001275 (RPL)APPLICANT NAME (L,'F. Ml)
ADDRESS
PERMIT APPLICATION -J'"3 • U', Q'., ' • ,
City of La Duinta
t, Department of Building and Safety �.` ". �' ' "•
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This permit becomes void if. work not commenced within 180 days from date of
issuance, OR, if work has been suspended or abandoned fe r a period of 180 days. + .
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`1= CERTIFICATE OF EXEMPTION FROM WORKERS=MPEASATIONINSURANCE: This section need not be completed it
,LICENSED CONTRACTORS DECLARATION: I hereby affirm that .l am licensed under provisions Chapter, 9
the.permit•is for one hundred ($100) o, less: I certify Oat in the performance of the work for which this permit is
-'of
' (commencing with Section 7000) of Division.3of the Business and Professions Code, and my.licensis in full force t �'
issued, I shall `not employ any person in any manner seas to become subject to the Workers'Compensation Laws of
and effect. / r, S�c�' r`1
— ``L'ic.
California.
Applicant.
License Class+ Numb`er',�'
Date
,
.7,:. Y�W'�,- R
Date" •-- Contractor
NOTICE.TOAPPLICANT:If,aftermakin thisCertificat3ofExemtion,.oushouldbecome.subjecttothe•Workers'..,''
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` OWNER-BU1 ER OECL•ARATION:'�l hereby affirm -that I am exempt from the Contractor's License Law for the, '
/
Compensation provisions of the Labor Code, you, muse forthwith. comply with such provisions onthis permit shall
be deemed revoked. '^ + �•
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requir�a permit to • ••
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-ION;
construct, alter, improve, demolish, or repair any structure, prior.to its issuance; also requires'the applicant for •
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICA ++ ,
such permit to file a signed_ statement that he is licensed pursuant to the provisions of the Contractor's License Law ''
'D I hereby'certiiy -that no excavation five'(5) or more feet in depth into which a person i's required to descend, will be
,(Chapter 9 (commencing.with section 7000) of Division 3 of the Business and Professions Code) or that he is exempt
made in connection with'work authorized by this pernrt, 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 a permit
demolition or dismantling thereof, will be more than th ay -six (36) feet high. (Chap 3.2, Grp 2, -Art 2, Sec341, Titlell,' r "
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.): ' `
"'C.A.C.)
❑ I, as owner of the property, army employees with wages as their sole compensation, will do the work, and the . ,
•;< . 'O 'As owner -builder, I -will not employ anyone to do'work which would require a permit train the Division of, "
structure is not intended or.oftered.for sale (Sec. 7044. Business and Professions Code: The Contractor's License,
• Industrial Safety, as noted above, unless such persor has a permit to do such work from that division. ' -
' Law does not apply to an owner of property who builds, orimproves thereon, and who does such work himself or
:
• through his own employees, provided that such improvements are not in or offered for sale. If, however, the ....
p,Division(olandustrial Safety. Permit No. . - — I _
building or improvemnt is sold within one year of completion, the owner -builder will have the burden of proving;that-"'. :
Date' L Applicant
he did not build or improve for the purpose of sale.). '.' -_. s:'. -- ••
CONSTRUCTION LENDING AGENCY:,l herebyaltirm thalthere is a construction lending agency for the performance
0 I, as owner'of the property, am exculsivelycontracting with licensed contractors to construct the project (Sec,:.L,
of the work'for• which this permit is issued (Seo. 309T Civ: C.). - .`_ •�
7044, Business. and Professions Code: The Contractor°s License Law does not apply to an owner of property who
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Lenders Name '
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
END
Contractor's License Law.). .. ._
- Lender's Address
❑'I am exempt under -Sec. - B. 8 P.C. (Attached Certificate). -.,
I certify that) have read this application and state that :he above information is correct. I agree to comply with all
' "Date Owner'
city and county ordinances and state laws relating to b rilding construction, and hereby authorize representatives
of this county to enter upon the above-mentioned'proverly for inspection purposes. • , ,
WORKERS'• COMPENSATION DECLARATION: I hereby affirm that'I have a certificate of consent to self -insure, ora
'.certificate of Workers"Compensation Insurance
11, or'a certified copy thereof (Sec. 3800: Lab'C.).
' Signature of Applicant or Agentf Date
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.Policy No. Company
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CERTIFICATE OF COMPLIANCE AND AUTHORIZATION Of�NTRY: I certily,l have read this application and state That
❑ Certified copy is hereby furnished + t •
�'-the information given is correct. I agree to co°mply'witt. all state laws and county ordinances relating to buidling
.O Certified copy is filed with the Cny Building Inspectidn.Department orCdy • - Department.
const'uctp ri and authorize. a' representative of the CiP{fol La OAta Department of Building and Safety to enter
, e -
Ne to�whJich I is t the inspections..• •.x
Date Applicant
PD
upon p�`operty have applied`lor� p • ,or purpose of making -
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'Signature of Applicant or Agent / % Date
` • ,
- Print Applicant/Agent Name
APPLICANT NAME (L,'F. Ml)
ADDRESS
CITY/COMMUNITY/STATE/ZIP Lie ex.T.
.�1`iU .
.•:�''
JOB SITE ADDRESS/SPACE 51_523 Avenida Villa
CITY//COMMUNITY/STATE/ZjIP T1` A_=_, '_•; CA: , 92253 •
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Elect. CCC 1.00 _ f/y'• �
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•RNG
SE ..
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TRACT -
LOT
MOO
,Se
,
TRACT NAME
OWNER NAME (L, F. MI). .. .. �SMMM Mr. M�z
=7�7�J .
CONTRACTOR -FIRM NAME
applicant
ADDRESS QVC -
CITY/COMMUNITY/STATE/ZIP
abme
PHONE • 340-4700 ! .
LICNC
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ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE 0
LICNC 0 , •
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USE OF PERMIT
Pool and spa
ASSB'
BL
ZON
-
FSB
SSB,
RSB
OFC
., . ZONE ORD N
LOT, SZ -
END
SIDE
APPVPRMT ii 3DAT. E PWL
Permit install 28,'x 24 pool with attacbed"
per
spa ,as pe PLEMS7 •
Mech. Fee 16.00
Plan Cgs. Fee ' 56.22 ' J
C���biiG.6. FSM 86.50 ,•
Elect. CCC 1.00 _ f/y'• �
SMI 'Fee .77
Pluming Fee' 18.00 ,
Investigation Fee 66.75 `
}
wired to have a 5' 'fence if
closer ' oan
..
'TOTAL � 257.24 ` ` •t
• FEE
BLDG I DEPT.
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M.ALUATION JE01000000
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
Steel3
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
1
'T J
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick 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 Pyt
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service.
32 Final