0387 (SATT)PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
77.3.2t :�.
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.
ADDP, 50. Baas 1000
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
' LICENSED CONTRACTORS DECLARATION: I hereby affirm 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 not employ any person in any mannerso asto become subject tothe Workers' Compensation Laws o1
and effect. -
California. '
License Class Lic. Number
Date Applicant
--'Dale Contractor.
NOTICE TO APPLICANT: If, after making this Certificate of Exemption,.you should become subject to the Workers' •'
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from th Contractor's License 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
6.90
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.thatheislicensed pursuant totheprovisions ofthe Contractor'sL•icenseLaw,
❑ Iherebycerfitj that no excavationfive(5)ormorefeetindepthintowhichapersonisrequiredtodescend,willbe
' (Chanter 9(commencing with section 7000) of Division 3 at the Business and Professions Code) or thathe 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 exemption. Any violation of Section 7031.5 by any applicant for a permit
demolition or dismantling thereof, will be more than thirty-sik (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341. Title 8.
subjects the applicant to a civil penalty of not more than,five hundred dollars ($500.):
C.A.C.) '
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 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 Contractors License
Industrial Safety, as hotel above, unless such person has a permit to do such work from that division.
Law does not apply to an owner of property who builds, or improves thereon, and who does such work himself or.
CITY/COMMUNITY/STATE/ZIP
through his own employees, provided that such improvements are not intended or offered for sale. If, however, the
0 Division of. Industrial Safety Permit No.
building or improvernnt is sold within one year of completiw the owner -builder willhave the burden of proving that
Date Applicant
he did not build or improve for the purpose of sale.)+;'
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
❑ I, as owner of the 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
❑ 1 am exempt under Sec. ::.B. & P.C. (Attached Certificate). :
I certify that I have read this application and state that the above information is correct. I agree to comply with all
Date Owner
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
LOT SZ
of this cdunty'to'enter upon the above-mentioned property for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I havea certificate of consent to self -insure, ora'
END
certificate of Workers' Compensation Insurance , 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 l have read this application and state that
D Certified copy is hereby furnished.
the information given is correct. I agree to comply with all state laws and county'ordinances relating to buidling
O Certifie l t or'City DepartmenG
cop is wr wen
d tiith the City Building Inspection Dep
construction, and authorize a,representative of the City of La Ouinta Department o1,Building and Safety to enter
���
upon the property for which I have applied for this permit for the purpose of making inspections.
Date Applicant
APPLICANT ME (L..F, MI Dration & cali fmi a-
ADDP, 50. Baas 1000
CITY/COMMUNITY/STATE/ZIP a�,�,,,
.222, 5,3,^aa
,A
JOBySITE 32.1 j,� PACVCrIIiJ.iGl Fevw t/� .
//�Y/COMMU,___
CI Ii, ta,, ICA 92253
BOK
PAG
PRC
C
Plan Check Fee
TWN
RNG
SE
S
TRACT
1765
LOT
1
6.90
PluibiM Fee
GD-
SB
.
nit 14
Unit
TRACT NAME
Y mus Club Villas
OWNiMot Cay4Toirnia
CONTRACTOR -FIRM NAME .. .. ,
SS
ADP* 0, Box 1000
r ITY/CO Q=ta� ZICA 92253
PHONE w
X15-2888
L1CNC n
413636
s
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE*
LICNC N
USE Or„EJPj, ITS/F/D W/7►ta....�hed /,•,rage
= / �.l LSSILEI
8L
ZON
FS8
SS8
RSB
OFC
ZONE ORD
LOT SZ
END
. SIDE.
Signature of Applicant or Agent
Print Applicant/Agent Name
Date
APPUPRMTDATE
0,87 l2+83*
Permit to build 2187 Sq. Ft. of
and Garage
Mechanical. Fee-
$ 28.50
Plan Check Fee
279.50
Clonstructicn Fee
430.00
Electrical. Fee
35.08
Sly Fee
6.90
PluibiM Fee
68.50
Property Development Flee
450,00
A
4 i983
-
s
TOTAL
T L
$ 1,298.48
BLDG.
VALUATION $98,724.20
DEPT.
5.
Bond Beams
NO.
OPERATION 'DATE INSPECTOR
NO.
OPERATION DATE INSPECTOR
%-
BUILDING APPROVALS
7
MECHANICAL APPROVALS
1
Set Back It
33
Ventilation System -
2
Ftgs & Frms
34
Plenums & Ducts +
2A
Slab Grade
.35
Furnace.Compart. '
.3
Steel
36
Inlets & Outlets
I 4.
Grout Blocks
37
Combustion Air
5.
Bond Beams
38 1 Compressor
6
Roof Deck
r�? p
%-
39 "Appl. Clea rarice"
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
11
Exterior Lath
`
3 �O `T
/
? rr
1.2
.Internal Lath
.Internal
_/P
(/
12A
Drywall
/
13
Finish Grade
INSULATION
Thick R
Value
7A
Walls (Batts)
/
ca
� �q gLf • c,— "✓
I
>
126
Ceiling (Batts)
S(V
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
S1472
f -1-
'
25
25
Final
I
^%R#A01
ELECTRIC APPROVALS
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire j
29B Bonding
30 Fixtures
31 Service
32 1 Final
Tank
E SYSTEM SIZE atION
Pit L..Line
REAR OF PROPERTY. LINE
P/L P/L
STREET NAME