0823 (SATT)'APPLICANT NAME (L, F. MI(
ILI�Dew t O�orp. •.
ADDRESS I•. ' . ' . .
P.O. Box 1000
r PERMIT APPLICATION r
• City of La Dg and
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.orabandoned for a period of 180 days.
BOK
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. Lcertify that -in the performanceof 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 inany manner so asto become subject to the:Workers'CompensatioRLaws of
and effect.
California.-
. License Class - ' Lic. Number -
Date Applicant '
Date Contractor
NOTICE TO APPLICANT: If, atter 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 '
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.
- "• ,
' construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for '
- • • DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
•. such permitto file asigned statement that he is licensed pursuant to the provisions of the Contractor's License Law
'� 'O 1 hereby certify that no excavation five (5) or mz ore feet in depth I , nto which a person is required to d6scend, will be
(Chapter 9 (commencing with section 7000) of Division of the Business and Professions Cade) 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
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.): -.
C.A C) • " - - - .a::•+a�. -
- 0 I, as owner of the property. or my employees with•wages as their sole compensation, will do the work, and the •.,
' 6O'As owner -builder, I vwill'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 Industrial Safety Permit No.
building or improvemnt is sold within one year of completion, the owner -builder will ha_v-etheburden ofproving that
Date' Applicant
- he did not build or improve for the purpose otsale.).
CONSTRUCTION LENDING AGENCY: 1 hereby affirm that there is a construction lending agency for the performance
0 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 contractor(s) licensed pursuant to the
• - ZONE ORD . •
Contractor's License Law.). _
Lender's Address
0'1 am exempt under Seca B..B P.C. (Attached Certificate). e
I certify that I have read this application and state that the above information is correct. I agree to comply with all
Date - r 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 l have read this application and state that ' %''.;
• 0 Certified copy is hereby furnished:-, .
thezfnformation given is correct. I agree to comply with all state laws and county ordinances relating to buidling - •• • .
0 Certified cdpy is`filed with the City Building Inspection Department or City Department.
construction, aid authorize a-representatiiv,e ohthkity of La�Ouinta Department of Building and Safety to enter
-
Date Applicant".rT�9%L�1�
upon the propd`nyy forwhichI have appliedAo�rrthis/permit for the purpose of making inspections.
r Signature of Applicant or Agent v Date f
•
Print Applicant/Agent Name
'APPLICANT NAME (L, F. MI(
ILI�Dew t O�orp. •.
ADDRESS I•. ' . ' . .
P.O. Box 1000
CITY/COMMUNITY/STATE/ZIP
la Quanta, CA 92253
JOB SITE AOORESS/SPACE -
78^143 Calle Norte
CITY) 1LU&.AT'ZIP 92253 "
BOK
PAG
PRC
C
-
TWN
FIND
SE.
S,
TRACT
18767
LOT,
.260.00
Construction Fee
MOO
SB
'
unit 44
TRACT NAME
RA�wia laC�l ta Pbase 11 '
- .
OWNERNAME lL. F, MI..I .. r�tCorp•
CONTRACTOR -FIRM NAME _ '. " . • .. _ ,
same-,
ADDRESS •- .
P.O. Boit 1000 '
CITY/COMMUNITY/STATE/ZIP
La Qu=ta CA 92.253.1
PHONE .
.345-2888
LICNC 11
413630-
13636'ARC/ENG
Prop. Dev.'Fee
'ARC/ENGFIRM NAME '
ADDRESS '
CITY/COMMUNITY/STATF/ZIP ..,
PHONE •
LICNC . /
..
USE OF PERMIT
4 tl . Elect. Plumb. Build.*
81L
ZON
FSB
•SSB.
SSB-
RSB
OFC"
• - ZONE ORD . •
- LOT SZ -
TOTAL'
FEE
1,230.74
END..,
rSIDE
APPL/PRMT
6-A4,84
_y_ •
Permit to build 2101
Sq. Ft. of
Condominium
Aieeh Fee
-28.00
2tan Cheek Fee
.260.00
Construction Fee
400.00
33.54
SMI Pee
4
6.20"'
Plumb Fee
53.00
Prop. Dev.'Fee
450.00
r
TOTAL'
FEE
1,230.74
" EVALUATION 88672.60
BLDG. DEPT.
A
Ah
NO.
OPERATION ATE INSPECTOR
NO.
OP 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.
eSteel
�C
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
%
39
Appl. Clearance
7
Framing `"0
6
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.
❑
NP'N
ADDITIONAL INFORMATION
✓vv J it�•
_ CIA
� ..�
51 a�18 C
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall i �b
73 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
or -
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPftOVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
-REAR OF PROPERTY LINE
PSL 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