001164 (BLDG)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.
LICENSED CONTRACTORS -DECLARATION: l hereby affirm that Lam licensed under provisions of Chapter 9.
• (commencing, with Section 7000) of Division Sof the Business and Professions Code, and my license is in full force
and effect.
License Class Lic. Numbed
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 ti le a signed statement that h e is licensed pursuant to the provisions of the Contra ' ctor's License Law
(Chapter 9 (commencing with section 7010) of Division 3 of the Business and Professions Code) orthat 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 five hundred dollars ($500.): ..
O I. as owner of the property, or my employees with.wages as their sole compensation, will do the work, and the
structure is not intended or, offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License
Law does not apply to an owner o1 property who builds; or improves thereon, and who does such work himself or
through his own employees, provided that such improvements are notintended or offered for sale. If, however, the
building or i mprovemnt.is sold within one year of completion, the owner -builder will have the burden of proving that
he did not build or improve for the purpose of sale.).
❑ I, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
builgs or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
..Contractor's License Law.).
0. 1 am exempt under Sec. _ ..B. 8 P.C. (Attached Certificate).
Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.). .
Policy No. Company
❑ Certified copy is hereby furnished.
O Certified copy is filed with the City Building Inspection erft o' ityy Department.
Date Applicant ��1*91M.1101
APPLICANT NAME (L. F', MI) Iancbakk '
ADDRESS � 1000
P.O.
CITY/COMMUNITY/STATE/ZIP
Ch.' 92253
Lpa •Quint�,a,
*,'
JOB SITE ADDRESS/SPACE 70100 Calle.'*rte ,
CITY/COMMUNITY/STATE/ZIP I$ SC�+ta, • CA 92253
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187
LOT
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TRACT NAME Dam la Qujta
OWNER NAME (L. F. MI) +mow� * k .
CONTRACTOR -FIRM NAME .
Applicaica nt .
ADDRESS above
CITY/COMMUNITY/STATE/ZIP abme
PHONE •
345x-2888
LICNC .
'
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE •
LICNC II
USE OF PERMIT
Pool R troansest
BL
ZONFSB
SSB
SSB
RSB
OFC
ZONE ORD •
LOT SZ
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section neednot 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 i n any manner so as to become subject to the Workers' Compensation Laws of
California.
Date Applicant
NOTICE TO APPLICANT:. If, alter 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. (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.
❑ 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. 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. s
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 of La Ouinta Department of Building and Safety to enter
upon the Aperty for which I have applied for this permit for the purpose of making inspections.
/ Sig ifure aAp'p (cant or Agent Date
1 J�I �
Print Applicant/Agent Name
APPL/PRMT■ LI � DATE Bldg•
Permit to build 150 sq. ft. of pool
restrotnst for public use. All resp.
required to be on M
msech. Fee 9.00
Plan Check Fee 59.41
ODnst. Fee 62.50
Elect. Fee 17.75
SMI Fee .50
PlunbiM Fee 30.00
PA 1 D i985
TFEE
179.16
BLDG. DEPT. VALUATION 6,300.00
Ah
Ah
NO.
OPERATION ATE
INSPECTOR
NO.
ri
OP 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 Beam>
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 Lart
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 PiI
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final