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001014 (SFD)%Ie� C=P. ADDRESS"' . . ... .. . :, . . . , . .. . il P.O. B= 780 CITY/COMMUNITY/STATE/ZIP La QLdnta,, CA 92253 lip PERMIT APPLICATION .80K City of La Ouinta Department of Building and Safety, PAC I C -This permit becomes void.if work not commenced within. 19OAays from date of issuance, OR, if work:has been suspended or abandoneflo� a period.of..,180 days, V CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE:, This section need not be completed if LICENSED CONTRACTORS DECLARATION: I hereby affirm,that I am licensed-uffidwprovisions of Chapter..9 the permit is for one hundred ($100) o, fess. I certify: tiat in the performance of the work for which this.permit is of the Business Profes ions Code: and mY.license is in full force (commencing with Section 70001.of Division.3 s issued; I shall not employ any person in any manner. SO 3S to become subject to the Workers'Compensation Laws of and effect. California. License Class Date Applicant 4 • Contractor 0 1 e - NOTICE TO APPLICANT: J!, after�making this Certificate 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 for. the Compensati qp rovisions of the Labor Code, you mus: forthwith comply with such'provisions or this permit shall *roev6ked. following reason (Sec. 7031.5. Business and Professions Code: Any city or countywhich requires a permit to,,. be deemed 4 consiruct, 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 file'a signed statement that he isticen.sed pursuant to the provisions of the Contractor's License Law 0 1 he' by certify that no excavation five (5) or more ic e -ef in depth int6which a per§on i . s required to descend; will be (Chapter 9(qommencing w ' ith section 7000) of Division 3 of the.Business and Pro.fessionsCode)or that he is exempt I made in. connection with Work authorized by this pe(rdit: and that no building structure,- scaffolding, falsework, or. therefrom and the basis. W the alleged exemptiorf. Any violation of Section 7031.5 by any applicant for a permit demolition or dismantling "thereof, will be'more than trirty-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 (SWO.): C.A.C.)' 0 1. as owner of the property: or my employeps.with wages as their -sole compensation, will do the work, and the owner -builder, I will not employ anyone to do work which would require a permit from the Division of '0 As - 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 ply 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 Division of Industrial Safety Permit No.. building oLimprovemnl.is sold within- one year of completion, the owner.-builder.will have the burden of proving that Date-----'; Applicant !% • he did not build or improve for the.purpose of sale.)...- 'CONSTAUCTION,CENDING AGENCY: I hereby affirm that th6re is a construction lending a'gin;y.for the performance 0. I..as owner ofilhe property: am exculsively contracting with licensed contractors to construct the project (Sec: -of themork for.which this permit'is issued (Sec.. 309, Civ. C.). 7044, Business and Professions Code: The Contractor's License Law does not -apply to an owner of property who Lender's 4- e -builds or. improves thereon, and who contracts for such projects with aicontractor(s) licensed pursuant to the . . am Contractor's License Law.). . , . 1. . .. . . I. ! - — . Lender's Address t. - 0.1,am,exempt under Sec. - B. & P.C. (Attached Certificate). I certify that.) have read this application and state that the above information,is correct. I agree to comply with all . Date. t 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 p -operly for inspection purposes. WORKERS' COMPENSATION DECLARATION: -1 hereby affirm that I have a certificate of consent to self -insure, ora? certificate of Workers' Compensation Insurance lor a certified.copyjhereof-.(Sec. 3800: Lab. Q. •Signature of Applicant or Agent Date Policy No. Company -CERTIFICATE OF COMPLIANCEAND AUTHORIZATION 3F ENTRY: I certify lhave read this application and state that 0 Certified copy is hereby furnished. the information. given li—scorrect iagree.to-comply with all state laws and county ordinances relating to buidling .0 Certified copy is filid.W'ith the City Building Inspection Department or City Department 'ity of La Quinta Department of Building and Safety to enter construction. anRa�thorize a,'representative of the , — 'which — h I"have/appli6d'fbr this 3ermit fof the purpose of making inspections. jupon the RoPjehyo.r Date Applicant Signature of"A:pplicant or Agent Date Print Applicant/Agent Name &4 APPLICANT NAME (L.- F.• APPUPRMT %Ie� C=P. ADDRESS"' . . ... .. . :, . . . , . .. . il P.O. B= 780 CITY/COMMUNITY/STATE/ZIP La QLdnta,, CA 92253 JOB SITE AOORESS/SPACE � _! . 49-274.Avenida Vista Bonita CITY/COMMUNITY/STATE/ZIP la Quinta, Ch 92253 .80K PAG PAC I C TNM RNG' SE S TRACT 14496r-;[ LOT 22- MOD G-3 so TRACT NAME Santa Rwa Vcm OWNER NAME (L. F. MI) CONTRACTOR -FIRM NAME Anden ADDRESS` - : '. above CITY/COMMUNITY/STATE/ZIP PHONE 0 LICNC 4 564-R15 333762 ARC/ENG FIRM NAME Barry &xkms ADDRESS 1531- Cbamla Street CITY/COMMUNITY/STATE/ZIP I &inta Bagbam. M 93101 PHONE N LICNC 0 USE OF PERMIT SJ�Wle fC-MUV &Oell_iney BL ZON -'FSB SSB. :SSB AS13 OFC1 'ZONE ORD LqT-LSZ -1,..•-'EN. SIDE 16'T52 Pendt to canstruct 21316. iq. ft. of su=LF-le fmily dwelUn4 with attached-' 'garage. This P'e'=L t -to replace,' # 0428 Mdh.'Fee Uqao,Qql I Plan Mack Fbe _32*,z5-, 'Mact. Flae P4r&ing Fee 3,4.00. Ac 7 4ij FQN 410 to- TOTAW FEE' A BLDG. DEPT. VALUATION TI N 4 NO. OPERATION ATE INSPECTOR NO. OP ATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS 1 Set Back 33 Ventilation System 2 Ftgs & Frms a 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 S 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 • r1Ao0*6 ///! O K �'• - SEWAGE SYSTEM SIZE & LOCATION 11 Exterior Lath � ., � 12 Internal Lath 12A Drywall 13 Finish Grade INSULATION Thick Value 7A Walls (Batts) 12B Ceiling (Batts) 12CT Ceiling (Blown) 14 1 Final PLUMBING APPROVALS 15 Ground Plumb 16 Water Piping 17 Rough Plumb S 18 Vents 19 Sewage Disposal 20 Sewer f ' 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, d= 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service 32 Final I I d