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0607 (RPL),w 1"r APPLICANT-IIAr�E, (7 �, �} ©� :5A � ��j /Y� L.. �•i LI 'AD/I7EJSS-Fjt��, C`4 NgI_T�VN/STAT Z IP �j.P9� r I JOB TEE/A QIIESS/SPACE SI' y / r4 PERMIT APPLICATION BOK City of La Ouinta' C Department of Building and Safety - This permit becomes void it work not commenced'within 180 days from date oNssuance. OR,;if work has been'suspend,ed or abandoned'fc-. a period of 180 days. ` ° "' •- ' ' r ++ _ �•• ' ' CERTIFICATE OF EXEMPTION FROM WORKERS' COMPEIIISATION INSURANCE: This section need not be completed if LICENSED CONTRACTORS DECLARATION: Thereby' affirm .that' I am licensed under,'-provisions of Chapter'9 • - the permit isfor one hundred ($100) o, -less. I certify Leat in -the performance.of•the work for which this permit is - (commencing with Section. 7000) of.Division;3of the Business and Professions Code, and my license is�i I full force ' ': *.issued. I shall not employany person in any manner soas to become subject to the Workers' Compensation Laws of and effect. I %f'2o �(f) California. License Class Lic. Numb •✓• Date Applicant ' Date " Contractor. V+' tatk,iz _ : • .NOTICE TO APPLICANT: If, atter makin this Certificare of Exemption, you should become subject to the Workers' ' J/ ' OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law;tor the • - Compensation provisions of the _Labor Code, you must forthwith comply with such provisions or this permit shall ' t following reason (Sec. 7031.5. Business and Professions Code; Any cityor 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 permit -to file asigned statement that he is licensed pursuant to.the pro visions of the Contractor's License Law - " ..;'p Ihereby c rtilythatnoexcavationlive(5)ormorefeelindepthintowhichapersonisrequiredtodescend,wi11be ' (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 authorised 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 . _ 'bemolition or dismantling thereof. will be more than Wirtysix (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.). a=•iJ,%, C.A.C.) 0 Pas owner of the property, or my employees with wages as their sole compensation, will do the work, and the 17 As owner -builder, I will not employ anyone to d. work which would require -a permit from the Division of t ,-Structure isnot intended or offered for sale.(Sec..7044, Business and Professions Cade: The Contractor's LicenseIndustrial Safety,.as'66ted above, unless'such perserhas.a permit to do such work from that division. •• 4Law does not apply to an owner of'property who builds, or,improves%thereon, and who does such work himself or • ' . . v' .. - through his own employees, provided that such improvements are not intended o�r`offered forsale. II, however, the--, ' :. ,0 Division of Industrial Safety:Permit No. r buildingorimprovemntissoldwjihinoneyearofcompletion,theowner-builder will have the burden of proving that. ., Date.' "" Applicant he did not build or.improve for the. purpose of sale.). . _ . 1 �' CONSTRUCTION LENDING AGENCY. I hereby affirmttr it there is a construction lending agency for the performance r 0 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. 309;.Civ. C.): . 7044. Business and0.Professions Code: The Contractor's License Law doesnot apply to an owner of property who "• ,, SIDE: „ builds or improves thereon; and who contracts for -such projects with acontractor(s) licensed pursuant to the ;fender`s Name ., - + .Contractor's License Law) :. 5.: Lender's Address 4. •O fain exempt under Sec: ' `. 8..8 P.C.!(Attached.Certificate):. ' f certify that I have read -this application and state the t the above information.is correct: I agree to comply with all Date • .. 4' Owner f '" � city and county ordinances and state laws relating tobuilding construction, and hereby authorize representatives 4 I of this county to'enterupon the above-mentioned property for inspection purposes: WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have'a certificate of consent to sell -insure. ora - certificate of WorkeFs' Compensation Insurance , or a'certified•copy thereof (Sec.: 3800. Lab. C.). , Signature of Applicant or Agent Date • Policy No. Company,CERTIFICATE OF COMPLIANCE AND AUTHORIZATION -)F ENTRY: I certify I have read this application and state that ..: 0 Certified copy is hereby furnished.. ". ',. " .. 'the information given is correct. I agree to comply.wih all state laws and county ordinances relating to buidling ' ! D Certified copy is filed with -the -City Building,Inspection'Department.or City' Department.. '. construction, and authorize a'representative of the :ity of La Ouinta;Department of.Building and Safety to enter for for oermit for inspections. Date Applicant I upon the property which I have applied -this -the purpose of making + Signature of Applicant or Agent _ Date f " Print Applicant/Agent Name • + ,w 1"r APPLICANT-IIAr�E, (7 �, �} ©� :5A � ��j /Y� L.. �•i LI 'AD/I7EJSS-Fjt��, C`4 NgI_T�VN/STAT Z IP �j.P9� r I JOB TEE/A QIIESS/SPACE SI' y / r4 CITY/COMMU2 TV/STATE/ZIP il✓✓ BOK PA''//G PRC C i TWN RNG - . SE•' I'S- moo Ilse TRACT NAME OWNER NAME (L: F. MI)• ,. ... ' • �.. - .... CONTRACTOR -FIRM NAME•• .+ - •. ADDRESS _ CITY/COMMUNITY/STATE/ZIP PHONE II - + - LICNC # 7 .. 'ARC/ENG FIRM NAME . •• . _ ADDRESS.. CITY/COMMUNITY/STATE/ZIP E{� PHONE N' 'LICNC # - . USE OF PERMIT BL' ZON -.FSB SSB SSB RSB' OFC •I ti ZONE ORD''# •+_, ,. ,� 'LOT SZ , f .END, ,, SIDE: „ APPL/PRMT • n V .�?/ - V3`° - ✓ � *17 VALUATION BLDG. DEPT. o ., NO. OPERATION DATE INSPECTOR NO. OPERATION DATEINSPECTOR 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. ❑ OP'N NO. ADDITIONAL INFORMATION f 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 PSL P/1 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service 32 Final STREET NAME