001062 (RPL)PERMIT APPLICATION
City of La Duinta
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. -
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force .
and effect.
C -S`' � vX19
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
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 so as to become subject to the Workers' Compensation Laws of
California.
License Class -1 Lic. Number -
Date Applicant
�/
&/2
Date' - 7 -• Contractor/L - I f'/"A`r�
. NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'.. ,
OWNER -BUILDER DECLARATION: Thereby affirm that 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:
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
such permit to file a signed statement thathe is licensed pursuant to the provisions of the Contractor's License Law
01 hereby certify 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 7010) of Division 3 o1 the Business and Professions Code) orthat he is exempt
made in conneetiomwith 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, willbe more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art2, Sec 341• Title 8,:",
subjects the applicant to a civil penalty, of not more than five hundred dollars ($500.):
CAC.)
0 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the ...
0 As owner-buildeF, 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, acid who does such work himself or
t
through his own employees, provided that such improvements are not intended or offered for sale. II, however, the _
q,Division ot.lndustrial Safety Permit No.
building or improvemnt is sold within one year of completion, the owner -builder will have the burden of provipg that
he did not build or improve for the purpose of sale.).
0 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 loan owner of property who
builds or improves' thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
Contraclor's License Law.).
0 1 am exempt under Sec. B. 8 P.C. (Attached Certificate).
Date — Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that 1 have a certificate of consent to self -insure, or a
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.)..
Policy No. Company
0 Certified copy is hereby. furnished. «
D'Certified copy is filed with the City Building Inspection Department or City Department.
Date Applicant
APPLICANT NAME (L. F. MI)
Neptune Pools
ADDRESS
73-885 Hwy 111
CITY/COMMUNITY/STATE/ZIP '
Palm Desert, CA 92260
JOB SITE ADDRESS/SPACE
78-178 Calle Norte
CITY/COMMUNITY/STATE/ZIP
.La Qminta, CA 92253
BOK
PAG
(,J1
PILL,
C
TWN
RNG
SE
S
TRACT
LOTMOD
12.12
Const. Fee
32.50
SB
5.00
TRACT NAME
Dune La Quinta
OWNER NAME (L. F. MI) '
Gary Kerne
CONTRACTOR -FIRM NAME - -
An licant
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP '
above
PHONE •
LICNC 0
ARC/ENG FIRM NAME '
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE*
LICNC 4
TOTAL
FEE
USE OF PERMIT
So
BL
ZON
FSB
SSB
SSB
RSB
OFC
ZONE ORD o
LOT SZ
END
SIDE, '
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.):
Lender's Name
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.
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify l 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 of La Duinta Department of Building and Safety to enter
upon the property for which I have applied for this permit for the purpose of makingi pections.
M
Signature�App� t or Agent —� Date
Print Applicant/Agent Name
APPLIPRMTF�
_1
nnnf/
GATE
11-29-84 POOL
Permit to install 6 foot spa
as para approved
plans.
Mech. Fee
9.00
Plan C fee
12.12
Const. Fee
32.50
Elect. Fee
5.00
SMI Fee
.50
Plumbing Fee
5.00
YA QV 9
TOTAL
FEE
64.12
BLDG. DEPT. VALUATION 2,000.601
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.
❑
NPON
ADDITIONAL INFORMATION
G�
/ IR,5
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
126 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