RPL (001214)77313 Calle Mazatlan
001214
PERMIT APPLICATION
ADDRESS P.O., Box 1593.
City of La Quinta
JOB SITE ADDRESS/SPACE r
Department
of Building and Safety •
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25.0.2,
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.. -
Elect. Fee .••
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CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
L01.84
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-LICENSED CONTRACTORS DECLARATION: I -hereby affirm. that. l. 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 this permit is
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(commencing with Section 7000) of'Division 3 of the Business and -Professions Code, and my license is in full force.
issuedJ shall not employ any person in any.manner so as to become subject to the Workers'Compensation Laws'of
TRACT NAME
Santa -.-Rosa Cove,
and effect. 4;
California.
ADDRESS
ADDRESS
above
License Class Lic. Numb
'
Date Applicant
Date 11 -Y - qtzj -.1"y
Contractor. , . __ :=
NOTICE TO APPLICANT: If; after -making this Certificale*of Exemption, you:should become subject to the Workers'
ARC/ENG FIRM NAME
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt.from the Cohliactoj-'s License' Law forthe:
-Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
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-following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to
be.deemed re4oked.`
TOTAL
FEE
construct, alter,-improvi, demolish, or repair anyrstructure, prior to its issuance, also requires the applicant for
DIVISION. OF INDUSTRIAL SAFETY PERMIT CERTIFICXT(ON-,.'
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such permit to file a signed statement that heis licensed pursuant to the provisions of the Contractors License Law
0 1 hereby certify that no excavation five (5) or more feet in depth into which aiIerson is required to descend, will be
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,-(Chapter 9 (commencingwith section 7000) of Division 3 of the Business and Professions Code) orthat he is exempt .
-made in conhection withwork authorized by this permit and that no building structure, scaffolding. falsework,or
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therefrom and the basis for the all ege.4, exemption. Any violation of Section 7031.5 by any applican I for a -permit -
demolition opdismabtlinj thereof; will be more than thirty-six (36).feet high. (Chao 3.2. Grp 2, Art 2, Sec 341, Title fl:
subjects the applicant to a civil penalty of not more than..five hundred dollars ($500.):
C.A.C.)
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• 0 1, as -owner of the property, or -Ty employees with wages as their sole compe;salidn, will,do the work, and the
0 As owner -builder, I•will:not employ anyone to do.work which would require appermit from the Divisionof
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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 imp rcives-thereon, and who does such work himself or
.
0 Division of Industrial Safety Permit NOV';
through'his own employees, provided that such,4finproyements are no I intended oi .offered for sale. lf;however, the
building or improvernnt is sold within one year otcompletion; the owner -builder will have the burden of p!oving 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'
'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.,.3097, Civ. -C.).
7044, Business and Professions Code: The Contractor's License Law does not apply to an.owner of property -who"
lender" Na. m
builds or improves -thereon., and who.contracts for such projects with a contractor(s) licensed pursuant,to the
•Coniractor's. License Law.).<
Lender's Address
0 1 am exempt under Sec. B.4 P.C.0ttached Certificate).
I. certify that. I have read this application and state that the abo_ve.intormation .is correct. I agree to comply with all
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Date Ownei z
city and county ordinances andstale laws relating to building construction, and herebyauthoFize representatives
of this county to enter upon the abovernentioned.properly for inspection purposes..
WORKERS' COMPENSATION DECLARATION: I hereby.affirm that I have a certificate of consent to self, insure, ora
certificate of Workers'4CII mpensation, Insurance ; or a -certified copy thereof (Sec. 3800:. Lab. C!).
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Signature of Applicant or Agent Date
Policy No. Company.
..:.:CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF.ENTRY: I certify I have read this application and state that
0 Certified copy is hereby furnished.
given is correct. I agree to comply with all state laws and county ordinances relating to buidling .
0 Certified copy is filed with the City Building Inspection Deloartmint or City Departmenl ,
pristruc , and authorize a representativmL
, tion the City of La Ouinta Departmentof Building add Safety to enter
e, I '_ " I-tiave,applied] I& ihis permiffor the purpose of making. inspections.
uporfehepr ,erty, or which,
Date Applicant
'[p
Signature of Applicant or Agent Date -
Print Applicant/Agent Name
'APPLICANT NAME (L. F. MI) Hamilton's -
ADDRESS P.O., Box 1593.
CITY/COMMUNITY/STATE/ZIP Balm' Desert, CA 92253
JOB SITE ADDRESS/SPACE r
CITY/COMMUNITY/STATE/ZIP -La Quinta,-CA 92253
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25.0.2,
Const. - Bee -
38.50
Elect. Fee .••
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TRACT NAME
Santa -.-Rosa Cove,
OWNER NAME (L. F. MI)
A- licant-
CONTRACTOR -FIRM NAME, Applicant -
ADDRESS
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP above
PHONE 0346-48o4l-
1*1.193TI0445
I
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE N
LICNC #
TOTAL
FEE
USE OF PERMIT Spa..
61.
1
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FSB
SSS
SS,
ASB
OFC..
ZONE ORDS
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APPUPRMT n-ni 11. 4 2-0!1 E-85
'POOL
-Permit to install a 61
x 81. spa
'as per approved plans.
Plari Fee.
25.0.2,
Const. - Bee -
38.50
Elect. Fee .••
5.00
SMI Fee - -
.50,
TOTAL
FEE
69`0' 02
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BLDG. DEPT.
VALUATION
40
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Ah
NO.
OPERATION
INSPECTOR
NO.
OPE ION 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.
❑
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ADDITIONAL INFORMATION
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SEWAGE SYSTEM SIZE & LOCATION
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
PSL P)
STREET NAME
26 Power Pole
27 Conduit
'28 Service Entrance'
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final