0390 (SATT).LICENSED CONTRACTORS DECLARATI
(commencing with Section. 7000) of Divi
and effect.
License Class Lic..Numher
Date Contractor
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 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 70M) 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 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 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.).
. 0 I, as owner of the property, am exculsively contractingwithlicensed 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 contractors) licensed pursuant to,the
Contractor's License Law.)..
0.1 am exempt 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 , ora certified copy thereof (Sec. 38M. Lab. C.).
Policy No. Company
O Certified copy is hereby furnished. ..
0 Certified copy'is file/w/ith the City Building Inspection Department oreCity Department.
Dates W/3/d�! 3 Applicant
PERMIT APPLICATION
City of La Duinta
Department of Building and Safety
i•
This permit becomes void if work not commenced within 180 days from date of issuance: OR, if work has been suspended or abandoned.for a period of 180 days.
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
DN:.I hereby affirm that -1 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, I shall not employ any person inany mannersoasto become subject to the Workers'Compensation Laws of
California.
AP LICANT NAME (L F, MI,_ t t ��im of
�'�'^�iy£'aTTM`�p"n� f �1,f�ia
i
ADDRESS _
P. O. Boat 1000
CITY/COMMUNITY/STATE/ZIP
la Quinta, CA 92253
JOB SITE ADORESS/SPACE
77-315 Avenida F'e mando
CITY/COMMUNITY/STATE/ZIP
Ta Quinta, CA 92253
BOK
PAG
PRC
C
Plan Check Fee
TWIN
RNG
SE
S
TRACT
18765
LOT
l
6,34
Plumbing Fee
MOD
C
SB
Mdt 17
TRACT NAME -
�nis Club Villas
OWNER NAME (L. F. MI)
JTiA�Jl}LTJ Qarmoratcn of California
CONTRACTOR -FIRM NAME
Same
ADDRESS -
P. O. Bow 1000
CITY/COMMUNITY/STATE/ZIP
La Quinta,. CA 92253
PHONE •
345-2888
a
198
LICNC
413636
(114
cit 0:I En .}
, ` S
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE N
LICNC •.
USE OF PERMIT
Cbsd: 5/F/D W/Attached Garage
BL.
ZON
- FSB
SSB
SSB
RSB
.OFC,
' ZONE ORD M -
. LOT SZ .
END
SIDE.
.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: .
O 1 hereby.certifythat no excavation five (5) or 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 be more than thirty-six (36) feet high. (Chap 3.2; Grp 2: Art 2, Sec 341, Title 8,
4 C.kc:)
0 As owner -builder, I will•nol employ anyone to do workwhichwould-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 Safety Permit 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 1 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 l have read this application and state that
the information given is corre0d agree 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 for which) have applied for this permit for the purpose of making inspections. .•
Signature of Applicant or Agent Date
Print Applicant/Agent Name
.APPVPRMT DATE
q0 12�"J�83
�.
Permit to build 2,083 Sq. Ft. of donf5aminiwn
and Garage
Med" cal Fee'
$ 28.50
Plan Check Fee
263.90
Oanstructi�an Fee
406.00
FlectricIal Fee`
33.78
SMI Fee
6,34
Plumbing Fee
68,00
Property D�Lo�n�ent Fee
450.00
a
198
(114
cit 0:I En .}
, ` S
4L I
TOTAL
FEE
$ 1,256.52- -
VALUATION $90,705.80
BLDIa. DEPT.
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
A
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.
❑
NPON ADDITIONAL INFORMATION
� I ,a
syr/
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath 0 /�
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick . R
Value
7A Walls (Batts)
128 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 Service
24 Gas Test S
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
P/L PA
26 Power Pole
27 Conduit
28 Service Entrance
.29 Wiring 3
29A Grounding Wire L� j
29B Bonding
30 Fixtures
31 Service
32 • Final
STREET NAME