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0162 (SFD)PERMIT APPLICATION City of La Duinta 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 for 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 Professiohs 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 from the Contractor'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 Cod:) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500.): 0 I, as owner of the property, 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 forsale. If, however, the building or improvemnt 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 property, am 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 builps 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. Date Owner B. 8 P.C. (Attached Certificate). 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. Lat. C.). .Policy No. Company Certified copy is hereby furnished. ❑ Certified c py isaliled with,the City Building Inspection Dep tmenvor t�z'Y 0 Department. Date Applicant 1 7 1 APPLICANT NAME (L, F. MI) o �,;uintia 3,oint venture ADDRESS ,0.0. Don 700 CITY/COMMUNITY/STATE/ZIP ?._a J,,Adntra y Ca 92233 JOB SITE ADDRESS/SPACE 56`"x..1 Avonida Vista PoB ita CITY/COMMUNITY/STATE/ZIP -..a �_)ulntii , Ca 92253 BOK PAG PRC C :10ch. Fee _ TWN RN G SE S 'J�5G—:, LOT 110.50 Building Fee 13-1 se 450.00 TRACT NAME - �� n�:4u A'o0ta Cavo OWNER NAME (L. F. MI) CONTRACTOR -FIRM NAME Et,rlucan L.J7�QAtian ADDRESS ^ t�".CJ. Boli 8 CITY/COMMUNITY/STATE/ZIP ,U,t1iu:UIMa,LZ PHONE N Y3-5 -131.5 LICNC-N NC 7 ARC/ENG FIRM NAME ADDRESS CITY/COMMUNITY/STATE/ZIP PHONE M t LICNC N USEOF PERMIT O ingle 7 amily Dwalling BL ZON FSB SSB SSB RSB OFC ZONE ORD N LOT SZ END SIDE CERTIFICATE OF EXEMPTION FROM WOF<ERS' COMPENSATION INSURANCE: This section need not be completed if the permit is for one hundred ($100) o, ess. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in: ny manner so as to become subject to the Workers' Co mpensation Laws of California. Date Applicant NOTICE TO APPLICANT: It after making this Certificate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. DIVISION OF INDUSTRIAL SAFETY PERM T CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) oi moie feet in depth into which a person is required to descend, will be made in connection with work authorize 1 by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8, C.A.C.) ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from that division. 0 Division of Industrial Safety Permit Nb. 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 issLed (Sec. 3097, Civ. C.). Lender's Name Lender's Address _ I certify that I have read this application : nd state that the above information is correct. I agree to comply with all city and county ordinances and state law: relating to building construction, and hereby authorize representatives of this county to enter upon the above mentioned property for inspection purposes. Signature of Applicant or Agent Date CERTIFICATE OF COMPLIANCE AND AUTHRIZATION OF ENTRY: I certify I have read this application and state that the information given is correct. l agree t - comply with all state laws and county ordinances relating to buidling construction, and authorize'�a representa dve of the City of La Ouinta Department of Building and Safety to enter upon the property for which I. have a'ppljcd forthis permit for the purpose of Aaking inspections ; �+fd 'Sj6nature4i Applicantror Agenf � Date Print Applicant/Agent Name �e APPL/PRMT "`�'r} ti DATE> Porrilt to comtruct ,�Rodol ttiollin �,%rago 423 sq, Ft. ?C�ti© cover 112 �q. Ft. :10ch. Fee _ $ 31..00 Electrical. F00 32.25 Plumbing i NO. OPERATION DATE MECHANICAL APPROVALS BUILDING APPROVALS 1 Set Back 35 Furnace Compart. 2 Ftgs & Frms 37 Combustion Air 2A Slab Grade 39 Appl. Clearance 3 Steel 41 Smoke Detection Device 4 Grout Blocks 43 Final 5 Bond Beams 6 Roof Deck 7 Framing �p 8 Vents 9 Garage Fire Wall 10 Fireplace P. L. ❑ 10A fireplace T.O. ❑ 11 Exterior Lath /0 12 Internal Lath 12A Drywall 13 Finish Grade INSULATION Thick R" Value 7A 12B Walls (Batts) 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 3 25 Final INSPECTOR NO. OPERATION DATE INSPECTOR MECHANICAL APPROVALS 33 Ventilation System 34 Plenums & Ducts 35 Furnace Compart. 36 Inlets & Outlets 37 Combustion Air 38 Compressor 39 Appl. Clearance 40 Fire Damper 41 Smoke Detection Device 42 Commercial Hood 43 Final OADDITIONAL INFORMATION NOO.. 17 ELECTRIC APPROVALS I 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 29B Bonding " 30 Fixtures 31 Service 32 Final SEWAGE SYSTEM SIZE & LOCATION Tank Pit L. Line STREET NAME REAR OF PROPERTY LINE