0502 (RPL)APPLIC
ADDRESS
.2 L-
CICOMMUNI VITATE/ P�r��A /
•CI�/COMMUNITY/STATE//ZIIP_
BOK PAG PRC C TWN •c' RNG " ' SE S
'Tii'AJT�� LOf� MOD SB
TRACT NAME
OWNER NAME (L: F. MI)
CONTRACTOR -FIRM NAME .• ,
ADDRESS -
CITY/COMMUNITY/STATE/ZIP - ..
PHONE,11/
ARC/ENG FIRM NAME'
ADDRESS
CITY/COMMUNITY/STATE/ZIP .. •.. '
PHONE N ' LICNC M -
USE OF PERMIT -
St. ' ZON - FS8 SSB Sob RSB .
' I
., ZONE ORD, w..,,i^ LOT
APPVPRMT" n
'717 OX
A VALUATION
BLDG. DEPT.
PERMIT APPLICATION r
-
City of La Ouinta
Department of
Building and Safety Al .
_ This permit becomes void if work=not commenced within 180 days from date of issuance,'ORr if work has been suspended or. abandoned to, a:period:of 180 days. ,.
:, y ,• ' ;;I,.
�of'Chapter
,: CERTIFICATE OFEXEMPTION FROM WORKERS'COMPEGSATIONINSURANCE' This'section need not be completed if
LICENSED, CONTRACTORS DECLARATION: .I hereby, affirm that•I am licensed under provisions 9
. . .•the permit is, for one hundred ($100) o, less:.) certify Oat in the performance of the work for, which this permit.is
.(commencing with Section 7000) of Division 3 of the Business and Pr� ssi�Coodde,a d my license.isrin lull force;.
.. , issued, I shall employ any person in manner to become subject to Workers`CompensationLaws of !
and effect. <.!�
California.
License Class Lic. Number 1
Date Applicant '
4� ' Z.
' Date Contractor. ' -
NOTICE•TO APPLICANT: If. -alter making this.Certificata of Exemption; you should become subject to the Workers'
e•° • ^
• OWNER -BUILDER DECLARATION: I hereby'affi-rm that I am exempt Iron the'Contracto',%s Licehseaw for the
'Compensation provisions of the Labor.Code, you.mus forthwith comply with such provisions or this•permit shall
bebeemed revoked. `- -
following reason (Sec. 7031.5. Business and Professions Code: Any cit} or county. which requires,a.permit to
-
construct, alter, improveidemojish..or: repair any structure, prior to•its i::suance, also requires the,applicant for
- DIVISION OFANDUSTRIAL SAFETY:PERMIT.CERTIFICA710N .;
such permit to file a signed statement that he is licensed pursuant to the pr rvisions of the Contractor's License law:
0 1 hereby certify that no excavation five (5) or more feetin depth into Which apersonis required to desce4 will be
(Chapter 9(commencing with sectiond000) of Division 3,o1 the Businessard Professions Code) orthat he is exempt'
made in connection With work authorized by this permit, and that no building structure, scaffolding; lalsework: or'
, therefrom.and the basis for the alleged exemption. Any violation of Section 70315 by any appficant.for a permit. '
'' '- demolition or Dismantling thereof, will be more than tYirtysix (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 .ollars: S500.):--
C.A.C.) ' r
.0,1, as owner ol.the:properly, or my employees with wages as their sole :ompensation, will do the work; and the
;• 17 As'owner-tiuilder, I will not employ anyowtiiAv work which would require' a permibfrom the Division of.
structure -is not intended: or offered for sale (Sec. 7044, Business and Pro-essions.Code: The Contractor's License
Industrial Safety; as noted above;'unless such,persen has a permit; to do such work from that division. '
Law does not apply to:an owner of property who builds, or improves then -on, and who ,does such work himself or
throughhis own employees. provided that such improvements are not intwided or offered for sale. If; how-ever,'the
o Division of Industrial Safety Permit No.
building or improvemnt is sold within one year of completion, the owner-bLilder wiJI.have the burden of provingthat
..: Date' Applicant. -
he did not build or improve for the purpose of sale.)._
CONSTRUCTION LENDING AGENCY: hereby affirm lhlt there is a construction lending agency for the pedofinance
- O, 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 and Professions Code: The Contractor's License Law does not apply to ao.owner of property who
7644.
Lender's Name
builds or improves thereon; and.who contracts for such projects with :I contractor(s) licensed pursuant. to the
... ,
' {
Contractor's License Law.).
Lender's Address
❑ I am exempt under Sec. B. 8 P.C. .(Attached, Certificate).
I certify that I have read this application and state th A the above information is correct. I agree to comply with all ;
'' Date ' Owner
city and county ordinances and state laws relating tabuilding construction, and hereby authorize representatives r
of this county to enter upon the above-mentioned p operty for inspection purposes.
.WORKERS' COMPENSATION DECLARATION: I hereby, affirm that I have -a zertificate of consent to self -insure: ora
cerlificate'oVINorkers' 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 IF ENTRY: I certify l have read Misapplication and state that r
❑ Certified copy.fs hereby furnished.
the information- given is correct.] agree to comply with all state laws and county ordinances relating to buidling
•.0'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
• - ., ..
_
. upon the property for which 1, have applied for this Fermi[ for the purpose of making. inspections..
Date • Applicant-
"
Signature of Applicant or Agent Date
-Print Applicant/Agent Name i
APPLIC
ADDRESS
.2 L-
CICOMMUNI VITATE/ P�r��A /
•CI�/COMMUNITY/STATE//ZIIP_
BOK PAG PRC C TWN •c' RNG " ' SE S
'Tii'AJT�� LOf� MOD SB
TRACT NAME
OWNER NAME (L: F. MI)
CONTRACTOR -FIRM NAME .• ,
ADDRESS -
CITY/COMMUNITY/STATE/ZIP - ..
PHONE,11/
ARC/ENG FIRM NAME'
ADDRESS
CITY/COMMUNITY/STATE/ZIP .. •.. '
PHONE N ' LICNC M -
USE OF PERMIT -
St. ' ZON - FS8 SSB Sob RSB .
' I
., ZONE ORD, w..,,i^ LOT
APPVPRMT" n
'717 OX
A VALUATION
BLDG. DEPT.
'SZ, c.?
END'
SIOEi
APPLIC
ADDRESS
.2 L-
CICOMMUNI VITATE/ P�r��A /
•CI�/COMMUNITY/STATE//ZIIP_
BOK PAG PRC C TWN •c' RNG " ' SE S
'Tii'AJT�� LOf� MOD SB
TRACT NAME
OWNER NAME (L: F. MI)
CONTRACTOR -FIRM NAME .• ,
ADDRESS -
CITY/COMMUNITY/STATE/ZIP - ..
PHONE,11/
ARC/ENG FIRM NAME'
ADDRESS
CITY/COMMUNITY/STATE/ZIP .. •.. '
PHONE N ' LICNC M -
USE OF PERMIT -
St. ' ZON - FS8 SSB Sob RSB .
' I
., ZONE ORD, w..,,i^ LOT
APPVPRMT" n
'717 OX
A VALUATION
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
10A
Fireplace T.O.
❑
NP'N.
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 t
22 Water Softener
23 Water Service
24 Gas Test
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
PSL PiI
STREET NAME'
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 - Service
32 Final