001311 (RPL)LICENSED CONTRACTORS DECLARATI
(commencing with Section 7000) of Divi
and effect.
License Class Lic. Number
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 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 the
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 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 improvemnt 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
builds or improves thereon, and who contracts' for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
❑ 1 am exempt under Seca n—*r 8:;8 P.C. (Attached,Certificate).
Date Owner_,
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell -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 Department or. City' Department.
Date Applicant
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.
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
ON: I hereby affirm .that I am licensed under provisions of Chapter. 9 • the permit is for one hundred (5100) o. less. I certify that in the performance of the work for which this permit is
sion Sof the Business and Professions Code, and my license is in full force issued. I shall not employ any person in any manner so as to become subject to the Workers'CompensationLaws of
California.
APPLICANT NAME (L, F{ MI) �r�.•
1'iL • & Mrs. • ►sherrGI
ADDRESS '
52-125 Avenida Oortez
CITY/COMMUNITY/STATE/ZIP
Ia Qulinta, CA 92253
JOB SITE ADDRESS/SPACE
above
CITY/COMMUNITY/STATE/ZIP
above
B� ,yam
>PAG )
/
P� / FC
TWN
RNG
SE
S
TRACT
LOT.
12.00
MOD
SB
14.00
TRACT NAME '
OWNER NAME IL. F, MI'A W i a t
CONTRACTOR -FIRM NAME '
licant
ADDRESS
abovle
CITY/COMMUNITY/STATE/ZIP
above
PHONE •
LICNC .
'
ARC/ENG FIRM NAME '
ADDRESS '
CITY/COMMUNITY/STATE/ZIP '
PHONE 0
LICNC M
'
USE OF PERMIT Pool
BL
ZON
FSB
SSB
SSB-
RSB
OFC
ZONE ORD . "-
LOT SZ
-
END .
SIDE
Date Applicant
NOTICE TO APPLICANT: If, 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 revolted.
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, w ill 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, Sec341, Tille8t'
C.A.C.)'
❑ 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
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 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 property,for which I have.applied for this permit for the purpose of making inspections:
Signature of Applicant or Agent yr Date
Print Applicant/Agent Name
APPL/PRMT fl :3
1 1
A OJ�pC PO
Permit to construct
16 x 88 pool 'as
per approved plans and applicable
ordinances.
Plan Check Fee
48.42
Clonst. Fee
•79.50
Elect. Fee
12.00
SMI Fee
.60
Plumbing Fee
14.00
TOTAL
FEE •.
149.52
A'057Z
BLDG. DEPT. .
4 J VALUATIr6 9.5 c z
o.�oo
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION DATE" INSPECTOR
-BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System m
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
35
FurnacetCompart.
3
Steel
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air ti
5
Bond Beams
38
Compressor
6
Roof Deck
39
Appl. Clearance r
7
Framing
40
F,ire 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.
❑
NO
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)
126 Ceiling (Blown)
14 Final �J
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
w
p/L P/L
STREET NAME ..
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
on
CrrY OF LA QUINTA
Commmity DevelopmenVBodg. Dept..
CONDITIONALLY
ACCEPTED Fop, Cokjtgl3ll
E T INSTALIKf 100 AS PUt
AND ALL APPLICABLE CODES
`
IDAT V 1 6
DEPTH
SHAPE o ) / is
CODE
TILE CCLCR n -t 5, � Yi - G
12" COPING ,) L,) ,
POCL CAPACITY (GALS)__L/
PU'P CAPACITY(G.P.M.)
FILTER (SO,FT.)--- to
PULPC J ► Z
H.P.
FILTER RATE (G.P.M.)
TURNOVER (G. P.M.)
BOARD
COLOR
VACUUM LINE ��a
SKUTER LINE / yp -
RETURN LINE ' -
M IN LINE
SKIM'ER
FEATER —
GAS LINE BY: —
ELECTRIC BY,
- - L I GIT - 1-p UJ
TINE CLOCK T r p
— BAD(WASH TO
AMI S I PHON VALVE 2/q %
DECK 1 NG'
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SLIDE
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DEEPCITY ' _ 'ra to'
i
S r END SHALLOW CROSS ST.
END
PHOrE —
SCALE: /g „ = 1'O"
DATE
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BY: S iP L/r--
001
JOHN R. HACKER
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52125 Cortez (Avenida)