0857 (COMB)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'suspended or abandoned for a period of 180 days.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that 1 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.
1 License Class Lic. Number
Date Contractor. -�u�� r uT • "r..
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 Contractors 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 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 1, as owner of the property, or.my employees with wages as their sole compensation, will clothe 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 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.).
0 I, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec. .
7D44. 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 contractor(s) licensed pursuant to the
Contractor's License Law.). _
0 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'ot Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab: C.).
Policy No. Company
0 Certified copy is hereby furnished.
y0 Certified copy is filed with the City Building Inspection Department or'City Department.'
Date..Applicant • Yi'(: ,Jr•G 't fir
APPLICANT NAME (L, F, MltPtwslev Te=Us 4.1..►{a:6100 .'; s w
ADDRESS 74-533 Pepper Tree .
CITY/COMMUNITY/STATE/ZIP '
Palm Desert, (M 92260
JOB SITE ADDRESS/SPACE
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OWNER NAME (L. F. MI)
CONTRACTOR -FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE •341-3493
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ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP '
PHONE • I I
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USE OF PERMIT '
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END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be'completed it
the permit is for one hundred ($100) It, less. l certify that in the performance of the work for which this permit is
issued, I shall not employ any person i n any manner so as to become subject to the Workers' Compensation 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 PERMIT CERTIFICATION:
❑ -I hereby certify that ho excavation t'ive (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 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, Sec341, Title8.
C.A.C.) -
❑ As owner -builder, I'&ill 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 peiinit to do such work from that division.
❑ Divjsion 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. 3097, Civ. C:).
Lender's Name
Lender's Address
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above mentioned property for inspection purposes.
Signature of Applicant oTAgent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify l have read this application and statethat
the information given is correct. I agree to comply with 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 : ! Date
Print Applicant/Agent Name 4i
APPL/PRMT w JII R S T `r-TY7-84 Comb.
Pe-23it to install 16 light stwrlards
and approx. 480 lineal ft of 10' high
chain link fence for termis courts as
per approved plans 9 cable,
ordinances,"'
P
R' Elec. 12.00
�Ldg. 62.50
aup .50
�I 75.00
G APB
C`
NOSY TOTAL
FEE
75.00
Y
VALUATION
BLDG. DEFT.
NO.
OPERATION
DATE
INSPECTOR
NO.
OPERATION,
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL'APPROVALS'
11, '
; Set Back
33 '
V,entilationSystem
2
Ftgs &• Frms
34
Plenums &Ducts
2A •
Slab. Grade
35
Furnace Compart.
3
Steel-
36
Inlets & Outlets'. '
4
Grout Blocks
37
Combustion Air
51.
Bond Beams
38
. ,Compressor
6
Root 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. ❑
OPIN 'ADDITIONAL .INFORMATION-
N
r
1,c2 7y.: • ` /
- -
_._.-.
~
SEWAGE.SYST,.EM SIZE:& LOCATION .,
11
Exterior Lath
12
Internal Lath
12A,
Drywall
13" ,
• • Finish_ Grade.
INSULATION
Thick ;
Vaaluelue
.
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
ELECTRIG'APPROVALS,
REAR OF PROPERTY, -LINE
-
'
P/L
,
STREET NAME
26
Power Pole
27
Conduit
28'
Service Entrance
29
Wiring
29A
Grounding Wire
296
Bonding.
30.'
fixtures
31
Service
,, }
32
Final
"