001346 (RPL)PERMIT APPLICATION ) j/oai
City of La Ouinta lJ "' v
Department of Building and Safety
This permit becomes void if work not commenced within 180 days from date of issuance, OR, it work has been suspended,or abandoned for a period of 180 days.
TRACT NAME
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 Chapter 9
the permit is for one hundred ($100) o• less. I certify thatin the performance of the work for which this permit is
(commencing with Section 7000) of Division 3 o the Business and Professions Code, and my license is in full force
issued, l shall not employ any,person in any manner so as to become subject to the Workers Compensation Laws of
and effect.
California.
License ClassLic. umber
Date Applicant
Date ••• Z •-�' Z• Contractor
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subjectIto the Workers' '
OWNER-BUILBER DECLARATION: I hereby 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 octhis-permit shall,.,,:
- be deemed revoked.*
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
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,
01Weby"certify that no excavation fivd(5) or more feet in depth into which a person is required to descend, will be '
(Chapter 9 (commencing with section 70(10) of Division 3of 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, lalsework, 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, Title8,
subjects the applicant to a civil penalty of not more than five hundred dollars (SWO.):
° C.A.C.)
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-bluilder, 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
SioU Flee
through his own employees, provided that such improvements are not intended or offered for saleAf, however, the
0 Division of Industrial Safety Permit No.
building orimprovemntissold within one year ofcompletion, the owner -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
0 I, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec.
of the work 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
O
18.00
Contractor's License Law.),
Lender's Address
0 I am exempt under Sec. B. & P.C. (Attached Certificate).
1 certify that I have read this application and state that the above information is correct.I agree to comply with all
Date Ownercity
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. .4
.
' '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. Q. : •
- ,,.
Signaiure 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
0 Certified copy is hereby furnished.
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
0 Certified copy is filed with ,the City Building Inspection Deparfinent or City Department.
construction, and authorize a representative ot..lhe City of La Ouinta Department of Building and Safety to enter
Date . Applicant
upon the�propertytfor vlhittl I,fiave a yphed4or this permit for the purpose of m k' I'
tJ
Signature of Applicant or Agent Date
APPLICANT NAME (L, F, MI) swan
Pools
ADDRESS 67-652 Raimo Rd. .
CITY/COMMUNITY/STATE/ZIPPalm Spr+ s' CA 92262 .
JOB SITE ADDRESS/SPACE 51_286 _ Velar
oo
CITY/COMMUNITY/STATE/ZIP
La Quintan M 92253
PRC C TWN RNG I SE S
TRACT LOT ,n MOD I SB
Print Applicant/Agent Name t
APPL/PRMT 22-85 POOL
Permit to construct one 15' x 30'
pool and 5' x 9' spa as per moved
plans.
TRACT NAME
Mec • �
17.550
•
OWNER NAME (L, F. Mn suttM
Plan Cbhck Fee 56.22
CONTRACTOR-FIRM NAME �I licanl t
Const. Fee
86.50
ADDRESS
above -
Elect. Fee
14.00
-
CITY/COMMUNITY/STATE/ZIP
abave -
SioU Flee
• 77
PHONE 0
LICNC 0
PludAN Fee
�J'
O
18.00
ARC/ENG FIRM NAME
-
'
ADDRESS
-
CITY/COMMUNITY/STATE/ZIP
'
-
PHONE •
LICNC •
..
USE OF PERMIT
Pool and spa
BL
ZON
FSB
SSB
SSB
RSB
-
OFC
ZONE ORD •
LOT SZ
END
SIDE: -
TOTAL
192.99
.:
FEE
7
792.. 4 23
i
M r
<-�
2.
Y
VALUATION�0•-
BbDD'EPT,
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.
❑
NPI ADDITIONAL INFORMATION
' Fj
/moiJJJ
�' /l/e S _
/
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 .Internal Lath/Q/4
12A Drywall
t3 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/1
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final