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0524 (SATT)PERMIT APPLICATION • City of La Dg a • Department of Building Safety CIT, �V/COM�MUNLT�Y/$TA'r CA 92705 ' and 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. BOK 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 asto become subject to the Workers'Compensation Laws of And effect. California. 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•BUILOER DECLARATION: I' hereby 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 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 issuance, also requires the applicant for. DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: such permit to.fifeasigned statement that heislicensed.pursuant tothe provisions ofthe Contractor's License Law 01h'erebycertify that noexcavation five (5)ormore feet indepth into which aperson isrequired todescend, will 'be. i (Chapter 9(commencinq with section 7000) of Division 3 of the Business and Professions Code)or that he isexempt 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 If demolition Odismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec341, Title8. subjects the to a civil penalty.of not more than five hundred dollars ($500.): C.A.C)`• O I. as owner of the property, or my employees with wages as their sole compensation, will do the work, and the ' ❑ 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 through his own.empfoyees. provided that such improvements are not intended or offered for safe. If, however, the 0 Division of Industrial Safety Permit No. _,_building or improvemnt is sold within one year of completion. the owner -builder will have the burden of provingthat Date Applicant he did. not build or improve for the purpose of sale.l: d:, , CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance O. Las 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 ❑ 1 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. I agree to comply.with all. Date Owner' city and county ordinances and state laws relating to building construction, and hereby authorize representatives SIDE. 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 No. Company. ❑ Certified copy is hereby furnished. ❑ Certified Copy is filed with the City Building InsUection,DepartmeOtAr City.-- _ e Department: Date Applicant �1"'�� �L APPLICANT NAMEaF„ MI) LIAO 1D. t,►ZAJIyM ADDRESS matin Avenue,, Shite 231 CIT, �V/COM�MUNLT�Y/$TA'r CA 92705 ' JOB -SI DDRESS/SPACE 1.5) 'vj.,Ra Eb Nopal a53 CITY/COMMUNITY/STATE/ZIP � U.NWY/taA,E/ZM 92253 !C BOK PAG. PRC "C - TNM RING SE S TL.16640-3 LO10 34.67 ME Fee M 2B SB ' . TRACT NAME De La zOWNER �/ Same NAME(LF„MI_y xm CONTRACTOR -FIRM NAME - ADDRESS CITY/COMMUNITY/STATE/ZIP 1-L 558-3766 TOTAL - . FEE LICNC ARC/ENG FIRM NAME ADDRESS CITY/COMMUNITY/STATE/ZIP PHONE N LICNC //!� ��,,��������� 1 USr�'ID SE OF IT tVUtJiA2l.4nJim) BL ZON FSB SSB SSB RSB OFC ,. ZONE ORD N 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 the information 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 l,have applied for this permit for the purpose oUrnaking inspections.- . Signature of Applicant or Agent Print Applicant/Agent Name Date APPL/PRMT.1 DATE 40-84 Ctrido Permit to clmstruat 1,894 Sq. Ft. of S/F/D with 400 Sq. Ft. of Garage per appxoved PSS mechanical' Fee ' $ 18.00 Plan Check Fee ''Paid Constructicin Fee 445.50 EA- xical Fee 34.67 ME Fee 7.32 Plw ing Fee 61.00 Property Develognent Fee 450.00 Y 083 vc • LZ ll�• -.6.C.Y TOTAL - . FEE 1' p(JIlb *49 -?.Lu 3 f*a140tiu VALUATION - BLOG. DEPT. Ah Ak NO. OPERATION MATE INSPECTOR NO. OPWATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS 1 Set Back 33 Ventilation System 2 Ftgs & Frms f - — G 34 Plenums & Ducts 2A Slab Grade 35 36 37 Furnace Compart. Inlets & Outlets Combustion Air 3 Steel 4 Grout Blocks 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. Net NPON 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 G PLUMBING APPROVALS 15 Ground Plumb 16 Water Piping C 17 Rough Plumb 18 Vents 19 Sewage Disposal • 20 Sewer 21 Water Heater 22 Water Softener 23 • Water Service 24 Gas Test 25 Final r'f ��rj•�. G, _. Tank Pit L. Line ELECTRIC APPROVALS. i _ REAR OF PROPERTY LINE - P/L Pi STREET NAME 26 Power Pole 27 Conduit f 28 Service Entrance' 29 Wiring 29A Grounding Wire /` _ / -�� �G 29B Bonding 30 Fixtures 31 Service 32 Final 7..