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0418 (SATT)PERMIT APPLICATION City of La Ouinta - rg ,,1' • 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 fc- a period of 180 days. LICENSED CONTRACTORS DECLARATION: I hereby. affirm that I am licensed under provisions of Chapter 9 ' (commencing with Section -7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic. Number Date Contractor OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt fronmthe Coritractor's License Law for the 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 such permit to file a signed statement.that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with section 7000) of Division 3 of the Business and. Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violationofSection 7031.5 by any applicant fora permit ;. subjects the applicant to a civil penalty of not more thanfive hundred dollars ($500.): ❑ I, as owner of the properly. or my.employees with wages as their sole compensation, will do the,work, and the structure is not intended or offered for sale (Sec. 7044,.Business and Professions Code: The Contractor's License 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 building or i mprovemnt is sold within one year of completion, the owner -builder will have the burden of proving that he did not build,or improve for the purpose of sale.). , ❑ I, as owner of,the propertytam•exculsively contracting with licensed contractors to construct the project (Sec. 7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the ' Contractor's License Law.). ❑ 1 am exempt under Sec. B. 8 P.C. (Attached Certificate). Date Owner 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 t ❑ Certified copy is hereby furnished. �• / , s » , p\Certified copy is ed w h f city Building Inspection Dep�r meat or Department. Date_ Applicant X APPLICANT NAME (L. k41ADDR�.GiV.iJlAl SS P, U, Hoop 780 la - Y,�it 9,22253 ,2 u� 00ADDREAv W da Vista Bonita CITY/COMMUNITY./STATE/ZIP 1a itA, CA 92253 BOK I PAG PRC C Plan Check'Fee TWN RNG SE S TRACT 4Y96—Z LD,T, 2 7.39 PlunbjM Fee m,, 3 `T-• SB - TjiACT NAE � �� OWNER NAME (L. F. MI) •- CONTRACTOR -FIRM NAME ��:atllon ' ADDRESS s Abme CITY/COMMUNITY/STATE/ZIP 564.4315 3J.3762 ARC/ENG FIRM NAME ADDRESS ' CITY/COMMUNITY/STATE/ZIP PHONE N ' } III, FEE LICNC P &JP/) with Attached Garage BL 1 1 ZON FSB SSB SSB RSB OFC ZONE ORD #...,, LOT SZ • END SIDE CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if. the permit is for one hundred ($100) o, less. I certify that in the performance of the.work for which this permit is issued. I shall not employ any person i n any manner soxas to become subject to the Workers' Compensation Laws of, California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificat: of Exemption, you should become subject to the Workers Compensation provisions of the Labor Code, you mus: forthwith comply with such provisions or this permit shall be deemed revoked. DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be. . .'made in connection with work authorized by this permit, and that rib building structure, scaffolding, falsework, or ,demolition or dismantling thereof, will be more than th rty-six (36) feet high. (Chap 3.2, Grp 2. Art 2, See 341, Title 8. C.A.C.) ❑ As owner -builder, I will not employ anyone fb do work which would require a permit from the Division of IndustrialSafety, as noted above, unless such persoe has a permit to do such work from that division. ❑ Division of Industrial -Safety.Permit No. Date' Applicant CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for. which this permit is issued (Sec. 309x, Civ. C.). Lender's Name Lender's Address I certify that I have read this application and state tha the above information is correct. I agree to comply -with all . city and county ordinances and state laws relating to 7uilding construction• and hereby authorize representatives of this county to enter upon the above-mentioned pnperty for inspection purposes.. Signature of Applicant or Agent Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION IF ENTRY: I certify I have read this application and state that the information given incorrect. I agree to comply.w lh 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 I have applied for this permit for. the purpose of making inspections. Signature of Applicant or Agent Print Applicant/Agent Name Date ,APPL/PRMT n a 1 R 1DATE 2;;28-8L7L `/D Permit to constrwct 20326 Sq. Ft. of S/F/D with Attached Garde Mecha iical. Fee $ 26.00 Plan Check'Fee 291.20 doatstracti+on Fee 448.00 'Electrical Fee 36.90 SMI Fee 7.39 PlunbjM Fee 73.00 Property Develapnent Fee 450.00 P UEL Z 9 1983 ' } III, FEE $ 1,►332.49 BLDG. DEPT. VALUATION $105,867.60 Ah r1 NO. OPERATION 15ATE INSPECTOR NO. OP ATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS 1 Set Back 33 Ventilation System 2 Ftgs & Frms 34 Plenums & Ducts 2A Slab Grade 35 1 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. ❑ 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) 12B 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/� . ' P/I +,;? �C; STREET NAME 26 Power Pole ' 27 Conduit 28 Service Entrance 29 Wiring .. 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service 32 Final