001296 (BLCK)PERMIT APPLICATION
City of La Ouinta
• Department of Building and Safety
This permit becomes void if work not commenced within.180 days from dale.of
issuance, OR, if work has beensuspended or abandoned for a perioftf 980 days., :
• r.l
, 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
r 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, Ishall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of .
and effect.
California.
License Class Lic.Aumber: ' r r^/�
Date Applicant
.Date Contractor % � +`7 R -tom'
-NOTICE TO APPLICANT: If, aftermaking this Certificate of Exemption, you should become subject-to,the,Workers' -
OWNER -BUILDER DECLAMATION:: I fiereby affirm that I am exempt from the Contractor's License Law_ for.the -
Compensation,provisions of the Labor Code, you must forthwith comply with such provisions or this'permit shall -
. following reason (Sec. 7031.5. Business.and Professions Code: Any city or county which requires a permit• to
be deemed revoked.
construct; alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
a
•- such permit to file a signed statement.that.heislicensedpursuanttotheprovisionsof.theContractor'sLicense.Law ,.
.01 hereby certify thatnoexcavationfive(5)ormorefeetindepthintowhichapersonisrequiredtodescend,willbe '
(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,theybasis for the alleged exemption. Any violation of Section 7031;5 by any applicant for a.permit
--demolition 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.):
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
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-
0 Division Industrial Satery Permit No.
through his own employees. provided that such improvements are not intended or offered for sale. If, howevergthe
of
building orimprovemnlissold 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
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.):.
7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who,
Lender's Name
builps or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the ;
Contractor's License Law.)..
Lender's Address
' 0 1 am exempt under Sec. .8. B.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
SIDE•t
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 selWnsure„ or a
certificate of Workers; Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.). .
$fgnature of Applicant or Agent Date
Policy No.Company
u.• .
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF, ENTRY: I certify I have read this application and state that
❑Certified copy is hereby furnished. -:. • Z_
the information givenis correct. I agree to comply with all state laws and county ordinances relating to.buidling
O:Certified copy is filed with the City Building Inspection Department or City Department.
Date ApplicanF
construction; -and authorize a,representativvee of the City of La Ouinta Department of Building and Safety to enter
upon,th-e•properly for•wplch 1 have applied for this permit for the purpose of making inspections.
/,,,•_•,,,� _
f Signature of Applicant or Agent Date
•�
APPLICANT NAME (L. F. MI( pue i. ►C7�
ADDRESS . -
46-120 Calhoun n St.
CITY/COMMUNITY/STATE/ZIP
Irdio, CA 92201
JOB SITE ADDRESS/SPACE. 0
48-100 Vista TaGLnal
CITY/COMMUNITY/STATE/ZIP ..
Ya �C.inba, CA 92253
BOK
PAG
PRC 11
C
20.00
TWN
RNG
SE
S
TRACT
LOT
MOD
I SB
-
TRACT NAME M��� -- .}TM'yam TT� �^ '
Lagma De La Paz
OWNER NAME (L. F. MQ
M.B. Johnson
CONTRACTOR -FIRM NAME ..
applicant
ADDRESS
armlicant
CITY/COMMUNITY/STATE/ZIP '�,�.,,�M. -
abam
PHONE 0347-3-566 ^ 7_3566 \
LICNC F
ARC/ENG FIRM NAME
ADDRESS
-CITY/COMMUNITY/STATE/ZIP • - '
PHONE M
LICNC
TOTAL
FEE
USE OF PERMIT Si gn
BL
ZON
FSB
,SSB.
SSB i
RSS
OFC
ZONE ORD M
LOT SZ
END
SIDE•t
Print Applicant/Agent Name
APPVPRMT ■ ■
q g 3-201- S MISC. .
Penni t, to install
2 ' Udall signs at Entrance
to be wounted on Chen Wall as per
abbrplived plans •
Elect.
20.00
Plan Check
36.72
Const. Fee
56.50
SMl Fee
.50
:t ..
TOTAL
FEE
113.72
A040.7
BLDG.DEPT
3„ 2 0 1: !
VALUATION 5,000.00
Ak
NO.
OPERATION I -ATE
INSPECTOR
NO.
O ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Ser 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
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)
128 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/L �P/1
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures "
31 Service
32 Final