001362 (RPL)' PERMIT APPLICATION.
t City of La Ouinta d
Department of Building.and Safety
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.
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COMPENSATION INSURANCE: This be if
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LICENSED CONTRACTORS DECLARATION: I hereby affirm, that I am licensed under provisions of>•Chapter 9
CERTIFICATE OF EXEMPTION FROM WORKERS' section need not completed
the permit is for one hundred ($100) o. 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 is infull force
issued. I shall not employ any, person in any manner so as to become subject to the. Workers'CompensationLaws of;
and effect. -nye f /� (
1`L•ic.
r California. '
Applicant
License Class Number.
Date • Contract 4 1 r � (,CA !/ �� �, /V J y
Date
NOTICE TO APPLICANT: If, after making this Certilicate�of,Exemption, you should become subject to the Workers:, . '•
�i — Contra -
-OWNER-BUILDER DECLARATION: I hereby affirm that I am exempt from the-Contractor'sLicense Law forth
Compensation provisions of the Labor Code; you must •orthwith comply with such provisions or.this permit shall
- '
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following reason (Sec. 7D31.5, -Business and Professions Code: Any city or county which requires a permit 11 ..
be deemed revoked.' -
construct, alter, improve, demolish; or repair any structure, prior to its issuance, also requires the apPlicantAr,_•,
DIVISION OF INDUSTRIAL SAFETY,PERMIT CERTIFICAT ON: .
such permit to file asigned statement that he isficensed pursuantto the provisions of the Contractor's License Law.
,Ohhereby certifythat noexcavation five (S)ormore fee in depth into which ape rsonisrequiredtodescend,willbe
' (Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) or.that he is exempt
made in connection with'Work authorized by this permi-, 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 thereof, will be more,than thirysix (38) feet high. (Chap 3.2• Grp 2, Art 2, Sec341, Title 8• '
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
C.A.C.)
.0 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the .
❑ As owner -builder, I will not employ anyone to do vork which would require a.permil from the Division of '
structure is not intended or offered for sale (Sec:.769, Business and Professions Code: The Contractor's License .
, ... Industrial Safety; as noted above, unless such person nas 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 improvementsare not intended or offered for sale. If, however, the
0 Division of Industrial Safety. Permit No.
building orimprovemntissold within one year ofcompletion. the owner -builder will have the burden.otproving that
Date Applicant.
he did not build or improve for the purpose, of sale.). -
r.. CONSTRUCTION LENDING AGENCY: I hereby affirm thalhere is a construction lending agency for the performance:
0 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,contractoc(s) licensed pursuant to the
-
Contractor's License Law.).
Lender's Address
0 1 am exempt under'Sec. B.,B P.C: (Attached Certificate).
l certify that I have read this applicationand state that the above information, is correct. l agree to comply with all
Date Owner '
city and county ordinances and state laws relating to br ilding construction, and hereby authorize representatives
-
of this County to'enter'upon the above mentioned projerty for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, ora
certificate of'Workers' Compensation Insurance ,-or a certified copy thereof (Sec.,3800. Lab. C:)•; .
Signature of Applicant or Agent/ Date
Policy No.. Company
I
CERTIFICATE gF COMPLIANCE AND AUTHORIZATION OFIENTW I certify.) have read this application and state that
m0 Certified copy is hereby furnished.
the, information given is collect. I agree to comply witt*all tate laws and county ordinances relating to buidling A .
� '
.0 Certified copy is filed with,the City Building Inspettion.Department.or City, Department. •;:
,.
�:•,-construction, and authorize a repreSentative!of the City of la Ouinta Department of Building and Safety to enter
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upon the property forwhichwhich II have applfed far this'pe: niitt'for the purpose of making inspections. • r J .. t
Date .. Applicant.
,
�� \ K✓i " j ��� s b% . �tii 3' 1
Stgnature•of.Applicant or Agent 1 J Date
Print Applicant/Agent Name
APPLICANT NAME (L. F. MI)
{YM 1
_>
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111 .
CITY/COMMUNITY/STATE/ZIP .
Palm Desert, CA 92260
JOB SITE ADDRESS/SPACE » 53-470 -Avetuda �, i
CITY/COMMUNITY/STATE/ZIP.
fa QAainta, CA 92253
BOK .PAG PRC .0 TWN RNG ,,,- SE •S
TRACT LOT MOD SB • _ ` "� •.' C
4,•
TRACT NAME w
OWNER NAME (L. F. MI)
CONTRACTOR -FIRM NAME
' Applicalnt
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP • ,
_ above
PHONE •.• R'' - l LICNC
ARC/E{N-G-FIRM:NAME
\.
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ADDRESS
CITY/COMMUNITY/STATE/ZIP -
PHONE 1 LICNC M
USE OF PERMIT
Po6i ol
BL ZON FSB SSB_ TSSS RSB OFC
ZONE ORD.#. ♦ LOT SZ .V. ' ;.R. END SIDE
APPVPRMT
� � -���
5•-2-85 POQL
Permit to install one pool as. per approved
plans.
Mech. Free 17.50
r
Plan Check Flee 56.22
Const. Fee 86.50
Elect. Free 14.00,-.
SMI Free • 74
Plumbing Fee 18.00
INbESTIGATIM FEE
NO WORK IS TO BUM IILTT L PEAL'S' -
OB�A72=. M NOr E Mr-ahaN DXGG04
WI2�� PRIOR APPR;, it : '' ' V `•~
\: rr, fir=
-- TOTAL
FEE •
!A'0-8 8 5 . _ 5. 1
BLDG. DEPT.
1*� k
VALUATION ,459.00
r
40
APPVPRMT
� � -���
5•-2-85 POQL
Permit to install one pool as. per approved
plans.
Mech. Free 17.50
r
Plan Check Flee 56.22
Const. Fee 86.50
Elect. Free 14.00,-.
SMI Free • 74
Plumbing Fee 18.00
INbESTIGATIM FEE
NO WORK IS TO BUM IILTT L PEAL'S' -
OB�A72=. M NOr E Mr-ahaN DXGG04
WI2�� PRIOR APPR;, it : '' ' V `•~
\: rr, fir=
-- TOTAL
FEE •
!A'0-8 8 5 . _ 5. 1
BLDG. DEPT.
1*� k
VALUATION ,459.00
r
40
!A'0-8 8 5 . _ 5. 1
BLDG. DEPT.
1*� k
VALUATION ,459.00
r
40
NO.
OPERATION DATE INSPECTOR
NO. OPERATION 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.
❑
NOADDITIONAL INFORMATION
1
-
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 r '
_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
25Final
.
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
PSL P/l
STREET NAME
26 Power Pole
27 Conduit
.28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding {
30 Fixtures
31 Service
32 Final
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ORDER NO. A27590
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