0 As ownef-builder' I will not'employ anyone to do work which wouldrequire a permitfrom the Division of. structure is. noNiotended or offered for sale (Sec..7044,.Business and Professions Code: The Contractor's License Industrial Safety, as notedabove. unless'such personlhas 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. <. P • _ ` tnrough his own:employees: provided that such improvements are not intended or offered,for sale. ll, however; the . O Division of Industrial Safety Permit No. • building orimprovemntissoldw(ithinone year ofcompletion,the owner -builder will have the burden ofprovingthat Date iApplicant he did not build or improve for„the purpose of sale.).. ; ,lr CONSTRUCTION LENDING AGENCY: I hereby affirm.thaMhere 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 •?' 0A am exempt under Sec. B..B. P.C. (Attached Certificate). -; I certify that I have read this application and state that :he above information is correct I agree.to comply with all , Date' Owner cityand county ordinances and state laws relating to b Wiling construction, and hereby authorize representatives ' of this county to enter upon the above-mentioned pro,�erty for inspection purposes. ; WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of .consent to self -insure, ora • .certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec} 3800. Lab. C.). , ^ Signature of Applicant or Agent Date Policy No, Company .. I •^ _ „ CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:. I certify I have read thisapplication'and state that . O Certified copy is hereby furnished. - �� 1 o r the information given is correct. I agree to comply with allstate laws and county ordinances relating to buidling . � i I � ./ -� • f . 17/Certifiedcopy is filed with the City'Buildirig Inspection Department, or City Department. . . construction, and authorize a' representative of the Ciy of La,.Ouinta Department of Building and Safety to enter >• • , riT A !� 1 / /1 "p� / 3 upon the properfy,for which I have applied for this permit for.the purpose of making inspections. / MDlicant APPLICANT NAME (L. ADDRESS P. • of B=-780' CO�s E52aC 92253 .. . ; JI BI'• ADDRESS/SPACE _uerta COMMUNITY/STATE/ZIP (A 92253 BOK PAG PRC C .TNM 291,20 RNG SE'/, S. 'Y496;.;2 LOT A j�S Plumbing Fee ” MOD SEI 4 TRACT NAME �. Santa lbsa Cave OWNER NAME (L• F. MI) . CO�NTRACTO�R-SRMN, ,AME ...i. L{ ADDRESS- CITY/COMMUNITY/STATE/ZIP 5 , 5ONE=3:315 ' L133762 ) ARC/ENG FIRM NAME _ ADDRESS' CITY/COMMUNITY/STATE/ZIP P.aHONE N LICNC 0USE - - '. OF PERMIT V/F/D 4ith shed Garage ` 1 BL' ZON FSB -SSB- SSB RSB OFC'• ' . 'ZONE ORO • �',.. ' -LOT. SZ ^ - -END SIDE k. W7 Signature of Applicant or Agent Print Applicant/Agent Name Date APPLNRMTDATE n lz-•28•.83 non, S/F/D P=y dt� to mnstnict 2,3 26 Sq. Ft, of S/F/D t� with Attached Garage Medianial Pee ;= :5-0 $: 26,00 'Plan.' (berk Fee a 291,20 Cmwtnzctian Fee 2,2.S/ G 448.00 Electrical Fee 36:90 SM Fee Plumbing Fee ” .739,00 Property Devealopmaht Fe~ ' . 4 City ,®l a Quints TEFF •. a' „332.49 �' 'r•-4- YV #;r'�' '.f ��,- �at� BLDG. DEPT. r 5�,., Ex• vt� I a � .s, VALUATION $l05 j867:60 �Wry a Ak NO. OPERATION TATE INSPECTOR NO. OP TION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS S 1 Set Back 33 Ventilation System 2 Ftgs & Frms 34 Plenums & Ducts 2A Slab Grade Aida FurnaceCompart.. 3 Steel -35 I 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 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 S 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/L 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