001368 (RPL)PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
This permit becomes void if work not commencedwithin 180 days: from date of issuance,. OR, it work has. been suspended or abandoned for a period of 180 days
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ADDRESS
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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 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 in lull 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 yL�i%c Number -�•! f 1 J
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I
Date Applicant
Date Contractor, '�Jf = ��
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'
OWNER -BUILDER DECLARATION: I hereby affirm thpt•I am exempt from the'Contractor's License Law for the
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.
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construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for•1
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
0, therebycertify that no excavation five (5) or more feet in depth into which a person is required to descend, will be
(Chapter 9(commencing with section 7000) of Division 3 of the Business and Professions Code) or thatheisexempt
made in connection with work authorized by this permit, 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 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.):
C.A.C.) "
❑ 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 work which would require a permit from the Division of
- 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.
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. 11, however, the
Q Division of Industrijl Safety Permit No.
building or improvemnt is sold within one year of completion, theowner-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 performance
O 1, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec.
of the7.mork 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
RSB
Contractor's License Law.).
Lender's Address i�
O 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.) agree to comply with all
DateOwner
city and county ordinances and state laws relatinglto building construction, and hereby authorize representatives
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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, or a .
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certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.).
Signature of Applicant or Agent/ Date
Policy No. Company
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' CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and statethat
❑ Certified copy is hereby. furnished.
the information given is correct. I agree to comply with all state'laws and county ordinances relating to buidling.
,.❑ Certified copy is filed with the City Building Inspection Department or City Department.
construction, and authoriie�:representauve of the City of LaOuinta Department of Building and Safety to enter
•upon the fbr>whic I have'appli7ed frit this for the of inspections.
Date Applicant
property perm! purpose making
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APPLICANT NAME (L• F. MI) we� �1�►
L17``773—N5
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ADDRESS
CITY/COMMUNITY/STATE/ZIP Palm Desert,, CA. 92260 .
JOB SITE ADDRESS/SPACE
M 51-701 Avenida i3barez
CITY/COMMUNITY/STATE/ZIP '
La Quinta, CA 92253
BOK '.
PAG
PRCC
SMI Fee .84
Plumbing Fee 18.00
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TRACT
LOT
MOD
SID
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TRACT NAME -
OWNER NAME (L. F. MI) -
David Woodard
CONTRACTOR -FIRM NAME
Applicant
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP .,.�,�.,�M
abouts
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ARC/ENG FIRM NAME -
ADDRESS
CITY/COMMUNITY/STATE/ZIP • - - -
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USE OF PERMIT
Sunning Pool
BL
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FSB
S58
SSB
RSB
OFC '..
ZONE,ORD I..
LOT SZ
END,*
SIDE,
u Signature of
Print Applicant/Agent Name
Date
APPVPRMT DATE
5-6-8LL. POM
Permit to install cne 28' x 14' pool with
61 found spa as per appraved pians.
Mach flee 17.50
Plan (heck Flee 60.12.
Const. Fee 92.50
Elect. Fee 12.00
SMI Fee .84
Plumbing Fee 18.00
'TOTAL
.200.96
A0944 _ 5
BLDG. DEPT.
b
VALUATION 11,100.00
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 ` of
G Z
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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.
❑
O.
NO.
N
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
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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