001302 (RPL)IEA11111T AMUCATTO>t
Oty of U QuInu
Department of Building end Safety
This permit becomhes void if work not commenced within 180 days from date of Issuance. OR. N worA los Dem suspended or abandoned for a perlod of 180 days.
LICENSED CONTRACTORS DECLARATION: I hereby Om that 1 am licensed under provisions of Chapter 9
Jccr' '-:no with Section 70001 of Division 3 of the mess and Professions Code. and my license is In full force
WK
;.I ease Class Lit. Nu", -
Owe � t _. Contracts .
OWNER -BUILDER DECLARATION. I hereby affirm tact 1 am exempt from the Contractor's license Law Por the
following reason (Sec. 7031.S. Business and Prolessras Code: Any city or county which requires a permit to
construct, after. improve. demolish, or repair any sbacsure, prior to its issuance. also requires the applicant tar
such per mit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
(Chapter 91commencing with section 70001 of Division 3d the Business and Professions Code) or that he is exempt
therefrom and to basis for the alleged exemption. Any violation of Section 7031.S by any applicant for a permit
subjects the applicant to a nava penalty of not more tfsen five hundred dollars 4500.►:
O L as owner of the property, of my employees wit wages as their sole compensation. will do the work, and the
structure is not invaded or offered for safe (Sec. 71741 Business and Professions Code: The Contractor's License
Law does not appy to an owner of property who txal@s or improves thereon, and who does such work himself or
through his ohm employees, provided that such inproveamts are not Intended or offered for sale. it. however, the
budding or improvemmt is sold within one year of cotr0ebon. the owner -builder will have the burden of proving that
he did not build or Improve for the purpose of sale.).
O L as owner of the property. am exurisivdy, wraraWmp with licensed contractors to construct Me project (Sec.
7044. Business and Professions Code: The Commuter's license law does not apply to an owner of property who
bu0ps at improves thereon, and who contracts for reek projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
O 1 am exempt under Sec. B. & P.C. (Aftached Certificate).
Date Owner
WORKERS' CONIPENSATIDN DECLARATION: 1 hereby aft., tat I have a certificate of Consent to self -insure, or a
certificate of Workers* (bnpeneation Insurance . or a eartifhed copy thereof (Sec. 3800. Lab. C.).
Policy No. Company
O Certified copy is hereby furnished.
O UrTilied Dopy is riled with the City Building Inspection Department or City Department.
Daft Applicant
APPLICAM KUM 0. F. MI) 'i ' les Clarke
ADDREss .
36770 Cathedral Cigym
:eTYAl)(31WAtM TY W ATEMP
Cathedral City, CA 92234
JOB SM ADORESSIMPACE
46-525 WasbAngtim
CITY/Cf>1M11QTY/STAYEfZW
Ice Quints, CA 92253.
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Plan Check 1'w
83.52
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Elect. Free
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END
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CERTIFICATE OF EXEMPTION FROM WORKERS* COMPENSATION INSURANCE: This section few notee0
the permit is for one hundred (SIOD) 0. loss. l certify that In the parlor mance of the work for which Mrs
faaued. Ishan not employ any person in any manner so as to become SAM, to the Workers' Conpmsatio
California.
Des Applicant
NOTICE TO APPLICANT: U. after making this Certifiate of Exemption. you should become subject to the fire
Compenxtion provisions of the labor Code. you must "with comply with such provisions or this perrrit
be deemed revoked.
DWISON OF INDUSTRIAL SAFETY POW CERTIFICATION:
O 1 hereby cc" that no excavation five (5) or more feet in depth into which a person is required to descend. wil l
made in connection with work authorized by this permit, and that no building structurc scaffolding, fstsework i
demolition or dismantling thereol. will be more than thirty-six (3G) feet high. Pap 3.2. Grp 2 Art 2. Sec 311. Trod
CAC.) i
O As oww-builder. I win not employ anyone to do work which would require a permit from the Division j
Industrial Safety, as noted above, unless such person has a permit to do such work from that division. 1
O Division of Industrial! Safety Permit No.
oats Applicant
CONSTRUCTION LENDING AGENCY: I Deretty affirm that there is a conatnuction lending agency for the
of the work Sar whieth this permit is Issued ¢tic. 3097• Civ. C.).
Lender's
Lender's
I certify thaf I have read this application and state that the above inlormation is correct. I agree to comply with i
city and county ordinances and state laws raising to building construction, and hereby authorize repramtaw
of this county to enter upon the above -Mentioned property for Inspection purposes. It
h
Signature of Applicant or Agent Date e
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION O ENTRY: I certify 1 have read this application and state N
the irdorahation given is correct [agree to comply with all state laws and county ordinances relating to Duidfi
construction, and authorize a representative of Me City of La Guinta Department of Wiling and Safety to erg
upon ft fo which ve a110119 -for s peen the purpose of making 'InspeChons. i
Signature of Applicant of Agent Date
Print Applicant/Agent Name
APP`ONITn
3J115 85 POOL
Plemit to install
One 35' x 19' ppol
with a 7' x 6'
spa as per approved
Naas.
mech. Flee ,-
17.50
Plan Check 1'w
83.52
Const. Free
128.50 '
Elect. Free
1.26 ✓
Pluffbing Flee
18.00
s
V
TOTAL
248.78
ASSESSOR VALUATION 17 400.00 h