RPL (001216)77263 Calle Mazatlan
001216
PERMIT APPLICATION
_ ' c City of La Og a
r Department of Building and Safety i
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.
7L
CITY/COMMUNITY/STATE/ZIPPalm Desert# CA 92253
CERTIFICATE OF, EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: Shis section need not be completed if ^
LICENSED CONTRACTORS DECLARATION:' I .hereby affirm that I am licensed under provisions of Chapter 9
the permit is for one hundred ($100) o., less. I certify that in the performance of the work for which thiVpermit is
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force '
issued. I shall not.employ any person in any manner so as to become subject -to the Workers'CompensationLaws of
and effect. - /11
`
California. .. ^
License Class. Lic..•Number % ---
Date Applicant
• Date - - -Contractor.
of Exemptionou should. become,subject.to the Workers',
NOTICE TO APPLICANT: If, after making this Certificate „ y
' w
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the • .
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall _
following -reason (Sec. 7031.5. Business and Professions Code: Any city or 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 tofileasigned statementthat heislicensedpursuanttothe provisions ofthe Contractor'sLicense Law -
01hereby'certifythat noexcavation five (5)'ormoiefeet indepth into whithaperson isrequired todescend, will be ..
(Chapter 9 (commencing with section MOD) o1 Division 3 of the Business and ProfessionsCode)or that he isexempt ..
made in connection with'work authorized 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 :-...,
demolition or dismantling theieot will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2; Sec 341, Title 8,
subjects the applicant to a civil penally of.not more than five hundred dollars ($500.):C.A.C.)
.0 1.. as owner of the property, or my.employees with wages as their sole compensation, will do themork: and the ,
0'As owner -builder, I .will not employ anyone 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 a 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 that such improvements are not intended or offered for safe. If. however, the
❑Division of Indosl ial Safety Permit No
building orimprovemntissold within oneyearofcompletion, theowner-builder will havelheburden ofproving.that
Date Applicant
he did not build or improve for the purpose of sale.).
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
Las 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. 3097, Civ. C.).
7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
Lender's Name
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed' pursuant to the
RSB '
Contractor's License Law.).
Lender's Address
❑ 1 am exempt under Sec. B. 8 P.C. (Attached.C.ertificate).
I certify that I have read this application and state that the above information is correct. I agree to comply with all
Date Owner
'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.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that have a certificate of consent to self -insure, or a
SIDE
certificate of Workers' 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 OF ENTRY:.I certify I have read this application and statethat-
❑ Certified copy .is hereby furnished.
the information given is correct. I agree to comply with 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,City of LaOuinta Department of Building and,Safety to enter
uponcthe propertyrfoiwhich,l.have applied,forthis permit for. the purpose of making inspections.
Date Applicant
/-!/ .''f. J{/%.'! + r • .
'
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPLICANT NAME (L, F. MI) Hamilton's '
ADDRESS ' P.O. Bok 1593
.n
7L
CITY/COMMUNITY/STATE/ZIPPalm Desert# CA 92253
JOB SITE ADDRESS/SP_CE
CITY/COMMUNITY/STATE/ZIP La Quinta , CA 92253''
1L
86K
P',.i/
PiRC
r f
C
TWN
PINGSE
S
i.A'CT496—.1L
L9718,9
38'.50
Elect. Fee
MOD
SB
SMI Fee
TRACT NAME ' Santa ' Rosa Cove
OWNER. NAME (L. F. MI) - .. ..
CONTRACTOR -FIRM NAME Applicant .
ADDRESS above
CITY/COMMUNITY/STATE/ZIP above
PHONE A 346-48`0
LICN 0
5 ,
ARC/ENG FIRM NAME - - - -
ADDRESS - -
CITY/COMMUNITY/STATE/ZIP -
PHONE N
LICNC .
...
USE OF PERMIT Spa .
SL
ZON
: FSB
Sse
SSB
RSB '
OFC
ZONE ORD N
LOT SZ
- -
END
SIDE
APPVPRMT ■iw,` _
• ER
"015:O.i
POOL '
-Permit to install
a 6' x
8' spa
as per approved plans.
-'Plan? Check 'Fee•
25.02
Cosnt. Fee
38'.50
Elect. Fee
5.00
SMI Fee
.50
TOTAL
FEE
6 9.0 2
. esu
BLDG. DEPT. -• VALUATION
Ak
rl
NO.
OPERATION TE
INSPECTOR
NO.
OP ,, TION 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.
❑
NPON
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick Value
7R 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
P/L P/I
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final