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0634 (RPL)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 fora period of 180 days . ^ - . I • . ' •.. 1 ., . CERTIFICATE OF -EXEMPTION FROM WORKERS' COMF_NSATION 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).0, less. I certify that in the performance of the work for which this permit is .(commencing with Section 9000) of Division 3.of the Business and Professions Code, and mylicense is in full force • . issued, I shall not employ anyperson in any manner so as to become subject to the Workers'Compensation Laws of and effect. California. License Class Lic. Number Date Applicant u Date' Contractor NOTICE TO APPLICANT: If, after making this Cerlificnte of Exemption, you should, become subject to the Workers' OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License law'lor. the Compensation provisions of the Labor Code, you mast 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: ,. such permil.to file a sigDed statement that he is licens.ed pursuant to the provisions of the Contractor's License Law 0dherebycertifythatnoexcavationfive(5)ormore=eetindepthintowhichapersonisrequiredtodescend,willbe (Chapter 9 (commencing.with section 7000) of Division 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.*Usework, or - Aherelrom and the basis for the alleged. exemption. Any violation.of Section 7031.5 by any applicant for a permit ' demolition o(dismantling-thereof, will be more than fhirly-six,(36) feet high'. (Chap 3.2,'Grp 2, Art 2, Sec341, Title B. ' subjects the applicant to a civil penalty of not more than five hundred dollars ($500.): dr - .. C:A.C.) - - » ^ .0 I. as owner ol.the property, or my employees with wages as their sole compensation, will Bothe work, and they As owner -builder, I will not employ anyone to • o 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.lhat division.. - Law does not apply to an owner of properly who builds, or improves'thereon, and who does such work.himself or- . 0 Division 'of Industrial Safety.Peimit No. ' through his own employees: provided that such improvements are not intended or offered for sale. If, however, the r building orimprovemntissotdwithin one year opcompletion, the owner.builder will have the burden of proving that 'Dat e Applicant he did not. build or improve for the purpose o. sale.). -, �. j CONST.RUCT,iON LENDING AGENCY: I hereby affirm Oat 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•woik for -which this•permit is issued (Sect 307,.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 , . • - - - Coniractor's.License Law.). Lender's Address ' Cl I am exempt under Sec. AA 8 P.C. (Attached Certificate). I certify that I have.read this application and state It -at the above information is correct. I,agree to comply with all Date ' Owner r city and county ordinances and state laws relating t•• building construction, and hereby authorize representatives of this county to enter Upon the-above•mentioned property for'inspectiom 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. 3800. Lab. C.). , •^ 4.,. Signature of Applicant or Agent. Date' ' Policy No; Company. CERTIFICATE OF COMPLIANCE AND AUTHORIZATIONIOF ENTRY: I certify I have read this application and state that - O, Certified copy is hereby furnished. � � -• � I - � ,.- �D(Partmenl the information given is correct. I agree to comply vith all state laws and county ordinances relating to buidling ❑ Certified copy is*(iled`with the City Building Inspection De tment or City `= construction, and.authorize a'representative of theCity of La Ouinta Department of Building and Safety to enter upon the property for which I have applied foi Ihisipermit for the,purpose of making inspections. Date Applicant Signature of Applicant or Agent S. Dale . Print Applicant/Agent Name AP,f'1PUl%�I MELfI MI) /V ADD%ec,��la� CI TV/C�0�7`J UNI Y/S/92E � I, C•? JOB-S1T �— R P itl - U�ST p �tJ7 CI TYY/COMMUNITY/STATE/ZIP BOK PAG PRC C TNM - .FIND SE S TRACT.� ,yyyd:�. LOT G. J C4 .. MOD SB TRACT NAME/'' .. OWNER NAME (L. F. Mn .. •• ,r CONTRACTOR -FIRM NAME - • . -, ADDRESS CITY/COMMUNITY/STATE/ZIP PHONE a' / //� ,,// LIL NC ARC/ENG FIRM NAME[% ADDRESS .. CITY/COMMUNITY/STATE/ZIP - .. PHONE a LICNC It . . USE OF PERMIT - 81. ZON FS8 SSB- SSB RSB OFC ZONE ORD a,.; *; LOT SZ, .%' END SIDE , .APPUPRMT n�.�7�.�� ATE n ���� iT T� • �d/�7�cc �P.4 f1 s 1 TOTAL FEE VALUATION ^.2 � 00, .0 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 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 fireplace T. 0. ❑ OP'10A NO. ADDITIONAL INFORMATION NO. , I yI� , ' SEWAGE SYSTEM SIZE & LOCATION 11 Exterior Lath 12, Internal Lath 12A Drywall 13 Finish Grade INSULATION Thick al Value 7A Walls (Batts) 126 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 PiI 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service 32 Final STREET NAME