001366 (RPL)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. ORJf work has been suspended or abandoned for a period of 180 days. •
. I . • • - 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 that in the performance of the work for which this permit is
(commencing with Section -7000) of Division- of 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'Compensation Laws of
and effect. California.
License Class Lic: Num�r
Date Contractor IZZ./ t
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,equires-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 civil penalty of not more than five hundred dollars ($500.):
0 1, as owner of the properly, or my employees with wages as their sole compensation; will do the work, and the
structure is not.intended or offered for sale (Sec.7D44..Business and Professions Code: The Contractor's License
Law does not apply to an owner of property who builds, or improves thereon, acid 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.). r.
0 I, as owner of the property am ezculsively.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.).
0 1 am exempt under Sec. B.:& P.C. (Attached Certificate).
Date Owner le
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 .
•0 Certified copy is hereby furnished. .. -
O Certified copy is filed with the City Building Inspection Department or City Department.
Date • " • Applicant
APPLICANT NAME (L. F. MI)
DesertDesign
ADDRESS P.O. Box 1420
CITY/COMMUNITY/STATE/ZIP
1^ QW*n4t'�'�,,,,C 92253
JOB SITE AODRESS/SPACE 51-625 Eisertm-er
CITY/COMMUNITY/STATE/ZIP ' '
Ia Quinta, CA 92253
BOK
PAG
PRC
C
TWIN
RNG
SE
S
TRACT
LOT
48.42
Const. Fee
MOD
SB
12.00
TRACT NAME -
OWNER NAME (L. F. MI) AWlicafit -
CONTRACTOR -FIRM NAME
applicant
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP - •• -
above .
PHONE.
LICNC .
ARC/ENG FIRM NAME '
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE •
LICNC .
TFEE
USE OF PERMIT
Pool and fence
BL
ZON
FSB
-SSB.'
SSB
RSB •
OFC
ZONE ORD 0 ' -
• .LOT SZ
,;y
.. END
.SIDE
Date Applicant
NOTICE TO APPLICANT: If,.after making.this.Certificate of -Exemption. you should become subject to the Workers'
Compensation provisions.oftthehabor Code; you must forthwith comply with such provisions or this permit shall
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
0 1 hereby certify that no excavation five (5) or more feel in depttfinto 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, Sec341, Title 8,
C.A.C.) :r " "•`�•
0 As owner -builder, I will not employ'anyone 16 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. .r
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 herebyauthorize 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 statethal
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
construction, and authorize a 7eprese tative of the City of La Ouinta Department of Building and Safety to enter
upon the property for which.1 have as Pied for this p rmIt• or -the purpose of making inspections.
i Signature of Applicant or nt Date
Print Applicant/Agent Name
APPL/PRMT L
`lR
GATE
5=2-85 FOCiL
T A 2A
Pemit to install
one 11 x E%' pool and
190 lin. ft. of
6 foot high sttx= fence
and 50 lin. ft.
of Elrod 6 ft. high fence.
as per approved plans.
Mech. Fee
17.50
Plan Check Fee
48.42
Const. Fee
62.50
E&wt. Fee
12.00
SMI Fee
60
Plumbing Fee
14.00
TFEE
155.02
A09U6
BLDG. DEPT.
5 Z 1l
VALUATION 8240.00
NO.
OPERATION DATE. INSPECTOR
NO.
OPERATION DATE INSPECTOR
BUILDING'APPPOVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
35
Furnace Compare.
-3
Steel
216
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
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION. Thick
Value.l
7A Walls (Batts)
12B Ceiling (Batts)
1 =2C Ceiling (Blown)
14 Final
PLUMBING APPROVALS'
15 Ground Plumb
16 Water Piping
17 Rough Plumb
1.8 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 APPROVA LS
REAR OF PROPERTY LINE
P L. P
STREET NAME
26 Power Pole
27 Conduit
28 - Service Entrance
29 Wiring
29A Grounding Wire
Bonding
30 Fixtures
31 Service
32. Final