0389 (SATT)PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
?7-3/7.
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.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that l.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.
License Class Lic. Number
Date Contractor -
OWNER -BUILDER DECLARATION: I hereby'affirm that I am exempt from the Contractor's Licensefor 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 7000j of Division 3of the Businessand Professions Code) or that he is exempt
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.):
O I. as owner of the property, or my employees with -wages as their sole compensation, will do thework. and the
structure is not intendedor 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.).
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 in 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.). .
O 1 am exempt under Seca B.4 P.C. (Attached Certificate). '
J.
Date. Owner -
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have'a certificate of consent to self -insure, or a
certificate'ot Workers' Compensation Insurance ,ora certified copy thereof (Sec. 3800. Lab. C.). '... '•'
Policy No. Company
O Certified copy is hereby furnished. • . ; >a.v+ _.
O Certified copy is filed yr the City Building Inspectioyn7p�epa�meennUrr City Department.
Date �, r Applicant
�v
AP (CANT INAME (lF, MI„ ) t o f cAl f f�ya
1 AY�7.Y1•`p"/'1+
ADDRESS '
P. 0. BM 1000
CITY/COMMUNITY/STATE/ZIP '
Ia Q Uinta, CA 92253
JOB I25TI SKveWAa PAC F ..
CILaQWnta, SCA 92253-
2253-BOK
BOK
PAG
PRC
C
Plan Chwk Fee
TWN
RNG
SE
S
TRACT
18765
LOT
1
6.34
Plumbing Fee
MOD
Cit
SB
Unit 16
TRANAME ^
itL1i s Club Vilas
DWN,; E.g3NAr�E_-(L. F,i t CA,rpo atim of Cal folrn.�I,a
CO Tmfl_RAC?�, ORS -FIRM NAME
ADDRESS F* 0, Box 1000
CI Y/COM uNITrrsta, ZIP 92253
PH3454--22J8-�8�8W
tlC1 4 1988
L413636
Cstr r L" �83i 6
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE n
LICNC •
'
USE PERMIT
�JrliS/F/D W/Attached Garage
,
BiAiZON
L
FSB
SSB
SSB
RSB
OFC
• ZONE ORD 1 ,
LOT SZ
.END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE: This section need not becompleted 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:- W aftermaking 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 l hereby certify that no excavation five (5) of more feefin 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 ordismantling thereof, will be'more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec341, TilleB,
C.A.C.)
O As owner -builder, 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.
O 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 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, and authorize a representative of the City of La Ouinta Departmenrof Building and Safety to enter
upon the property for which I have applied for this permit for the purpose -of making inspections.
Signature of Applicant or Agent
Print Applicant/Agent Name
Date
APPUPRMT n i n g 1.DATE
2 1_1-83 colDJ,
Pemit to build 2,083 Sq. Ft.
of Candminium
and Garage
Mechanical Fee
$ 28,50
Plan Chwk Fee
263.90
Cmistructim Fee
406.00
Electrical Fee
33.78
SMI Fee
6.34
Plumbing Fee
68.00
Pm!PextY Development Fee
450.00
F
tlC1 4 1988
Cstr r L" �83i 6
TOTAL
FEE
$ 1„256.52
BLDG.DEPT.
VALUATION $90,705.80
NO.
OPERATION DATE
INSPECTOR
'NO. OPERATION DATE INSPECTOR
BUI.LDING.•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
�C
40 Fire .Damper
8
Vents
41 Smoke Detection Device
9
Garage Fire -Wall
42 Commercial Hood
10
Fireplace P.L.
ED
43 Final
10A,
- fireplace T.O.
❑
NOADDITIONAL INFORMATION
4
PSN
SEWAGE SYSTEM SIZE .& LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
t3 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb / 6
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
ELECTfIIC.APPROVALS
-REAR-OF PROPERTY LINE
P/L P%I
STREET NAME
26 'Power Pole': �'
27 Conduit
28 Service Entrance
•29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final