0832 (SATT)PERMIT APPLICATION
City of La Ouinta
• • 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.
• ` �• ••
. 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 provisionscof 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)'ol Division 3 of the Business and Professions Code; and my license is in full force.- • • •
issued, l shall not employ any person in any manner so asto become subject tothe Workers'CompensationLaws of
and effect.
California.
License Class. — Lic. Number
• Date Applicant'
Date - Contractor. . • -
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers', -
OWNER -BUILDER DECLARATION: I hereby affirm Ihaf' I,am exempt from the.Contractdr's'Lrcense Law lor'the ',•
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit 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 pursuantlothe provisionsofthe Contractor's License Law ,
'-0 1 h6reby certify that no excavation live (5) oir'more feet in depth into which a person is required to descend, will be
(Chapter 9(commencing with section 7000) of Division 3.of the Business and Professions Code)orthat he 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-six (36) feet high. (Chap 3.2; Grp 2 Art 2, Sec341; Title 8. '
subjects the•applicarttto a civil penalty of not more than five hundred dollars (5500.):
C A.0 p .' . ' x
0 Las 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 noted above, unless such person has a permit to do such work from that divisionr,
Law does not apply to an owner of property who builds, or1mproves thereon, and who does such work himself or '
-.
through his own employees, provided that such improvements are not intended or offered forsale. If, however the, ,
0 Division ,41 Industrial Safety Permit No. ;
building orimprovemniissold within one year ofcompletion, theowner-builder will have the burden of proving that.-,,,:,,
Date' Applicant'
L 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
0 I, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec:
1; 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
—
' ,
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the -
Lender's Name
.
Contractor's License Law.).
Lender's Address
❑ I am exempt under Sec:' B. 8 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
Oat I'f Owner
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
END,
of this county to enter upon the above-mentioned property 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 ; or a certified copy thereof (Sec. 3800.1ab. C.)..
Signature'of Applicant or Agent' Date
Policy No. Company
CERTIFICATE OF COMPLIANCE'AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that -
-0 Certified copy is hereby furnished. zik..
the information given is correct. I agree to comply with all.state laws and county ordinances relating to buidling • . ,
0•Cerlified dopy is filed with the City Building Inspection Department or City: ' Department.
construction, and authorize a representative of the City of La.Ouinta Department of Building and Safety toenter
— -•
Date Applicant
upon the property for`which I have'applied'for this permit -for the purpose of making inspections.
Y.
Signature of Applicant of Agent Date
nPrint Applicant/Agent Name
APPLICANT NAME -(L. F. MI)
Mr. _liJ'[XI'#_nt_ (brn.
ADDRESS ... .'_ • ,
.()- PDX 1000
CITY/COMMUNITY/STATE/ZIP �yy YUNl,iTr/sT� E/n�P 92253 - - •. • .
JOB SIT, ADORESS/SPA E
78-1I �le Norte
CITY/COMMUNITY/STATE/ZIP -
La Quinta, CA 92253
BOK -.
PAG
PRC.
C
TWN•
RING
SE,
.S
TRACT
18767,
LOT-
284.70
Construction Fee
MOO
SB
Uait 53 '
TRACT NAME
.011., OWNER �YiL:�liME ll� E4=m .. C_brm� -
CONTTOR•FIRM NAME
ne
ADDRESS
P.O. Box 1000
CITY/COMMUNITY./STATE/ZIP
Q ,.
La nta, U 92253
P28�2888
ILI04;:3636
Prop. Dev, Fee'
ARC/ENG FIRM NAME Al -
ADDRESS
CITY/COMMUNITY/STATE/ZIP -
PHONE .
LICNC 4
�
USE OF PERMIT Pltunb. Budd.
�. Elect. I 1
BL
ZON
FSB
. SSB .1.
SSB
RSB
OFC '
'TOTAL
FEE •
ZONE ORD M
• LOT SZ : .
END,
SIDE "
APPUPRMT
0.81,&
DATE
6-25-84
COMB
Permit to build 2349
5q. Ft. of
Comdominium'
Mech. Fee'
28.00
Plan Check Fee
284.70
Construction Fee
438.00
Elect.Me , '
36.54
Steil Fee
7.11
- Slumb: fee
55.50
Prop. Dev, Fee'
450.00
�^
'TOTAL
FEE •
1,299.85
VALUATION •101,037.40'.
• BLDG. DEPT. -
r-1
F-1
NO.
OPERATION
_,ATE
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 (9,4,e Gv t3GLS
'/ "
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
GaragekFi r"ell
42 Commercial Hood
10
Fireplace P. L. ❑
43 Final
IDA
Fireplace T.O. ❑
OP'NO. ADDITIONAL INFORMATION
//%/ �/� S �- /
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath �-
12 Internal Lath
12A Drywall13
Finish Finish Grade
INSULATION Thick R
Value
7A Walls (Batts) A 1,
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb O /r
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 4
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
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final