001361 (RPL)PERMIT APPLICATION-G�?ar`v
City of La Ouinta 6
Department of Building and Safety
This permit becomes void if work not commenced within 180 days from date of issuance. OR, if work hasbeen suspended or'abandoned for a period -of 180 days.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under 'prov isions of Chapter 9
(commencing with Section 7000) -of Division 3 of the•Busine"ss and Professions Code, and my license is in full force
and effect. 1.
License ClassLLIc. Number _
Date Contractor v f�
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
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a.permit
subjects the applicant to a civil penalty of not more than live hundred dollars ($500.):
❑ I. as owner of the property.,or my employees with wages as their sole compensation, will do the work, and the
structure.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 improvernm 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.).
❑ 1, 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 contraclor(s) licensed pursuant to the
Contractor's License Law.).
❑ 1 am exempt under Sec. B. & P.C. (Attached Certificate).
Date a Owner
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
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
construction, and authorize.a "representative of the City pf,La-0uinta Department of Building and Safely to enter
upon the property for which Lhave apphledfor.tlpis- rmWfl& the -purpose of making:inspections. -
Signature of Applicant orAgenl'6� Date
Print Applicant/Agent Name J
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This'section need not be completed if r`
the permit is for one hundred ($100) o. less. I certify that in the performance of the work for which this permit is
issued, I shall not employ any person in any manner soasto become subject to the Workers'Compensation Laws of .
California.
Date Applicant,
" NOTICE TO APPLICANT: It, 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:
O I hereby certify that no -excavation five (5) or more feet in depth into'which a person is required to descend, will be
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
.•,.demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chao`3.2. Grp 2, Art 2, Sec 341, Title 8,
...E -C.A.C.)
O As owner -builder, I will not •employ anyone'to do work whichwould 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.
A-
0 Division.ol 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, Civ. C.).' 6,
Lender's Name" Y
Lender's Address
I -certify that I have read this application and state that the 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 property for inspection purposes. -
Policy No. Company
❑ Certified copy is hereby furnished.
o Certified copy is filed with the City Building Inspection Department or City - Department.
Date Applicant
APPLICANT NAME (C, F. MI) "
Tberieau Const.
ADDRESS - -
80-916 Hwy 111
CITY/COMMUNITY/STATE/ZIP '
Indio, CA. 92201
JOB SITE ADDRESS/SPACE
48-721 San Vincente
CITY/COMMUNITY/STATE/ZIP
IJa Quinta, CA 32253
BOK
PAG
PRC
C
TWN'
RING
SE,
S
TRACT -
LOT
Const.
104.50
MOD
so
9U Fee
TRACT NAME
OWNER NAME (L. F. M1) Joe Roster
CONTRACTOR -FIRM -NAME -
Appliant
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
above
PHONE •
'LICNC A
'
ARC/ENG FIRM NAME ...
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE N
LICNC •
USE OF PERMIT
Pool
BL'
ZON
FSB
SSB
SSB
RSB
OFC '
ZONE ORD . ,.
LOT SZ
.END
- • SIDE
APPL/PRMT
DATE
5-1-85 POQL
Permit to eonstnmt 36'
x 161 pool as per
approved Plans.
Plumbing
18.00
Elect.
12.00
2h.
17.50
Const.
104.50
Plan Check
67.92
9U Fee
.95
*
FEE
220.87
A 0 8 7 9
BLDG. DEPT.
1
VALUATIO2N 13,000.00
NO.
OPERATION I DATE
INSPECTOR
NO.
OPERATION I 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
G !7,4
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
f=ireplace T.O.
❑
OWN
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 PSI
STREET NAME
26 Power Pole
27 Conduit `
28 Service Entrance
29 Wiring
29A Grounding Wire 74'
29B Bonding
30 Fixtures
31 Service
32 Final