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0595 (RPL)N LICANJ�,NAME [L�F, 41) ADDRESS �5 0- CITY//COMMUNITY/STATE/ZIP _T;.1J 10/ 0 A JOB'S TE DORESSISPACE CITYICOMMUNITY/STATFdilP 1,4 ll!/�AIJIA 40_ 4 e19 LIE' BOK PAG P RC- TWN-- FING SE. S TRACT MOD sa TRACT NAME OWNER NAME (L. F. MI) CONTRACTWOFIRM NA - ME 6. /m ADDRESS CITY/COMMUNITY/STATE/ZIP PHONE# I'LICNC N ARC/ENG FIRM NAME ADDRESS CITY/COMMUNITY/STATE/ZIP PHONE# LICNC # USE OF PERMIT ZON FS SSB SSB RSB OFC ZONE ORD LOT SZ:%NO APPUPRMT e - A e'5, Q TOTAL - -FEE VALUATION10 BLDG. DEPT... 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.susperided or'abandoned for a period of, 180 days. CE41FICAT'E OF. EXEMPTION FROM WORKERS' COMPEtSATION INSURANCE: This section need not be completed if 'LICENSED CONTRACTORS DECLARATION: I'hereby affirm that I am licensed•under provisions of Chapter 9 tthe,permit'istor one hundred ($100).o, lessA certify tiat in theperformance of the work for which this permit is (commencing with Section 7000) ofiDivision 3of the Business and Professions Code; and my license' in full force issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of and effect. California. :% License Class". LjIN2s Number P�414 my I Date Applicant ... . Dal Cont ractoi ..;�i,,NOTICEJO APPLICANT: If, after making this Certifican'of Exemption, you should become subject to the Workers" ,OWNER -BUILDER DECLARATION: I hereby affirm that'l am exempt from the Contractor's License Law for the T'. Compensation provisions of the Labor Code, you mus: forthwith comply with such provisions or this permit shall be deemed revoked. 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 DIVISION,OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:.- such , permit to file a:signed,statement that he is licensed pursuant to the provisions of the Contractor's License Law- 8 1 hereby certify that no excavati6.five (5)'or more fiiefin deplhintii.which arpirson is req6ired fo &scend,w'ill be '(Chapter. 9 (cornkmencing with section 7000) of Division 3 of the Business and Professions Code) or that heis exempt madeeiii,cohrictiori with work auth6rized by this pernfdand tfiatn - o building *structure, scaffolcliiig; falsework: or • therefrom and the basis for the alleged exemption. Any violation of Section 7031,5 bywy applicant for, a permit''_.;e ,Amolitionoidisniahtling th' riof. will be more than trirly-six (36) feet high. (Chap 3.2. Grp Z Art 2. Sec341.TitIi8.-1 subjects the applicant to 'a civil,penalty of not more than five hundred dollars ($500.);,' 0 L as..ow.ner-ol.the property; 9r.my employees with wages as their sole compensation, will do the work; and the' 0 As owner-builder;I will not employ to do work which would require a permit from the Division of 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 permit to do such work from that division.' 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 thals6ch improvements are not intended or offered for sale. If,.howeverAhe-- .0 Division of Industrial. Safety_ Permit No. ,building or improvemnt is.sold within oneyear.of completion; the ownerbuilder will havethe burden of proving that Date Applicant he did not build or improve for the purpose�of sale.). •. I . . .• � � .� . .� ". — Z., ! I CONSTRUCTION LENDING AGENCY "I' hereby, affirm thit there is a construction lend irig agency for the performance -.0 1, 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 an owner of property who ...... Lender's Name -builos'or improves thereon, and who'contracts, for.tuch- projects with a comractor(s) licensed pursuant to the - Contractor's License Law.). I . I . Lender's Address 0 1 am exempt 'under Sec. B. & P.C. (Attached Certificate): • I cerlify.lhatA have read this application and state th;.t the above information is correct. I agree to comply with all I : Owner city and county ordinances and stale laws relating toluilding'construction, and hereby authorize representatives I .Date of this county to enter upon the above-mentioned property for inspection p6rposes, WORKERS' COMPENSATION DECLARATION: 1 hereby affirm that I have a certificate of consent to self -insure, ora certificate of Workers' CompensationAnsurance,, or a certified copy'thereof (Sec. 3800. Lab. C.). Sig4atureotAppli6anto'rAgent • (Date Policy -No. Company. CERTIFICATE OF COMPLIANCE AND AUTHORIZATION IF ENTRY: 'l certify lhave read this application and state that • 0. Certified copy is hereby furnished.. the information given is correct. I agree to comply %ith all state laws and county ordinances relating to buidling, ❑ Cerilified'copy is filed - with the City Bu . it . ding. Inspection De , piirlment or City: - construction, and -authorize a 'representative of*lhe ',ity of.La Quinta Department of Building and Safety to enter. - Date Applicant .,. ., ... . . . �. t . I . Applicant upon the properlyf6r'�which I have applied for this 3ermit for the purpose of making inspections. Signature of Applicant or Agent Date Print Applicant/Agent Name N LICANJ�,NAME [L�F, 41) ADDRESS �5 0- CITY//COMMUNITY/STATE/ZIP _T;.1J 10/ 0 A JOB'S TE DORESSISPACE CITYICOMMUNITY/STATFdilP 1,4 ll!/�AIJIA 40_ 4 e19 LIE' BOK PAG P RC- TWN-- FING SE. S TRACT MOD sa TRACT NAME OWNER NAME (L. F. MI) CONTRACTWOFIRM NA - ME 6. /m ADDRESS CITY/COMMUNITY/STATE/ZIP PHONE# I'LICNC N ARC/ENG FIRM NAME ADDRESS CITY/COMMUNITY/STATE/ZIP PHONE# LICNC # USE OF PERMIT ZON FS SSB SSB RSB OFC ZONE ORD LOT SZ:%NO APPUPRMT e - A e'5, Q TOTAL - -FEE VALUATION10 BLDG. DEPT... SIDE - N LICANJ�,NAME [L�F, 41) ADDRESS �5 0- CITY//COMMUNITY/STATE/ZIP _T;.1J 10/ 0 A JOB'S TE DORESSISPACE CITYICOMMUNITY/STATFdilP 1,4 ll!/�AIJIA 40_ 4 e19 LIE' BOK PAG P RC- TWN-- FING SE. S TRACT MOD sa TRACT NAME OWNER NAME (L. F. MI) CONTRACTWOFIRM NA - ME 6. /m ADDRESS CITY/COMMUNITY/STATE/ZIP PHONE# I'LICNC N ARC/ENG FIRM NAME ADDRESS CITY/COMMUNITY/STATE/ZIP PHONE# LICNC # USE OF PERMIT ZON FS SSB SSB RSB OFC ZONE ORD LOT SZ:%NO APPUPRMT e - A e'5, Q TOTAL - -FEE VALUATION10 BLDG. DEPT... -• t 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. ❑ OP'N ADDITIONAL INFORMATION NO. !� r/2 �,4 o ]� 4� C`S�`�` SEWAGE SYSTEM SIZE & LOCATION C;- 11 Exterior Lath 12 Internal Lath 12A Drywall 13 Finish Grade INSULATION Thick R Value 7A Walls (Batts) 126 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/L STREET NAME P/I 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service 32 Final Q