0377 (SATT)PERMIT APPLICATION�' Y3
City of La Duinta � �f-
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 for a period of 180 days.
r . CERTIFCATE 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 to the Workers'Compensalion Laws of
and effect. - California.
License Class Lic. Number Date Applicant
Date Contractor
OWNEWBUILDER DECLARATION: I hereby affirm that 1 am exempt from the Contractor's License Law for the - k
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 jcommencing with section 7000) 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.):' rc;"a••. -
O I, as ownergf 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. 71344.. 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 i mprovemnt 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.). ^•,<r ,
O I, as owner of the property, am exculsively contracting with Iicensed'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.).
O l am exempt under Sec. . B. & 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 , or a certified copy thereof (Sec. 3800. Lab. C.).,
Policy No. Company
O Certified copy is hereby furnished.
• CertJted copy is filed
/withahe City Building InspectiourvD a 2ftmenl of City Department.
Datel a�r3l� Applicant.Fr (��010_
Tr
AP, ,P,�,ICA NAME. L( _F._MI)_ __t CA��tim of Wifomia
�f!'�llf7f7^P^fh
ADDRESS '
P. n. Box 1000
cLlT�r/cOM_ - MUNITrta,TE/z1C 92253a�
J! �_I(13"Ll�4+ft5'+M`�SS/SPA-CE �^ Fe=ianc 3 '
r,�TE/zIP
cl�a Quina
LCA 92253
BOK •
PAG
PRC
C
-
TWN
RNG
SE
S
18765
`DTl
296.08
Fee
E D
SB
-Fit 4
TRACT NAME
Ie ms Club Villas
"i iognent Corporation of California
CONTRACTOR -FIRM NAME
ADDRESS
P. 0. Box 1000
CITY/COMMUNITY/STATE/ZIP
cl�a�ia
LCA 92253
PHONE 0
345-12888
LICNC
413636
'
ARC/ENG FIRM NAME "
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE M
LICNC M
s�_ E OF PERMIT F/D W/AttacYaed Garage
BLL
Z�ONr'
FS8
ss8
SSB
RSB
OFC'
ZONE ORD ".
LOT SZ -
z END
SIDE
NOTICE TO APPLICANT: It, 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 l hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be
mai a in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
-demolition or dismantling thereof, will be more'lhan thirty-six .136j feet high. (Chap'3.2, Grp 2, Art 2, Sec341: Title8,
C.A.C.)
O As owner -builder, 1 will not employ anyone to do work which would require a permfl from lhe`Division.of
1ndustriM'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. Q.
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 Department of 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
APPL/PRMT W.77.1.
2L-TI3-83DA
C Mb
PlendtWild ild 2,382
Sq. Ft. of O ninium
and Gars
nlca-1 Fee
$ .28.50
Plan Che& Fee
296.08
Fee
455.50
Elec- tical Fie
37.51
SNI Fee
7.60
Plumbing Fee
71.00
Property Developrent Fee
450.00
1988
TOTAL
Is 1,346.7.9
BLDG.DEPT.
r '
VALUATION $108,249.2
NO.
OPERATION DATE INSPECTOR
NO.
OPERATION DATE INSPECTOR
BUILD•ING,APPROVAL•S
MECHANICAL APPROVALS
1
Set Back
33 —
' ' VentilationzSystem
2
Ftgs & Frms
34
Plenums.& Ducts
2A
Slab Grade
35
:Furnace Conipart.
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.
❑
NOADDITIONAL INFORMATION
!�
�EJB
, P SrV/ e TZt�
SEWAGE SYSTEM SIZE & .LOCATION
11 Exterior Lath
12 Internal Lath'/2%'G�
12A Drywall
13 Finish Grade
INSULATION Thick R ValueR
7A Walls (Batts)
12B 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 �7 ,
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR -OF PROPERTY LINE
P/L P/I
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance A 06
29 Wiring -
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
N