001032 (RPL)PERMIT APPLICATION
City of La Ouinta
• Department of Building and Safety •
This permit becomes void it work not commenced within 180 days from -date of issuance, OR, if.work has been suspended, or. abandoned for a period of .180 days.
LICENSED CONTRACTORS DECLARATION: I hereby affirm'that I am licensed under provisions of.Chapter 9 '
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
and effect.
i
License Class Lie. Num bf r-
Owet • _ ..\J. /J -S `- J' </ Contractor' _ / 6i'/ rri1<: •
OWNER -BUILDER DECLARATION: I hereby affirm that am exempt from the Contractor's License Law for the•
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 Contractors License Law
(Chapter 9fcommencingwith section701X)ofDivision.3ofthe Businessand Professions Code) orthat heisexempt .
therefrom and the basis for the alleged exemption. Any violation of Section 7031,5 by any applicant fora permit-; ,
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
0 I.1as 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, and who does such work himself or .
through his own employees. provided that such improvements are not intended or offered for safeAf, however, the,
building orimprovemntissold within oneyearofcompletion, theowner-builder will havetheburdenofprovingthat .
he did not build or improve for the purpose of sale.). • „-;•'r .
0' Itas.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.).
I
0 1 am exempt under Sec. B. 8 P.C. (Attached Certificate).,
r .e
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.).
Polis y 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)
G.H. P000lCmst.
ADDRESS 68-465 P+e-
CITY/COMMUNITY/STATFJZIP Cat •'-1C�LL, alcityoCh.
W
JOB SITE ADDRESS/SPACE-.
tfi ctt a T
CITY/COMMUNITY/STATE/ZIP .. -
Ta Ouinta. CA 92253
BOK
PAG_
PRC
C
TWN
FIND
SE-
S
TRACT
U3640-1.
LOTMOD
4
86.50
Elect. Fee
R 3]
SB
z
.74
TRACT NAME
T .,vtcnm T)P_ la Pam
OWNER NAME (L. F. MI)
CONTRACTOR -FIRM NAME
ADDRESS r
ah five
CITY/COMMUNITY/STATE/ZIP
T
PHONE A �'
LICNC .
ARC/ENG FIRM NAME -
ADDRESS
CITY/COMMUNITY/STATE/ZIP ,
PHONE n
TOTAL
FEE
LICNC •
,
USE OF PERMIT
8L
ZON
FSB''
SSB
Sse ,
RSB
.OFC"
'ZONE ORD.•
. LOT SZ
-
', END -
SIDE, ,
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
the permit is for one hundred. ($100) o, less. I certify that in the performance of the work for which this permit -is
issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of,
California.
Date Applicant
NOTICE.TO APPLICANT: If, after making this Gertificateof-Exemption, you should become.subject to the Workers'
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this•permitshall
'be deemed revoked.
DIVISION OF INDUSTRIAL'SAFETY PERMIT CERTIFICATION:
C l hereby certify that no excavation five (5) or more feet in depth into which a person is -required to descend, will be -
made iii 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, Sec 341, Title 8,
C.A.C.)
0 As owner -builder, I'will'nol 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.
0 Division of Industrial SafetyPermit No.
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-
cily.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. Lagree to comply.with all state laws and county ordinances relating to•buidling .
construction, and authorize a'representative of the•City of La Ouinta Department of Building and Safety.to enter
upon the property lorw ioell .hha a applied'for 1'his permit'lorthe purpose of making inspections.
` Signature of Applicant or Agent - Date
Print Applicant/Agent Name
APPL/PRMTDATE
• f { l nin
110-30-8 Pool.' .
. Permit W install all O 0 spa as per
apprtmed plass.
Mech. Fee
9.00
Plan Check'Fee
56:22
Ccnst• Fee
86.50
Elect. Fee
5.00
SMI fee
.74
Plumbing Fee,
5.50
oCT30
TOTAL
FEE
1.62.96
BLDG. DEPT.
VALUATION 10, 000.001
NO.
OPERATION MATE
INSPECTOR
NO.
OP ATION 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
3—z!9: --6
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.
❑
NOADDITIONAL INFORMATION
J
_
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-
PLUMBING APPROVALS
15 Ground Plumb
16 Water. Piping S g5 4
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
T
PIL. P/L
STREET NAME
26 Power Pole"
27 Conduit
28 Seivice Entrance
29 Wiring
29A Grounding Wire 3 –S
29B Bonding
30 Fixtures
31 - Service
32 Final