0825 (SATT)• r PERMIT APPLICATION
City of
La Og
a • +
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 period of 180 days. '
PAG
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 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']000) of Division 3of'the Business and Professions Code; and my license,is in full force ••
issued, I 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: iL after making this Certificate of Exemption, you should become subject to the Workers' .
OWNER -BUILDER DECLARATION: I liereby-affiim that 1 am exempt from the Contractor's License Law for the
>:t 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 . a ..
' construct, alter: improve, demolish, or repair any structure, prior to its issuanceralso requires the -applicant for
DIVISION OF INDUSTRIAL SAFETY, PERMIT CERTIFICATION:
such permit to file a signed statement that he is licensed pursuant totheprovisions ofthe ContractorsLicense Law ,.
O 1 hereby certify that n'6 ex6vation five (5) or more feet in depth ihto which a pers6A is rejuired to descendlwill 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, falsework. or
•therefrom and the basis for the alleged exemption. Any violation of Section 7031:5 by any applicant fora permit yr;'
- demolition or dismantling thereof, will be more than thirty-six (36) feet high.•(Cliiap 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.): " s'�t, •.•
C.A.C.) ,
O I. as owner of the�properly, or my employees with wages as their sole compensation, will clothe work, and the
O As owner -builder; l^wilt not employ anyone to do work which would require s permit .from the Division of- • ''"
• structure is not intended or. offered lot sale (Sec.3044, Business and Professions Code: The Contractor's License
Industrial Safety, is 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' '
USE OF PERMIT telc P11wb. Build.
Elect.
through his.own employees. provided that such improvements are not intended or offered for sale: If, however, the .r .
0 Division of Industrial Safety.Permit No.
building orimprovemntissold within one year ofcompletion, the owner -builder will have the burden of proving that
Date Applicant
he did not build or improve for th.e.purpose of sale.). ,., , , k %:
CONSTRUCTION LENDING AGENCY:' I hereby affirm That there is a construction lending agency for the performance
❑' 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, ;,).
7044, Business and Professions Cade: The Contractor's License Law does not apply -to an owner of property who
Lender's Name1 -1
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the,
ZONE ORD* •
Contractor's license Law.).
Lenders Address
O Gam 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 " 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, ora '• -
, - -
• 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 stale that
❑ 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 tiled with the City Building Inspection Department or City Department.
{construction and authorize a'represenlativ,, of the"City of La Ouinta Department of Building and Safety.to enter
Date . Applicant +.
,
upon /rthe property for.which Ihave applied front Is p mit for'the purpose•ol.making inspectionvs;
i��/r9J•'���+— �^�i !s
%1 Signature of Applicant or Agent Date
•
Print Applicant/Agent Name ••
APPLICANT NAME (L; F. MI)
TM i]QUP1.nrvw1rs1- irn-
ADDRESS lr.�i♦ L'Mli BM- 1020 "
c1coM,sTA`E/ZIPM 92253 ..
JOB SITE ADDRESS/SPACE ..
78-147 Calle Norte
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA'92253
BOK
PAG
PRC
C
-
TWN
FIND
SE-.:.
S
•TRACTLOT
18767
36.54
-
7.11
MOD
SB
'
Unit 46
.•
TRA Mia eSS uint_ Phase IIOWNER
NAME
AJILI LY Is Aa�C.LMI6pnellt
CONTR,AQTOR-FIRM NAME
►iL'thiY►
ADDRESS Hogs 1000
CITY/COMMUNITY/STATE/ZIP
.La z -ca, LA 92253 • •
PHONE:.
.sNo-2888
LICNC�
413' 636
?
ARC/ENG FIRM NAME Y" -
ADDRESS
CITY/COMMUNITY/STATE/ZIP -
PHONE .LICNC
TOUL
FEE
•
- -
USE OF PERMIT telc P11wb. Build.
Elect.
eL
ZON
FSB'
�.sse
SSB.
RSB
OFC
'
ZONE ORD* •
LOT SZ
..
END"
SIDE
APPVPRMT . DATE -
�IA C 6,25-84
•
COHB.
Permit to build'2349 Sq. Ft. of
Condominium.
Mecl Fee
28.00
Plan Cbbcic Fee
284.70
Construction Fee
438,,`00
81ect.,3Fee
36.54
SISI Fee
7.11
Plumb. Fee
55:50
Prop. Dev. Fee
450.00
1
TOUL
FEE
VALUATION 101,037.40
BLDG. DEPT.
r_1
All,
NO.
OPERATION
I MATE
INSPECTOR
NO.
OP .sATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
,
35
Furnace Compart.
q
teel
8
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
/02 f
39
Appl. Clearance
7
Framing loom /3
�
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. ❑
NON. ADDITIONAL INFORMATION
i`� 31�/��
(����✓W" �i� v
5
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall %
13 Finish Grade
INSULATION Thick al
Value
7A Walls (Batts) 424ho
126 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 .0 G'AR PGlilW/� �!
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
I :d