001304 (RPL)LICENSED CONTRACTORS, DECLARATI
(commencing with Section 7000) of Divi
and effect.
License Class Lic.,Numbe? % �n
.-Date - Contractor
OWNEk--BUILDER DECLARATION: I hereby affirm that I,am'exempt from the Contractor's License Law forth.
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 -
Cdherefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for aapermit
• subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
❑ 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, add 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.).
O 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.).
17.1 am exempl.under Sec. B. 8 P.C. (Attached Certificate).
Date Owner
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
O Certified copy i's hereby furnished.
O Certified copy is filed with the City Building Inspection Department or City Department.
Date Applicant
PERMIT APPLICATION
City of La Duinta
Department of Building and Safety
S3'
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 •480 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, ($100) o,.less. I certify that in the performance of the work for which this permit is. -
sion 3 of the Business and Professions Code, and my license is in full force• issued, l shall not employ any person'inany manner so astobecome subject to the Workers' Compensation Lawsof
California.
APPLICANT NAME (L, F, MI) Swan�ls
ADDRESS V-652 y�n F4oad `
CITY/COMMUNITY/STATE/ZIP , .aty' CA 92234 ,
JOB SITE ADDRESS/SPACE5533-845 Eisenhower
CITY/COMMUNITY/STATE/ZiLa 1 uinta, ,CA 92253
BOK
PAG
PRC
C
-
TWN
PING:
SE -
.S
TRACT
LOT..
.50
Plumbing Fee
MOD
SB
TRACT NAME
�..+
OWNER NAME (L. F. MI) Marty Rm ,.et i
Marty
CONTRACTOR -FIRM NAME a - ^
a�3p.r.i�Ilt
ADDRESS . mow_
limit
CITY/COMMUNITY/STATE/ZIP
above
PHONE a
320-5996
LICNC •
421014
-
ARC/ENG FIRM NAME '
ADDRESS
CITY/COMMUNITY/STATE/ZIP ,
PHONE 0 -
LICNC
TOTAL
USE OF PERMIT
Pool
BL
ZON
FSB
SSB
SSB
RSB
OFC.
ZONE ORD • .
l0T SZ
END
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 revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
'❑ lherebycertify that no excavation five (5) of more feet in depth into 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 more than thirty-six (36i feet higI (Chap 3.2, Grp 2, Art 2, Sec341, Title8,
C.A.C.) : . r . -J,,, .
0 As- own0-buifder,•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.
Date Applicant
CONSTRUCTION LENDUJG AGENCY: I hereby affirm that there is a construction lending agency for the performance
olthe 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, a Ind"authorize a,'representative oft1he Cityyof La Duinta Department of Building and Safety to enter
K upon the`p�py fos (which,il,hahpplied lour/ thi4pe n for the purpose of making inspections.
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPL/PRMT
o is / A
DAT;
3-27-85 POOL
Pexmit to construct a 15 x 30 pool as
per a� plans.
Plan Check Fee
40.62
Fee
62.50
�Con��s��t��.
FlTct. Fee
12YQ0 — 1aa00
SMI Fee
.50
Plumbing Fee
14.00
TOTAL
1299.62
A0503
BLDG.DEPT
3 2 7~ i
VALUATION %P�00.00
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
YT,3
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.
❑
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)
12C Ceiling (Blown)
14 Final J t
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_PROP.ERTY LINE
PSL 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