0339 (SATT)•,v- "`"� ` �" CQ•C�'
, I .PERMIT APPLICATION
r
City of La
Y : Q • �
Duinta » - '!'.
a Department of Building
and Safety
• This permit becomes void if work not commenced within 180 days from date of issuance. OR, if work has been suspended or abandoned lora-period of 180 days.' r
t. ' . - '• + . r
CERTIFICATE OF EXEMPTION FROM WO RKERS'COMPENSATION INSURANCE: This section need not be completed if
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I'am licensed under provisions ohChapter 9 : '
the permihis for one hundred ($100) o, less. I certify that in the performance of the work for'which this permit is
(commencing with Sectiod'7000) of Division 3 of the Business and Professions Code, and my license is in full force
issued. I shall not employ any person inany manner so as. -0 become subject tothe Workers`Compensation laws of
and effect.
California. ^• i
License Class Lic. Number
Date Applicant
Date ' • ' ' - "' • Contractor ••.• .. -
NOTICE TO APPLICANT: It, after making this•Certificate 0- Exemption; you should become subject to the Workers' ~^
• OWNER -BUILDER DECLARATION:' '-I hereby affirm that I am exempt from the Contracto'r's License'L•aw for the'
Compensation provisions of the Labor Code, you must fo,thwilh comply.with such provisionsorthis perm_it.shall -
following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to.,'
be deemed revoked..
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 that he is licensed .pursuanttothe.provisionsoftheContractor'sLicense Law ".
=.0fhereby certifythat noexcavation five (5)ormorefeetif depth into which' a person is required todescend,wifl.be ,
(Chapter -9 (commencing with section 7bOO) 01 Division Sof the Business and Professions Code) or that he is exempt••',
.' made in eonnection.with work authorized by this permit, and that no building structure, scaffolding, talsework, or ."
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit '
demolition or dismantling thereof, will be more than thirty, six (36) feet high. (Chap 3.2, Grp 2,'Art'2, Sec341, Title B.
subjects the applicant to a civil penalty of not more than five hundred -dollars (5500.):, -.
C.A.C.) _
.it 0 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 wcrk which wouldfrrequire a permit tram the. Division of -
structure isnot 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. •' ^' r
Law does not apply to an owner of property who builds, or improves thereon, and who does such work himself or •
,w �,
0 Division of Industrial Safety Permit No.
through his own.employees, provided that such improvements are not intended or offered for safe..lf, however; the- • -
-
building orimprovemntissold Within one year ofcompletion. the.owner-builder will have the burden of proving that;;•.
Date Applicant
he did not build or, improve.for the purpose of sale.).
a-
�..
CONSTRUCTION LENDING AGENCY: 1 hereby affirm that there is a construction lending agency for the performance -,-i
0 I, as owner of.the property, am:exculsively contracting with licensed contractors toconstruct the project (Sec:..
ofthe work for which -this permit is issued (Sec.'3097, C.v. C.). - • - - • - '-'�=
7044, Business -and Professions Code:. The.Contractoi s License Law does not apply to an owner of property who -
Lender's Name r
builds or improves thereon, and who'contracts for such projects with a contractor(s) licensed pursuant to the
• ZONE ORD 0 -: '
Coniraclor's License Law.). ,
Lender's Address
0=1 am exempt under Sec. B. 8 P.C. (Attached Certificate).
I certify that I have read this application and state that th. above information istcorrect. I agree to comply with all '•
l
Date" Ownec "' "'
city and county ordinances and state laws relating to buil ling construction, and hereby authorize representatives
of this county to enter upon the above-mentioned properly 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 , 6r.a certified copy -thereof (Sect 3800. Lab: C.)
Signature of Applicant or Agent bate *,
Policy No. Company.'.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF EIITRY: I I have this and that �*
'0'Certified copy is hereby furnished. .... Y•'...
certify read application state
the information given is correct. I agree to comply with al state laws and county ordinances relatingto buidling
' ❑Certified copy'is filed with the City Builoing I. ;p ionDepartment or City + ' Department.
,
construction, and authorize arepresentative of the City of La Duinta Department of Building and Safety to enter • :•
' s
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• : ,! / c � • ,
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upon the property for which I have applied for this'perrrii for the purpose of making inspections.'.
Date /f/- Applicant /• , J ,
_
Signature of Applicant or Agent Date ,
Print Applicant/Agent Name
APPLICANT NAME (L; F. MI) " ' '•
La Qu nta Joint Vemture
ADDRESS'.
P. 0. BOAC 780
CITY/COMMUNITY/STATE/ZIP -
La-,QuIas'CA,
�92253
JOB 7*ADDRESStSPACE �.
.50-066 Calle R^sarzta
CY M
CO, MUNI t/^T:TE/Z� 92253-
iJGl
���
P -o6
PRC
VT
CT
Plan Check Fee ' 291..20
TWN
RNG•
SE.'
S .
TRACT '
14496-1
LOT
146
-
1
MOO
1 i-3
[se
TRACT NAMantaE Cbw .. -
OWNER NAME (L. F. MI) -
CONTRACTOR -FIRM NAME
Andan • C =peratim
ADDRESS' -
P. 0, B= 780 -
CITY/COMMUNITY/STATE/ZIP - -
La Quints„ CA -92253
PHONE t" -
619--i564-1315333762
LICNC
ARC/ENG FIRM NAME - •••
ADDRESS - - - -
CITY/COMMUNITY/STATE/ZIP - ..
PHONE 0
LICNC 0 -
- -
OFIT
gle F=i ly Dwelling
BL-'
ZON;
FSB
SSB
SSB
RSB
OFC:
• ZONE ORD 0 -: '
LOT SZ
.{..
END
"SIDE.
APPL/PRMT DATE
Sib—
Penni•t to Omistruct Andel P -3-A '
Dwelling (1st Flaor)� 1,616 Sq. Ft. .
(2nd Flaor) 277 Sq.' �It. - -
Porch'_'
SQ. ft.
Gage '433 Sq. =Fto ,
Aiectiknical Fee 31.00 .. -... ,
Plan Check Fee ' 291..20
Canstrnetieh Fee 44$.00
El al Fee 31.25 ' ...
SMI Fee 7.39.
Plumbing Fee 52,50 -
Property Developulent Fee 450,00'.-
TOTAL '
f'1 '
-: FEE '• • $ 1.311.34.
BLDG. DEPT:
VALUATION $105,699.40 1 y
NO.
OPERATION DATE
INSPECTOR
NO. OPERATION DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33 Ventilation System
2
Ftgs & Frms
/p b
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.
❑
NADDITIONAL INFORMATION
O.
NO.
/QPM
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 L41 ZZ 13 Z Al
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage. Disposal
20 Sewer. �� 3
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test��c
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
PSL
STREET NAME
P/I
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final