RPL (001215)77293 Calle Mazatlan
001215
ADDRESS • • SOX 1-593
3
PERMIT APPLICATION r "
s City of La Ownta
/ Department of Building and Safety
CA 72--
CITY/COMMUNITY/STATE/ZIP La •Quintal 7225Y3
W3
• 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: :
81 -spa
_
•
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE:: This section need not be completed it A
T
LICENSED CONTRACTORS DECLARATION: hereby affirm that 1 am licensed under provisions of Chapter 9
the permit is for one hundred ($100) o, less. I certify that in the perfofmance of the work for which this permit is
- (commencing with Section 7000) of Division 3 o1 the Business and Professions Code *and my license is intuit force
issued: I shall not employ any. person in any manner so,as to become subject to the Workers' Compensation Laws of 'q
and effect.
California. V
License Class Lica-Number ! "• -
Date Applicant J
-• 'Date ' - Contractor ' ' { )
NOTICE TO APPLICANT::. If, aftenmaking this Certificate of Exemption, should become to the Workers' '
OWNER NAME (L. F. MI)
you subject
OWNER -BUILDER DECLARATION: I heieby, Mfirm tha14 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
be deemed
following reason (Sec. 7031.5. Business andProfessions Code: Any city or county which requires,a permit to • .
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 to file a signed statement that he is licensed pursuant to the provis ions of the Contractor's License Law -
&I - herebycertify that no excavation five (5) or more feet in depth into which a person is required -to descend; will be "
(Chapter 9 (commencing with section 7000) of Division 9 of the Business and Professions Code) or that he is exempt ,
' alleged -violation
'made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework-of
'demolition
. ,therefrom and the basis for the exemption. Any of Section 7031.5 byany applicant fora permit
or dismantling thereof: will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2• Art 2; Sec341, TitfeB,
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
C.A.C.)'
.O 1. as owner: of the property, or'my employees with wages as their sole compensation, will do the work,. and the:.
O As owner -builder. 1 will not employ anyone to do work which would require' a permit from the Division of y
' structure is not intended or offered for sale (Sec. 7044, Business and Professions Coder 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
SSB
through his own employees, provided that such improvements are not intended or offered for sale..lf, however, the
O•Division of Industrial Safety Permit No;
buildingorimproverrint is sold within one year of completion. the owner -builder will have the burden of proving 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
O I, as owner o1 the.property, am exculsively contracting with licensed contractors to construct the project (Sec. ,
Professions The Law does
of the work for which this permit is issued' (Sec. 3097; Civ: C.). ?
7044. Business and Code: Contractor's License not apply to an owner of property who; ..
Lenders Name
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
.SIDE
Contractor's License Law.).
Lender's Address
' O I am exempt under Sec:B: 8 P.C. (Attached Certificate);
I certify that I have read this application and state that the above information.is correct. I agree to comply with all •?t
' Date Owner
'." ' -' '
city and county ordinances and state laws relating to building construction; and hereby authorize representatives
of this county to enter upon theabove=mentioned property for inspection purposes. y.
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., Lab. C.).
Signature of Applicant or Agent Date }+.'
Policy No. Company
y..
'CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify l have read this application and state that <
O Certified copy is hereby furnished. r
the information given is correct. I agree to comply,with all state laws and county ordinances relating to buidling
O Certified copy is'filed with'the City Building Inspection Department or City Department. _
'
constructionsand authorize-a'representative of the City of La Ouinta Department of Building and Safety to enter
upon thegropertyp r. which IQ av 'applied for this permit for the purpose of making inspections.
Date Applicant
{t (,:r'✓. *
Signature of Applicant or,Agent Date
APPLICANT NAME (L. F. MI) Hamilton -I s
ADDRESS • • SOX 1-593
3
CITY/COMMUNITY/STATE/ZIP palm "Desert, CA 92253
JOB SITE ADDRESS/ PA'U
A I
CA 72--
CITY/COMMUNITY/STATE/ZIP La •Quintal 7225Y3
W3
SC/V
VCY4)C•
81 -spa
_
TWN
PING
SE'
S
JRaCJj 96—
L0186
C
MOD
SB
TRACT NAME Santa Rosa Cove '
OWNER NAME (L. F. MI)
CONTRACTOR -FIRM NAME Applicant -
ADDRESS above
CITY/COMMUNITY/STATE/ZIP above
iJ,
PHONE 0346-48041
38.50
LIU2*0445
Fee
ARC/ENG FIRM NAME '
ADDRESS -
CITY/COMMUNITY/STATE/ZIP •^
PHONE N
LICNC 0
USE OF PERMIT .. '
Spa
BL
ZON
•. FS8
SSB
SSB
RSB
OFC
ZONE ORD.• •;
LOT SZ,.
- END ..
.SIDE
Print Applicant/Agent Name
APPL/PRMT
nol 211S
2DA{@-8
- - POOL
Permit
to install
a 6' x
81 -spa
as per
approved
p
ons,
Plan Check .Fee
25.02 '
Coast.
Fee.,
38.50
Elect.
Fee
5:00
SMI Fee
650.
A
TOTAL'
FEE
•
•
69.02
BLDG. DEPT. VALUATION .2 i 900 • 00: - •
i Ali
NO.
OPERATION DA-, E
INSPECTOR
NO.
0PE13>.1 ON 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 R
Value
7A Walls (Batts)
128 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