001309 (RPL)APPLICANT NAME F.
ADDRESS
PERMIT
APPLICATION
City -of
La Ouinta
Department of
Building and Safety
This permit 6eComes void if work not commenced within 190 days from date of issuance. OR, -if work has been suspended or abandoned for a period of 180 days.
AFIC
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This'section need not be completed if
LICENSED CONTRACTORS DECLARATION: ['herehyaffirm 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*3 of the Business and Professions Code. and my license is in full force
issued. I shall rot employ any person in any mariner so as to become subject to the Workers'Compensation Laws:of
and effect.
California.
'License Class Lic. Number
DateApplicant
Date
NOTICE TO APPLICANT: If, after making this Ctrtifi6ale*of Exemption, you should become subject to the Workeirs,.m6.
OWNER -BUILDER DECLARATION: 1.6etiy if' tirm 'that 'I am exempt from the Contractor's LiZense Law for the
Compensation provisions of the Labor Code; you must forthwith comply with such provisions or this permit'shall,
be deemed revoked.
following reason (Sec. 7031.5. Business and Professions Code:. Any city or county which requires a permit to
59 -
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 thk he is licensed pursuant to the provisions ofthe Contractor's License Law
0 1 hereby certify�lhat no excavation five (5) or more feet in depth into which a person is 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 permit, and that no building structure, scaffolding, falsework, or
therefrom and the basis for the, alleged,tixemption: Any violation of Section 7031.5 by any applicant for a permit
demolition or dfimantling thereof, will be moie1han thirty-sii (36) feet high. (Chap 3.2, Grp 2. Art 2; Sec 341, Title & 1,t
subjects the applicant to a civil penalty of. not more than five hundred dollars ($500.):
C*Q
O. I. as owner of the property. or my employees,with'wages as their sole compensation, will do the work, and the
0 As owner -builder, 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 applyto an owner of property who bbilds..or improves.ther6n, and who does such work -himself or
.CONTRACTOR -FIRM NAME,
is and Patio's
e the
through his own employees. provided that such improv ments are not intended or offered for sale. It, however,
0 Division of Industrial,,Sately Permit No.
build ing or i mprovemnt is so Id within. one yeai of completion, the owner-buildermill have the burden of proving that
Date Applicant
he did not build or improve for the purpose of sale.).
ion
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending a gency for the performance
0, 1, as owner oithe 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.
Contractor's License Law.).
Lender's Address
0 1 am exempt under Sec. B. & P.C.Certificate).
I certify that I have read this application and.slate that the above information is correct. I agree to comply with all
Date ' s- - 4 >' -
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
PHONE 0
of this county to enter upon the above-mentioned property for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a Certificate of consent to.self-insure, or a'
certificate of Workers' Compensation lnsurance,, or a certified copy thereof (Sec. 3800. Lab.. C.).
Signature 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 Wit'g Inspection Department or City Department.
din
construction, and authorize a *representative of the City of La Quinta Department of Building and Safety to enter,
Dale :Applicant,
p ope. w,
upon the for h*eh I have applied for this or the purpose of making inspections—
-B
SS
Signature of Applicant or Agent Date
APPLICANT NAME F.
ADDRESS
CITY/COMMUNITY/STATVZIP�
*
LaQ,=xtta, CA 92253
-:
JOB SITE ADDAESS/SPACE
serftyww
Permit to constnict one.15 x330 pool
CITY/COMMUNITY/STATE/'ZIP-
92253
as per
135!�y
AFIC
TW, -
RNGS.
SE.
TRACT
44.52
59 -
M00
se
Const. Fee
68.-50
firs
Elect Fed
MOO
TRACT NAME U .,
"h
fl� "Fir
OWNER NAME (L. F, -MI);
'Baumhoffer
.CONTRACTOR -FIRM NAME,
is and Patio's
:55
ADDRESS
US
CITY/COMRAUNITY/STAf,(f)2!i'O;t
CA 92253
2 3 400
PHONE
LICNC I
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZiF, u
PHONE 0
LICNC
.T
USE OF PERMIT
SL:
ZON
k�F S8 j,
-B
SS
SSB
RSB
OFC
TOTAL
,
I 151'.57
J
FEE
ZONE ORD
LOT SZ
END
SIDE
e. -
Print Applicanl;Agent Name
APPUPRMT
n1J.nq 4DITI-85 POOL
Permit to constnict one.15 x330 pool
as per
Plan Check
44.52
59 -
Const. Fee
68.-50
firs
Elect Fed
MOO
SMI Fee•
:55
Flee
2 3 400
.T
TOTAL
I 151'.57
J
FEE
A 0 5 4 9
4 1
DO
VALUATION00-
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.
❑
NON
ADDITIONAL INFORMATION
� //�� 71-
(2� /� g2 4
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
72 Internal.' ath
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 Services
24 Gas Test
25 Final
Tank Pit •• L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
P/L P/
'
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding,
30 Fixtures
31 Service
32 Final
"