RPL (001207)77323 Calle Mazatlan
001207
PERMIT APPLICATION
cioty ;f La Ouinta
Department -Building and Safety
This permit becomes void it work not commenced within. 180 days from date
of,issuance..-OR: WWork has been suspended or abandoned. for a period of 180 days.
CITY/COMMUNITY/STATE/ZIP La. Qufb . rita, CA 92253
CERTIFICATE OF EXEMPTION FROM WORKERS',COMPENSATION INSURANCE: This section need not be completed it
LICENSED'CONTRACTORS DECLARATION: I hereby affirm -that I am licensed under provisions of Chapter 9
the,permil.is for one hundred ($100) It, less: I certify,that in the performance of the work for which this permit is
(commencing with Section 7000) of Division 3 of the Business and Professions'Code, and my license Win full force
issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of
and effect.
California.
•-License Class LicjNum er
'22't f
Date Applicantw
:nay
Date— Contractor
NOTICE TO APPLICANT: If, after. makingAhis Certificati6f Exemption, you should become subject to -the Workers'
w4f ILDER -DECLARATION: I he
0 hereby affirm that I In exempt froin'the Contractor's License.Law for the
Compensation provisions of the Labor. Code, you must forthwith comply with suc p royisionsorthis'permit-ShalI
p following' reason (Sec. 7031.5. 'Business and Professions Code: Any city or county which requiris-a permit to
be deemed revoked.
construct, alter,* improve. Aemi:ilish, of repair any structure, prior to its issuance. also requires the applicant for
DIVISION OF INDUSTRIAL SAFETY.PERMIT CERTIFICATION:
Such permit ' to file,a.signqd.statement that he is licensed pursuant to the provisions of.ithe Contractor's License Law-
0) hereby certify that no excavatio6five (5) or more feet in depth into which a p6rson is required to descend, will be
(Chapter -9 (commencing with section 7000)'of Division 3 of the Business and Professions Code)0 rihat he isexempt
made iri connection with work authorized by this permit, and that no -building structure, scaffolding, falsework. of
therefrom and the basis -for the alleged exemption. Any violatioh of Section 7031.5by any applicant for a permit
p
demolition or clismanlling'there6f, Will bimoire than thirty-six (36) feet high. (Chap 3.2. Grp Z Art 2, Sec341. TitleC'.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
c.A.c:) wn! tt f,
0 1, as owner,of lhe property, or my employees With wages as their sole compensation, will clothe work, and the
b 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 tor. sale (Sec. 7044. Business and Professions Code: The Contractor's License
Industrial Safety as noted above, unless such person has apermit 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 k,
LICNC 0
:1 through his own employees, provided that such improvements are not intended or offered for sale. If. however. the 0 Division of Industrial Safety Permit No..
*.building or improvemni.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 performa; c;
owner
01. as r 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
SSB
builds or*improves thereon, and who contracts -for such projects with'a contractor(s) licensed pursuant to the
Lendei'S Name
Contractor's License Law.).
Lender's Address—
1 0 1 am exempt under Sec. B. & P.C. (Attached Certificate).
I certify that I have read this application and state,that the above information is correct. I agrei to comply with all
Date wrier
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
TOTAL
FEE
of this county to enter upon the above mentioned property for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, ora
certificate of Workers' Compensation Insuranw, or a certified.copy thereof'(Sec. 3800. tab.,C.).
Policy No. Compady
Signature of Applicant or Agent. Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:9-ceitify [have read thisapplicationand stalethat.,
0 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 -
0 Certified copy is filed with t - he City Building Inspection Department or City Department.
constructidnand authorize`5 'representative of the City of La auinta Department of Building and Safety to enter.
on the property hich.1 have applied for,t is
permit forthi-purpose of making inspections:
Date' Applicant
`
Signature of Applicant or Agent R. Date
Print Applicant/Agent Name
i
t
APPLICANT NAME (L. F. MI) 0
Hamilt n;1 s
ADDRESS
P.O-.--BOX 1593
CITY/COMMUNITY/STATE/ZIP
Palm Deserts ''CA'92260
JOB SITE ADDRESSISOXCE7
Call e-
CITY/COMMUNITY/STATE/ZIP La. Qufb . rita, CA 92253
,!O,K31
PAGdV
C
TWN
RNG
SE
S
T14RACT496-
38.50
Elect. Fee
MOD
0 . lo
SO
TRACT NAME Santa ., Rosa Cove,
OWNER NAME (L. F. MI)
CONTRACTOR -FIRM NAME Appliciant'
ADD . RIESS above'*'
CITY/COMMUNITY/STATE/ZIP above
PHONE a 346-4804'
LICAF,9
.014451
ARC/ENG FIRM NAME
ADORESS
CITY/COMMUNITY/STATE/ZIP
PHONE 0
LICNC 0
USE OF PERMIT
Spa
BL'
ZON
FSB
SSB
SSB
RSB-
OFC. %
ZONE ORD#
LOT- SZ If
v,
p+
TOTAL
FEE
END
SIDE
APPUPRMT- ni 2nbATS
— 85 POOL'
Permit to -install
a 61
x. 88 spa
as per approved plans..,
'Plan Check Fee
.25.02
Const ..,Fee
38.50
Elect. Fee
5.;00
SMI Fee.
450
v,
p+
TOTAL
FEE
69`.02 •
-BLDWDEPT.i.-
IAL ATION 2,9010.00..,
U
rI
Ah
NO.
OPERATION TE
INSPECTOR
NO.
OP ATION 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
IDA
Fireplace T.O.
❑
NO.
NO.
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
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
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
PSL 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