0829 (SATT)PERMIT APPLICATION
City of La
Duinta
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. .
BON ' ` 'PAG
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed it
LICENSED CONTRACTORS' DECLARATION: 1 hereby affirm that I am licensed under, provisions. of Chapter -9 -
the permit is for one hundred ($100) o, less. lcertify 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 lull force '+
- issued. I shall not employ any person in any manner so as to become subject to the Workers'CompensationLaws of
and effect.
California.
License Class Lic. Number
Date Applicant '
Dale "- Contractor r - --
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 the Contractor's License Lawlor the f.
C.: Compof 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 pursuant to,the provisions of the Contractor's License Law
"'O1herebycertifythatnoexcavationfive (5)ormore feet indepth into which apersonisrequired todescend,willbe .
- (Chapter 9(commencing with section 7000) of Division 3 of the Business and.Protessions Code)or that he is exempt,
made in connection with'worRauthorized 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, Titlell.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500:): s. ra;_4.
C.A'.C.)`
• O I, as owner of the properly, or my employees with wages as their sole compensation, will do the work; and the <.
O As owner -builder, 1 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'Iioted above; unless silch'person hag 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 . •
USE OF PERMIT Elect. . Plurb. BuIld
•through his own employees. provided that such improvements are not intended or offered for sale. II, however, the x
.O Division of Industrial Safety:Permit No.
building orimprovemntissold within one year ofcompletion, the owner -builder will have the burden of proving that '.
•Date T Applicant'.he
did not build or improve for the purpose of sale.)i r; :.1. •'
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance •
O 1, 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
builgs or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
.
Contractor's License Law.).
Lender's Address
O 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 alb '
�' : • ••
.Date .. _ i , • � Owner •''. ' .: • _
city and county ordinances and state laws•relating to building construction, and hereby authorizeirepresentatives .
'
"WORKERS' COMPENSATION DECLARATION:I hereby affirm that I have a certificate of consent to self -insure, ora
of this county to enter upon the above-mentioned property for inspection purposes.
cehificate 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
O 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 Certified copy is filed with the City Building lhn pection Department or City ' :Department.
construction, and authorize a'repre'sentative/of the City of La Ouinta Department of Building and Safety to enter
' - v • . -
Date Applicant
uponntthee,property for4which I have applied for this permit forthepurpose of making `inspe'ctions.%' �i y
/
�'.0
GY/� "'�� (�
L T Signature of Applicant or Agent Date
—
Print Applicant/Agent Name -
AA `u �WIV E't -1:42 rit aDrp. '
r*V* Box 1000
CIS 4'i°O'�"Muuirai'.sjA; E/ZI p, 92253
JOB SITE ADORESS/SPACE -
78=155 Calle Norte
CITY/COMMUNITY/STATE/ZIP
La Ouint a CA 92253
BON ' ` 'PAG
PRC
C
.28.00
TWN..
FIND
SE.
S
TRACT
18767
LOT
SHI Fee
_
MOD
I SB
r Unit 50
""aM�OWNEREL,a Quasita, Phase II
tL �xJ fVr 'rt,L F Mlf�t Corp,
CONTRACTOR -FIRM NAME -
ADDRESS
levv Box 1000 _
CITY/COMMUNITY/STATE/ZIP
�y NIS /STA=ta'E/Z . 92253 •' . ,. '
` 2888 IONE
4 636
ARC/ENG FIRM NAME
ADDRESS - -
CITY/COMMUNITY/STATE/ZIP -
PHONE .
LICNC•
USE OF PERMIT Elect. . Plurb. BuIld
BL
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ZON
J.
FSB
-SSB
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OFC'''•
ZONE ORD a ,' _
LOT SZ
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END i
SIDE' . •y
APPUPRMT DATE
0879 6-25-84
COBB.
Permit to build.2349.Sq. Ft. of
Condominuim
Mech Flee -
.28.00
Plan Check Fee
260:00
Construction Fee
400.00
Elect. Fee
33,54'
SHI Fee
6,10
Plumb. Fee
53,00
Prop. Dev. Fee
450,00
.. TOTAL'.;.,•
FEE
230.74
BLDG. DEPT. VALUATION 88,672.60 •
• -• •
Ah
Ah
NO.
OPERATION
ATE INSPECTOR
NO. OPRATION 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 61Ae
36 Inlets & Outlets
4
Grout Blocks
37 Combustion Air
5
Bond Beams
38 Compressor.
S
Roof Deck
%a
39 Appl. Clearance
7
Framing o
z- 440
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. ❑
OP'NO. ADDITIONAL INFORMATION
� _2- !�
J Q
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall p9 D S
13 Finish Grade
INSULATION Thick
Value
7A Walls (Batts)
128 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/aGn%Q
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
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