000943 (RPL)'LICENSED CONTRACTORS DECLARATI
(commencing with Section 7000) of Divi
and effect.
License Class . Lic. Number
Date. ' Contractor '
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the
following reason, (Sec. '7031.5. Business and Professions Code: Any city or county which requires a permit to
construct. alter, -improve: demolish, or repair any structure; prior to its issuance• also requires the applicant for
such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law"
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) or -that he is exempt
r therefrom and the basis for the alleged, exemption. Any violation of Section 7031.5 byany.applicant for.a permit
subjects the applicant'to a civil penalty of not more than five hundred dollars ($500.):
� I. as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
esir cture is not.intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License
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 improvements are not intended or'offered for sale: If, however, the
building or improvemnt is sold within one year of.completion, the owner -builder will have the burden of proving that
he did not build or.improve for the purpose of sale.). ,
0 I, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec.
7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.). .
0 1 am exempt under Sec. B..B P.C. (Attached Certificate).
Date Owner
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 thereat (Sec: 3800. Lab: C.).
Policy No.. Company .
0 Certified -copy is hereby furnished. -
0 Certified copy is filed with the City Building' Inspection Department or City Department.
Date Applicant
PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
6'b -ode'(-
This permit becomes void it work not commenced within 180 days from date of issuance. OR, if work has been suspended or abandoned for ieriod of 180 days.
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSA-ION INSURANCE: This section need notbe completed if
ON: Ihereby affirm that I am licensed• under provisions of Chapter. 9 the permit is for one hundred ($100) o, less. I certify that n the performance of the work for which this permit is
sion Sof the Business and Professions Code, and my license is in full force issued, I shall not employ any person in anymannerso as t, become subject to the Workers'Compensation laws of
California.
APPLICANT NAME (L, F. MI) '
ADDRESS
1001 Dove Street # 140
CITY/COMMUNITY/STATE/ZIP
NewWrt Beach, CA 92660 •
JOB SITE ADDRESS/SPACE 7-
CITY/COMMUNITY/STATE/ZIP
T� f11nir*,q _ rA -S1
'9
831
114469-1
PAG
%����vv''
99
�V6
C'
TWN
RNG
SE
S
TRACT
LOT
1461.
5.00
SNB fee
MOD
SB
8.00
TRACT NAME Sant Iy��,� oM -
l.Ci iVJ�.Gi owe
OWNER NAME (L, F. MI) '
wftl-k",Tw A3 '4y7.:3T1
CONTRACTOR -FIRM NAME _
Owner
ADDRESS
abnva
CITY/COMMUNITY/STATE/ZIP
above
PHONE a
i
SEP 2 v
LICNC 8
-
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP '
PHONE 1
LICNC 0
'
USE OF PERMIT Ja=z_ /�
BL
ZON
FSB
SSB
SSB
RSB
OFC -
ZONE ORD 0
• LOT SZ
END
- .SIDE
Date Applicant
NOTICE TO APPLICANT:.If;after_making this Certificate of Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
be deemed revoked. '
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
b Ihereby certify that noexcavation five (5)ormorefeet indepthinto which aperson isrequired todescend, will be
• made in connection with work authorized by this permit, -a A that no building structure, scaffolding, falsework, or '
demolition or dismantling thereof, will more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8.
C.A.C.)
0 As owner -builder, I will not employ anyone to, do work which Would require a'permit-from the Division of
Industrial Safety, as noted'.above, unless such person has a permit to do such work from that division.
�0 Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit•is issued (Sec. -3097, Cir. C.). t
Lender's Name "
.lender's Address
I certify that.l have read this application and.state thatthe:above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction. and hereby authorize representatives
of this county to enter upon the above-mentioned propery for inspection purposes. '
Signature of Applicant or Agent Date
CERTIFICATE OPCOMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
the information given is correct. I agree to complywith'alt state laws and county ordinances relating to buidling
construction, and authorize a' representative of the City d La Ouinta Department of Building and Safety to enter
upon the property for which I have applied for this_perml for the purpose of making inspections.
r j ���tur�f.Applicant or Agent Date
Print Applicant /Agent Name,
APPL/PRMT i f P. n i f f1 3
DAT
9-20-84 CCM.
Pennit to install
fiberglass spa
as approved plans.
Pian Check Fee
40.62
Const. Fee
62„50
Elect. Fee
5.00
SNB fee
.50
Plunbing Fee
8.00
' 7cs. SO
i
SEP 2 v
Cad 0 uirbia
C
TOTAL
C C2—,
BLDG.DEPT. VALUATION ti,nnQ.in :;
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.
❑
OP'N ADDITIONAL INFORMATION
NO.
fl�
�{ p
i
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick al
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
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