RPL (001202)77333 Calle Mazatlan
001202
j f , PERMIT APPLICATION
City of
Department of
La Ouinla
Building and Safety
JOB SITE ADDRESS/SPACE 1•/,.. '
CITY/COMMUNITY/STATE/ZIP/ La Ninta,• °CA 92253V
of issuance. OR, if work has been suspended or abandoned for a period of 180 days:.•
• „y . This permit becomes'void if work not commenced within 180 days fro m'd 1 e:
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' CERTIFICATE OF EXEMPTION FROM;WORKERS' COMPENSATION INSURANCE:'This section need not be completed if' "'.,•
• LICENSED CONTRACTORS DECLARATION: l:hereby affirm that I am licensed under provisions.of. Chapter 9... ;;•"
ithe permit is tor. one hundred ($100) or less: I certify that in the.performance of the work for which this permit is, , •:.:
(commencing with Sectiom7000) of Division 3 of the Business and Professions Code. -and my license is in -full force' • ,
issued, l shall not employ any person in any manner•so as to become subject to the.Workers'Compensation Laws of. ,•
and effect.
!
California.
License Class LictNNumber r '`'—•
• Date Applicant
'Date
. - • Contractor ..
, NOTICEJO,APPLICANT: If, after making.this Certificati of Exemption, you should become subject to,the Workers:
+
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• OWNER -BUILDER DECLARATION: I hereby affirm that lam exempt from the,Contractor's License Law forthe
1 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 permkt lofile a signed statement that he is licensed pursuant.to the provisions of the Cbrilra.ctor's License Law,...
;'•O 1herebycertifythatnoexcavationfWe(5)ormorefeetindepthintowhichapersonisrequiredtodescend;willbe "
--(Chapter 9(commencing with section 7000) of Division 3 of the Business and Professions Code)or that he is exempt'.. ,
inade_in connection with work' authorized by this 'permit; and that no building structure, scaffolding, falsework, or
therefrom and the basis for the allege0 exemption. Any violation of Section 7031.5 by any applicant for a permit
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec341, Title B,`
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
'.PHONE 0-
O I: as owner of the property, or my employees with wages as their sole compensation, will.do the work, and the
O'As owner -builder, I will not employ anyone to do work which would require a permit from the Division bf
_.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? .
V Law does not apply to an owner of.property who builds, or improves thereon, and who does such.work himself or.
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•.. through his own:employees, provided that such improvements are not intended:or;offered for sale: If, however; the
O Division of Industrial, Safety Permit No.
.-buildingorimprovemntissoldwithinone.yearotcompletion.,the owner -builder will have the burden of proving that
Date' Applicant
he did not build. or improve,for the purpose of sale.). a
r
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance'
;O I, 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's Name
builds or improves thereon,'and who contracts for such projects with a contractor(s) licensed pursuant to.the
,LOT SZ .•
......Contractor's License Law.).
Lender's Address -
O 1 am exempt underSec. B. B.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
DateOG ner
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 I have a certificate.of consent to self -insure, ora,,:.-
ra•.:••certificate
certificateof Workers' Compensation Insurance ,.or. a certified copy thereof (Sec. 3800. Lab. C.).
>.
s • Signature of Applicant'or Agent :. .. ' Date
Policy No,Company
CERTIFICATEOF COMPLIANCE AND AUTHORIZATION OF ENTRY:. I certify I have read this application and state that .
,❑ Certified copy is hereby furnished
the informatio i-givenlis correct. I agree to comply.with all state laws and county ordinances relating lo.buidling • . J
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O Certified copy is filed with the City Building Inspection Department or City •
construction and auihoNe a'representatiive_of the City of La Ouinta Department of Building and Safety.to enter
;Department.
'-
— u on the' property for wWW,have ap'lied for this permit for the purpose of making inspections K
Date Applicant
1 l vt i i l/• • N%1
'
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPLICANT. NAME -(L; F; MI) Hamilton' s - -
AooaEss t _ p O , Box 15 9 3'
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CITY/COMMUNITY/STATE/ZIP" Panni 'DeSert',•'CA 922610
JOB SITE ADDRESS/SPACE 1•/,.. '
CITY/COMMUNITY/STATE/ZIP/ La Ninta,• °CA 92253V
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LOT 184,
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TRACT NAMESanta Rosa Cove
OWNER NAME (L, F. MI).
CONTRACTOR -FIRM NAME- . .
Applicant-.
ADDRESS above
CITY/COMMUNITY/STATE/ZIP abOVe -
PHONE II 34&-49041'
1 lc211445
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ARC/ENG FIRM NAME _- .. .. ..
ADDRESS ..
CITY/COMMUNITY/STATE/ZIP -
'.PHONE 0-
I LICNC 111' •
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USE OF PERMIT - Spa -
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• ZONE ORD 0, ,.;.
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END
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APPL/PRMT - '• • 21T —8 5 POOL '
Permit to install`•a' 6ft by- 8f
- spa as per approved plans.
Plan Check Fee 25:02
Const. Fee 38:50.
Elect. Fee `5.00,
SMI Fee .50.
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? VALUATION 2., 90.00. `I
BLDG. DEPT. , ,_ ' .x • , `:. < . f
Alk
Ah
NO.
OPERATION Dir
INSPECTOR
NO.
OPER3; I 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.
❑
NON
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)
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final