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0631 (RPL)APPLICANT NAME,(Le., W.) ADDRESS'... e -- 242--2' 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 Or a period of.180 days. • .-...• _ CERTIFICATE OF -EXEMPTION FROM-WORKERS'.COMPE NSATION INSURANCE: This section need not be completed it . - LICENSED CONTRACTORS 'DECLARATION: 1 •hereby'affifm that tam licensed under provisions of Chapter 9 the.permit is for• one?hundred ($100) o. less: I certify.ithat in'the performance of the work for.which this permit is - (commencing with Section 7000)'of Division 3 o1 the Business and Professions Code, and my license is in lull force- issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of and effect. f California. License Class Lic. Number _ . Date Applicant Date '= Contractor.:-- NOTICE TO APPLICANT:,If, after making this Certificae of Ekemption,.you should become subject to the Workers' r OWNER -BUILDER DECLARATION; I.hereby affirm'that'I- arri;eze'mpI from the Contractor's License Law for the. Compensation provisions of -the Labor Code, you mLst forthwith comply with such provisions or this permit shall Y• be deemed revoked.' r, following reason (Sec. 7031.5. Business and Professions°Code:.Any city or. county which requires a permit to CONTRACTOR -FIRM NAME • .• - .. ..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 file a sig nect statement Ahat he is licensed pursuant to.the provisions of the Contractor's License Law ❑therebycertilylhatnoexcaJationfive (5)ormore eel indepth into which apersonisretjoiredtodescend: will be, ' - (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 pernit; and that no buildinlystructore, scaffolding, falsework or therefrom and, the, basis.for the alleged exemption. Any violation of Section, 7031.5 by any applicant for a permit demolition or disriiantl'ingthereof, will be more than•--hirty-six (36) feethigh. (Chap 31, Grp 2, Art 2. Sec341; Title8. = subjects the applicanPto a civil penalty ot,not more than five.hundred dollars ($500): c. Ax.) • O 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'eo work which would require a permit from the Division of structure.is not intended onoffered for sale (Sec. 7044, Business and Professions' Code: The Contractor's License - ' Industrial Safety, as noted above,,unless such pers3n has a permit to do such work from that'division. L s - Law does not apply to an owner of property who builds, or improves thereon, and who does such work:himself or,' - . ,- •r • . • . +, . through his owd:emlployees• provided that such improvements are not intended ar offered.for sale. ll, however, the- Division of, Industrial Safety Permit No. building orimprovemntissold within one year'ofcompletion, the owner -builder will havetheburdenofprovingthat,, • • -Date ' Applicant he did not build or improve for the purpose of sale.).. '• = CONSTRUCTION LENDING AGENCY: I hereby affirm I iat there Is aconstructiori lending agency for the performance ❑ 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. 3017, Civ. C.). 7044. Business and Professions Code: The Contractor's License Law does not apply to an owner ofproperty who - ' ,. Lender's Name builds or improves dhereon,'and who contracts for such projects'with a contractor(s) licensed pursuant to the .., LOT SZ Contractor's License Law.). rw ... Lender's Address .1.0 1 am exempt under -Sec. ' B. & P.C. (Attached. Certificate).: r ., • I certify that] have read this application and state flat the above information is correct. l agree to comply with all ' Date Ownei: " ' city and county ordinances and state laws relating b building construction, and hereby authorize representatives:'• ; 'above of this county to enter upon the -:mentioned propertydor inspection purposes. WORKERS' COMPENSATION DECLARATION: I herebyaffirm that'l have'a certificate of consent to self -insure, ora " - "certificate of Workers' Compensation Insurance'; or a'certified.copy thereof (Sec: 3800:.L'ab. C.).' ' • Signature of ApplicanrAgent' Date' - ,.Policy No. Company CERTIFICATE OF COMPLIANCE AND AUTHORIZATIOP-OF ENTRY: I certify l have read this application and state that t ❑ Certified Copy is hereby furnished. • S ' / /" • ' � the information given -is correct. I agree to comply with all state laws and county.ordinances relating to buidling i the Cit La Ouinta Department Safety to o 'O Certified copy.Esfiled.with the City Building Idspection,Department or- •—11�Depertment. . construction, and authorize a:re resentative of of of�Buildin and y it P Y. P 9• enter r' f,� - 'e- - }�(�� !� "` ' upon the property for which I have applied Ior thi=_.permit for the purpose of making inspections. f Date Applicant Signature of Applicant or Agent Date : t^ Print Applicant/Agent Name , t APPLICANT NAME,(Le., W.) ADDRESS'... e -- 242--2' _3CE 444F CITY/COMyUNITY/STATE/ZIP - - BOK '/PAG- PRC C - - TWN' ANG SE -'. -S 1471-11,6 �® `'^• �T� �:[MOD- S8 TRACT NAME ' OWNER NAME (L. F. MI) - - - •- ' • - ' CONTRACTOR -FIRM NAME • .• - .. ADDRESS - •• CITY/COMMUNITY/STATE/ZIP - - PHONE N- >yb-yym NC -1 L•IC,v��s -... - ARC/ENG FIRM NAME ADDRESS - - CITY/COMMUNITY/STATE/ZIP PHONE N LICNC N USE OF PERMIT - BL - ZON FSB' SSB SSB RS8 OFC.: ` • ZONE ORD N <, j , .., LOT SZ .: r .END' SIDE.' ' APPL/PRMT � � ATE pC.fi/illT TO �-�N ST.E'lJG T' S�j% - .q5 ., � �l.•l� ��� ' ,� Elf � t ©�., .. � - ;. •� , - TOTAL{_.:. FEE a�_ s •; • r, VALUATION i .„ y• •? a ., BLDG:DEPT." - 1� n�. 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 10A Fireplace T.O. ❑ NPON ADDITIONAL INFORMATION' ✓/%/� 4// . I 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) 126 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/I • a+. STREET NAME 26 Power Pole 27 Conduit 28 Service Entrance ' 29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service 32 Final