001163 (CP)PERMIT APPLICATION
City of
La Ouinta
- 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:
BOK
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
LICENSED CONTRACTORS DECLARATION: I hereby_ affirm that I am 'licensed -under provisions of ChBpter: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 is in full force ' =. •
issued; I shall not employ any person in any mannerso as to become subjectto the Workers'Compens ation Laws of
and effect. �2 �•q �" („)
J Jam)
California.
License Class ic. Nu ber • l �.1s� !
YA37 �^' �a
Date ' ^ Applicant '
Date Contractor • /
NOTICE TO APPLICANT: if, after making this Certificate of Exemption, you should become subject to the Workers'
OWNER -BUILDER DECLARATION: I•hereby aflirm'thal I am '-exempt frrom the Contractor's License Law•loc the
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
ty. which requires a permit to
following reason (Sec. 7031.5, Business'and Professions Code: Any city of county.
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 tofileasigned statement that heislicensed pursuant tothe provisions ofthe Contractor's License Law ;' '
:•O`Iherebyiertifythat noexcavation five (5)ormore feet in'depthinto which aperson isrequired todescend, will.be `
(Chapter 9(commencing with section 7000) of Division Sof the Business and Professions Code)or that he is exempt •
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.)
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the.
O As owner -builder, I will nbi 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 .
• ' ' •- - • .-> a•
Ithrough
his own employees. provided that such improvements are not intended or offered for sale. If, however, the
o.-
., p. Division of.lndustrial Safety Permit No.. -
buildingorimprovemntissoldwithinone year of completion; the owner -builder will have the burden of proving that.-
building or improvemnt is sold within one
Date, ` Applicant:
he did not bgld or improve for, the purpose of sale.).
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency.for.the performance
❑ I, as owner of the property, am exculsively contracting with licensed contractors to construct.the.project (Sec: - •
..:of the work•for which this`peimit is issued (Sec. 3097, Civ: Q.
7044. Business and Professions Code:•,The Contractor's License'Law does not apply to an owner of property who,..
"
.> • • r
Lender's Name
builds or improves thereon, and who contracts for such projects with a contraclor(s) licensed pursuant to the'
Contractor's License Law.). c_
Lender's Address
" O 1 am exempt under. Sec. B. 8 P.C. (Attached Certificate).:'
I certify that'I have read -this application and state that the above information is correct 1 agree to comply with all
Date Owner
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
'SIDE
oPthis county to enter upon the above-mentioned property for inspection purposes.-
urposes.WORKERS'
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of conserit to self -insure, or a
' Certificate of Workers' Compensationansurance : or'a certified copy thereof (Sec. 3800. Lab.. C.).
$ignatu�e of Applicant or Agent Date
Policy No. Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF.ENTRY: I certify I have read this application and state that ..
O Certified copy -is hereby furnished. . •
the information given is correct. I agree to comply with allstate laws and county ordinances relating to buidling
O Certified copy Is 1ded'wrth the City Building Inspection.0e artmenl r City =� Department.
construction.. and authorize a' representative of the City of La Ouinta Department of Building and Safety to enter
Date�/,'���)nc� +k'
�./ MPlicant iris.��_50� c1+
upon the properrtty-(or/which I rave applie'tor this peTrmit for-purpo a of maki f specttions " ••
r!
% /�Lf�' i w`%' 9Crintll�i irF� U�
,� V�Sss nature off A Ic nt or A ent p Date
C>�gyS / p�� v/i%�
Print Applicant/Agent Name
APPLICANT NAME (L. F: MI) Nepb3nePools -
ADDRESS 73-885 Imy 111
CITY/COMMUNITY/STATE2IP
C
C ,. 92260
Palm Desert,
JOB SITE.ADDRESS/SPACE78-165 Calie Norte
CITY/COMMUNITY/STATE/ZIP La Quince, - CA 92253
BOK
PAG •
PRC
C
Public pool and
TWN
RNG
SE
S
TRAOjrbi•y� p"
!/
LOT
122.52 _
Oonst. Fee
MOD
SB
5.00;.
TRACT NAME ' ^ A t^
Dwia 1a I
OWNER NAME (L, F. MI) IanitnarA .
CDNTRACTOR-FIRM NAME
lt -
ADDRESS
ab
CITY/COMMUNITY/STATE/ZIP'j�� .. .. ,. •- ,
above
PHONE • 340-4900
LICNC 1
.. •
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP `• "'
PHONE A
LICNC /
'
USE OF PERMIT Pool wid , spa
BL
ZON
FSB
-SSB
Sse
.RSB
OFC
ZONE ORD • •
LOT SZ
END
'SIDE
APPL/PRMT- f. l 1-4 8S POOL .
ani163
Permit to install
at 25' by 39' publau
pool and 8' round
spa as per approved
pLans. .
Public pool and
spa require fencing.
meth. Fee
9.00
Plan &W&
122.52 _
Oonst. Fee
188.50 '
Elect. Fee
5.00;.
-SMI. Fee
2.03
Plumbing, Fee
8.00
.. •
— .. -
AL 1A
Ian
NOTAL • `.
FEE
335.05.
- VALUATION 28,500.00
BLDG. DEPT.
a
a
NO.
OPERATION MATE
INSPECTOR
NO.
OPE ATION 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.
❑
NON
ADDITIONAL INFORMATION
SEWAGE,SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
128 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