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000947 (COMB)r - VALUATION F 1800.00 • BLDG. DEPT. . �y PERMIT APPLICATION - r - " 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,ab5ndoned for a period of 180 days. - �' ; ' _ f • • �l., CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if.: '-LICENSED CONTRACTORS DECLARATION: I hereby,affirm that F am licensed'under provisions. of Chapter r9 .. the permit'is for one hundred (5100) 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 • Jssued. I shall not employ any. person in any manner so as to become subject to the Workers'Compensation Laws of .and effect -- California. '. r,License Class; �� Lic. Number Date Applicant • Date Contractor _ _NOTICE TO APP.LIGANT ,If; -,flet making this Certificate oLExemption,.you should become subject to the Workers ; OWNER-BUILDER.DECLARATION:.I hereby'affirm•that I am exempt from the Contractor's License Law for the•' r Compensation provisions.of the Labor Code, you must forthwith comply with such provisions or this permit shall r be deemed revoked. following'reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to r ' "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 tofile 'asigned statementthatheislicensed pursuant tothe provisions ofthe Contractors License Law ❑'Iherebycertify'thatnoeziavationfive (5)ormore feet indepth into which aperson isrequiredtodescend, will be -' (Chapter 9 (commencing with section 7000) of Division 3 of the Business and Profe`sionsCode) or that he is exempt. • therefrom and the basis for the alleged exemption, Any violation of Section 7031--,by any applicant for a permit ^ made iii connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or ' , 2: • "subjects the applicant to a civil penalty of not moreihan five hundred dollars ($500.): . demolition or dismantling thereof, will be more than thirty-six;(36) feet high. (Chap 3.2, Grp 2, Art Sec341, Title B, ' C.A.C:) ❑ I. as.owner of the property, or my employees with wages as their sole compensation; will do the work, and the . O As owner-66ilder, I will not employ anyone'to'do workwhich would require a permit from the Division' of c, structure is not intended or offered for sale (Sec. 7044. Business and Professions Code: -The Contractors License. Industrial Safety: as noted above; unless such person has a permit to 0o such work from that divisions -- 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 -• •0.0ivision of Industrial Safety Permit No. building orimprovemnt is sold within one year of completion. the owner-builder will have the burden ofprovingthat : Date Applicant - ..he did not,build or improve for the purpose.of sale.). • . 5, • • =. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agencyfor theperformance' ❑ Las owner. ofthe property: am exculsively contracting with licensed contractors to construct the protect'(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 ' '•'- L.ender's Name " builds or improves thereon,'and who contracts for such projects with a contractors) licensed pursuant to the . ' Contractor's License Law.). ' Lender's Address ❑'.l am exempt under Sec. B.,& P.C. (Attached Certificate).... I certify that I have read this application and state that the above information is correct. l agree to comply with all :x' 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, ora i certificate'of Workers' Compensation. Insurance'. or'a certified copy thereof (Secr3800. Lab..C.). •c ' . - ' 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 ' - • O Certified copy is hereby furnished: ' ' • • - - . • theAnformation given is correct. I agree to comply with all state laws and county ordinances.relating to buidling. '- ❑ Certified copy is filed with the City Building Ins(iectiori'Departmeilt or City Deparlmint 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 ; _ Signature of Applicant or Agent Date r Print Applicant/Agent Name F " .: APPLICANT NAME (L, F. Mi)s' - APPUPRMT. DA. E • •e Jl+idl rQ rlEii)f'' • www AAA CJQ : ADDRESSP.()- PDX Zn1 . • - CITY/COMMUNITY/STATE/ZIP ftlM Desert. CA 921061 Pen t to install block wall and JOB SITE ADDRESS/SPACE ' , .. ': :" • .- - +" txv cl •t ' - vi 1 Lir T , i int elect'ria entry gat-' as per approved CITY/COMMUNITY/STATE/ZIP _ . ".. .• "- -. - - -.. Lal avinta. 91A 92 7 r.1 PLMS. - BOK PAG •- PRC " C - •TWN - • RNG .SE - S _ . + - - - •- ., -� +; TRACT • • - LOT, .. MOD SB - •• : L . TRACT NAME • - - 1 ' - _ NA l l A Ta : r'i tn4a OWNER NAME L. F. MI) �. _ .. _• ,. , . .. , " CONTRACTOR-FIRM NAME. ' - • .. , _ .. .. • , _ , ' , 1 • . ... .. ADDRESS - .. • 'Plan Check Fee 21.12' f CITY/COMMUNITY/STATE/ZIP- ' Electrical Fae 7.00' PHONE 111 LICNC • SMI fte .50 ARC/ENG FIRM NAME • I • . . T.K.D. Associates Qonst. Fee", 32.50 .. , ADDRESS CITY/COMMUNITY/STATE/ZIP.r •" - - ' Pala ►Spiil•11 s CA- p,�s. iw PHONE 1' 320-8899 • LICNC • -' - • . - % USE OF PERMIT n1 �� *�,�� (• q _—j.� ^.,�,A , .. -, ' ' Wall & �t iC Gate a 1 • - • R'A • -y a •.a - 6' Q •.., BL ZON - FSB. SSB • SSB RSB OFC,:+' + '; 'gs'o .. • - , - ZONE - .r .'LOT SZ END END -SIDE. .. hi: TOTAL • 60 FEE • . r x r - VALUATION F 1800.00 • 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 Slab Grade 35 furnace Compart. 3 .Steel 36 Inlets & Outlets 4 Grout Blocks 37 Combustion Air 5 Bond Beams Q 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 I 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