0828 (SATT)PERMIT APPLICATION
City of La Ouinta
• Department of Building and Safety •
. Bcx 1000
C�
'Hy�OMMUNyl�?V�,Z- 7
/STATE/ITyP 92253 a
' This.permit becomes void it work not commenced -within 180 days Irom.date of
issuance, OR, if work has been suspended Ar abandoned for a period of 180 days: , ,= ' '. •-_
' A— I ' •• I • - ,;
•CONTRACTORS
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: -This section need not be completed it' '
LICENSED DECLARATION: I hereby affirm.9hal I am iicensed.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 as to become subject to the Workers'Compensation Laws 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'
•�e rh c - - -
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt frolo the Contractor's License Law for the
Compensation provisions of the Labor Code, you must I rthwith comply with such provisions or this permit shall
� • • V
' following reason (Sec. 7031.5. Business and Professions Cade: 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 lo.file a signed statement that he is licensed pursuant to the pr9visions of the Contractor's License Law
O'lh6rebyceTtifytha'tndex'cavat I ion live (5) or more feet iridepth 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)or that he is exempt•,,, ..
made in connection with work authorized by this permit, and that no building structure. scaffolding, fafsework, 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 applicant to a civil penalty of not morecthan-five hundred dollars ($500.): '
C.A.C.)•
O 1. as owner of the property, or. my employees with wages as their sole compensation, will do the work, and the
O As owner -builder, I will not 'employ� anyone to do work which .wouldrequire a permit from the Division of .
structure is not intended or offered lor.sale (Sec.,7044, Business and Professions Code: The Contractor's License-
.. Industrial Safety. -as noted abm- 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, add 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 olIndustrrial Safety, Permit No.' M
building.orimprovemnl 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.). _
'�'CONSTRUCTION`LENDING AGENCY: I hereby affirm that there is a construction lendingagencyfor the performance
C 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. 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 contractors) licensed pursuant to the
ZONE ORD • .:;:� •,
Contractor's License Law.).
Lender's Address
• •O 1 am' exempt under Sec. .. B. 8 P.C. (Attached.Certificate).' •- .,,
a. I certify that I have read this application and state that the above information is 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 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.). •
'
.'�` 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
-O Certified copy is hereby furnished.• _ - ., „ _ ..
the information given is correct. I agree to comply with all state laws and county ordinances relating tobuidling
O Certified copy is tiled with the City Building Inspection Department or City ` ! Department..' . ••
V
co6struciion, and authorize a' rep(esentative�ot the City of La Guinta Department of Building and Safety to•enter
upo5the property1&-which I hhave applied for this permit for the purpose of making inspections
Date ADDlicant.
' i%�fe7�Ati�af �f Y
Signature of Applicant or Agent Date
APPLICANT NAME (L, F, MI) - , s• '
TMT. rA=7P1nrxTl,'Y1 _ ( Inrn _
. Bcx 1000
C�
'Hy�OMMUNyl�?V�,Z- 7
/STATE/ITyP 92253 a
/S
JOB SITE ADORESSPACE -
78-153 Calle Norte
CITY/COMMUNITY/STATE/ZIP • i -
La Quinta, Ca 92253
BOK PAG,
PRC
C
-
TNM
RNG
SE.
S
TRACT
18767
LOT
SbtC Fee
8.37
MOD
.SB
Unit 49
R{AyCT NAME
TRACT �ta
la la Phaw '
%iy., Tom+ ZI -
OWNER NAME (L. F, MI)
t ;.
e)V4a1 y t C=P. . .
-'
CONTRACTOR -FIRM NAMEADDRESS
4�.U. B= 1000 -
N11Y/sT, E (
clrr/coMMu�w
La v92253
`34.5 =2888
-
`I%�1:i636
ARC/ENG FIRM NAME. - -
ADDRESS
CITY/COMMUNITY/STATE/ZIP • -
PHONE N _-
-
LICNC,N
-
USE �OFb�PERMIT E • Pl rb.. Build.
BL -
ZON •'
FSB
SSB
SSB
. RSB
-
OFC' -
ZONE ORD • .:;:� •,
LOT SZ'"..
END
, SIDE''
Print Applicant/Agent Name
APPUPRMT DATE , ,
fo- _ S-RGJ
•- • . ` ' .
COMB
Permit to build 2684 Sq. FT. of
Condominium
Mech'„ Fee •
37.00
Plan Check Fee
313.95
Construction Fee
483.00
" Elect. Fee ` , *, .. t
40.73
SbtC Fee
8.37
Plumb'. Fee
65.50
Prop. Dei►. Fee
450.00
f,W.z..s .7..,.
r
Ifni -it
-
r TFEE
11$98.55
t -
VALUATION 119, 414.40
BLDG. DEPT.
V
r-1
Ah
NO.
OPERATION
ATE
INSPECTOR
NO. O ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33 Ventilation System
2
Ftgs & Frms
34 Plenums & Ducts
2A
Slab Grade
35 Furnace Compart.
teel
o?D p
711C.
36 Inlets & Outlets
4
Grout Blocks
37 Combustion Air
5
Bond Beams
38 Compressor
6
Roof Deck .
la S
ik4
39 Appl. Clearance
7
Framing p /!j
/,%
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. ❑
OP'NO. ADDITIONAL INFORMATION
—
�✓ i 7
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath/
12A Drywall � �
13 Finish Grade
INSULATION Thick
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb 'f ,
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer eAk A&41/3
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test S
25 Final r
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