0783 (SATT)PERMIT APPLICATION
• City of La Ouinta
Department of
r
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 it .
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, l shall not employ.any person in any manner so asto.become subject tothe Workers'CompensationLaws of*
and effect. -
California. -
License Class Lic. Number.
Dale 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 that I am exempt from the Contractor's License Law for the +v
Compensation., provisions of the Labor Cade, you musLforthwith comply with. such provisions or this permit'shall
' 'C
following reason (Sec. 7031.5• Business and Professions Code: Any city.or county which requires a permit 10
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.tothe provisions oftheContractor's License Law
plherebycertify.fhatnoezcaJationfive(5)ormorefeetindepthintowhichapers'o'nisrequiredtodescend,willbe
' (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; talsework; or '
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for #,permit. _ :
demolition or dismantling thereof, will be more than thirty-six (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.): e:!+vi?.
C.A.C.). , +
O.I. as owneF 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; orimproves thereon, and who does such work himself or
r • • T
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 improvemnt is sold within one year of completion. the owner -builder will have the burden of proving that '
Date Applicant
he did not build or. improve for the purpose of sale.)..•+: . . >
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CONSTRUCTION LENDING AGENCY: I hereby affirfhUiat there is" a construction lending agency for the performance
' O 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. 30979Civ. C.).. .'
7044, Business and Professions Code: The Contractor's License Law does not apply to an owner 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
0 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. ) agree to comply with all'.
Date ' Owner
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
-
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.
certificate of'Work_ers' Compensation Insurance .or a certified copy thereof (Sec. 3800. Lab. Q.
Signature of Applicant or Agent t • Date '
No. Company
" CERTIFICATE OF COMPLIANCE AND AUTHORIZATION�OF ENTRY: I certify lbave read this application and state that -
0
O Certified copy is hereby furnished
Ger,
the.information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
0 Certified co Is filed with the Cit BuildingInspection Department fir Cit De artmeilt.
DY y D Y p
[construction, and authorize a'representative/of theCityofll a Ouinta Department•of Building and Safety to enter
upon'the<tirtiperiy for whlih I have applied for t is permi for the purpose of making inspections.
Date AppcantD
r / - Signature of Applicant or Agent Date
Y
�
Print Applicant/Agent Name
APPLICANT NAME L. F, Ml) '
-LNL Development Corp
ADDRESS _ .. �. ..
P.O. BOX 1000
CITY/COMMUNITY/STATE/ZIP
La .Quintal► CA 92253
JOB SITE AOORESS/SPACE-
78-154 Calle Norte'
CITY/COMMUNITY/STATE/ZIP
La Quints, CA 92253
BOK PAG
PRC'
C
.
TWN
FIND
' SE--
S
TRACT
•18767
LOT'
SMI Fee
-
MOO
SB
unit 4
TRACT NAME '
Duna La Quinta Phase II
OWNER NAME (L. F. MI) .. -
Y.YS Development Corp.
cuTD
l..lrStylRX NA
Yti00
ADDRESS
La Quinta;, CA -92253
CITY/COMMUNITY/STATE/ZIP .. •. `
PHONE . ' -
345-2888
LICNC ..
413636
,.
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP . - - `• . '
PHONE .
T T
LICNC •
USE OF PERMIT
C6nb.- Elect. Plumb.. Blde.
BL •.
ZON
FSB
SSB SSB
RSB
ZONE ORD . ' • ,
LOT SZ
]_i-,
END
'SIDE
APPL/PRMT DATE
�) 6•-25-84 -
�.
S'
Permit to build 3523 Sq. Ft. of '
Condminium
Mech Fee _
19.00•
Pian Check Fee
330.20
Construction Fee
508.00
'Elect; `Pee �
47.27
SMI Fee
9,07
Plumb. Fee
73,00
- Prop. Dev, Fee
600.00
LLJJ
T T
1,586.54
VALUATION 129,628.00'
BILE -11G. DEPT.'
a
a
NO.
OPERATION DATE
INSPECTOR
NO. OPERATION
DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33 ' Ventilation System
2
Ftgs & Frms
34 Plenums & Ducts
�5 L
2A
Slab GradeW,2(v/
v
35 Furnace Compart.
3
Steel
36 Inlets & Outlets
4
Grout Blocks
37 Combustion Air
5
Bond Beams
38 Compressor
6
Roof Deck
99*
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.
❑
NOADDIT1 NAL JN FORM
�i / -2�5 r•�
��-✓✓ U—zS "'CCCSSS
I ) 1 •�
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath q/�%
12 Internal Lath
12A Drywall ,
13 Finish Grade
INSULATION Thick" R
Value
7A Walls (Batts)
12B Ceiling (Batts)
126 Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb p2S
18 Vents
19 Sewage Disposal _
20 Sewer D
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final
Tank Pit
L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY
P/L
STREET NAME
LINE
P/I
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring ?
29A Grounding Wire U•� e73
29B Bonding
30 Fixtures
31 Service
32 Final