0782 (SATT)PERMIT APPLICATION
. City of La Quinta• /
Department of
Building and Safety
• This,permil 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„
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATIONINSURANCE: This,section'need not becompleted if ,
LICENSED CONTRACTORS, DECLARATION: I hereby affirm thal'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 inanymanner soas to become subject to the Workers'Compensation Lawsot
and effect.
California. t
..License Class Lic. Number
Date Applicant
Date "Contractors -;NOTICE
TO APPLICANT: If, after making this Certificate ol,Exemption, you should become subject to the Workers' '
OWNER -BUILDER DECLARATION: I •hereby affirm that 1 am exempt from"the`Contractor's License Law for 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 r,
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,permittofile asigned statement that heislicensed pursuant lothe provisions ofthe Contra ctor'sLicense Law •`
01 hereby certify that noezcavationlive (5)ormore feet indepth into which aperson isrequired todescend. will be -
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code)or thathe is exempt. , •
made in connection with workauthorized by this permit, and that no building structure, scaffolding, lalsework, or,
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit;,
demolition ordismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2. Sec341. Title8,
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 Contractor's License
- . Industrial Safety, as noted 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-
,.
-through his own employees, provided•that such'improvements are not intended or offered for sale. If, however, the,. • .
O,Division of fndustri� Safety Permit No.
• building or improvemnt is sold within one year of completion. the owner -builder will have the burden of proving that
Date- - Applicant.
he diQ not build, or improve for the purpose of sale.).
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending7agency for the performance
...0 I, as owner of the properly, 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
•LOT SZ
Contractor's License Law.). _ _
Lender's Address
,.0 1 am exempt under Sec. - — :.B. 8 P.C. (Attached Certificate).:.
: - , I certify,that I.have read.this application and state that the above.informationis correct. I agree to comply with all. ..
'Date Owner
: 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.
WORKERS' COMPENSATION DECLARATION: I hereby affirm than have a certificate of consent to self -insure, or ' `J
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 I have read thisapplication and state that
• 0 Certified copy fs hereby furnished. ,
M.,
'
the•information given is correct. I agree�to`comply with all state laws and county ordinances relating to.buidling
constructio0and autl�rize a'representative of the City of La Quinta Department Building Safety to
0 Certified copy is•liled with the City Building Inspection Department or City 5• ' • Department.' ..
Date Applicant
of and enter
upon the,property for which I have applied for this per ft for the purpose of mmaking irLspectiio�ns.
Signature of Applicant or Agent Date'
APPLICANT NAMEL: F, MI)
UM Develo'pment Corp.
ADDRESS - - -
P.O. Box 1000
CITY/COMMUNITY/STATE/ZIP
La Quitta, CA 92253
JOB SITE ADDRESS/SPACE •: ,
78-160 Calle Norte
CITY/COMMUNITY/STATE/ZIP r
La Quinta, CA 92253
BOK :PAG
.PRC.
C
a
TNM'
AND
SE
S
.TRACT
18767
LOT,'
54.83
SMI Fees �'° �.� y=`�
MOO
so
'Unit 3
TRACT NAME •'
Duna La Quinta Phase 11
OWNER NAME (L. F. MI)
LM Development Corp.
CONTRACTOR -FIRM NAME
Same
ADDRESS
P.O. Box 1000
CITY/COMMUNITY/STATE/ZIP
La'Quinta. CA 92253
PHONE ...
345-2888
LICNC .
413636
r
ARC/ENG FIRM NAME • ,::., ” _
ADDRESS _
CITY/COMMUNITY/STATE/ZIP t .
PHONE A
..,
LICNC
..,
USE OF PERMIT -
Comb.- Elect. Plumb. MR*
BL
ZON
FSB SSB SSB
RSB -
•OFC
ZONE ORD
•LOT SZ
,, END - ,
SIDE.. ,
Print Applicant/Agent Name
APPI/PRMT DATE
6_-25-84 �
• COMB .
Permit to Build 3868 Sq Ft. of
condominium
Mech-. Fee $
38,00'
PW Check Fee-
404.95
Condt. Fee
-623.00
Elect.'Fee
54.83
SMI Fees �'° �.� y=`�
12.29
Plumb, FRe'
75,50
Prop, Development Fee'
'750.00
--TOTAL
1,958,57..
• VALUATION 175,256.80
BLDG. DEPT.
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
//cz
35
Furnace Compart.
3
Steel
Q
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
OBD
39
Appl. Clearance
7
Framing
o2s
40
Fire Damper
8
Vents
41
Smoke Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P. L.
❑
43
Final
10A
f=ireplace T.O.
❑
NON ADDITIONAL INFORMATION
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_
I
�,� o � � •) 5
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SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R.
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb -7
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test /Q
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
PSL PyI
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring �3
29A Grounding Wire ap -
29B Bonding
30 Fixtures
31 Service
32 Final