0822 (SATT)PERMIT APPLICATION
' City of La Quinta
` . •,, ,� . 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. -
JOB SITE ADDRESS/SPACE '
MM EX 78-141 Chlle Norte
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 0
(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 in any manner so as to become subject to the Workers'Compensation Laws of
and effect.
California.
.License. Class Lic. Number
r DateApplicant
Date Contractor r..
NOTICE TO APPLICANT: If, after making this Certificatg 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*Ahall
be deemed revoked.
following reason (Sec. 7031.5. Business and. Professions Code: 'Any city or county which req uires`a permit to
MOO
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 asigned statement thathe is licensed pursuant to the provisions of the Contractor's License Law
- 0 1 hereby certify-thaino excavation five (5) or more feet in depth into which a pers on is required to descend, will be
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) orthat he is exempt
- made in connection with work'nthorized 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 fora permit
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2..Grp 2, Art 2, Sec341, Title B.
subjects the applicant to a civil penalty of not more than five hundred dollars (S50O.): -
C.A.C.) r r•ix
0 1. as owner 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 ariyone 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
r
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 orimprovemntissold within oneyear ofcompletion, the owner -builder wil I have the burden of proving that
... DateApplicant -
he did not build or improve for the purpose of sale.)..
-k;
L't-:+ CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for theperformance'�
. • 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 Contractors 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
-
Contractor's License Law.). , .
Lender's Address
0 1 am exempt under Sec. •� . B. 8 P.C. (Attached Certificate). _
. I certify that (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 acertificate 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 r . ead this application and state that
r O Certified copy is hereby furnished: - :. . • • '.. ,
�' the informationgivenis correct. I agree to complyiwith all state laws,and,county ordinances relating to buidling .
0 Certified copy is filed with the City Building Inspection Department or City Department.
..
'construction, and authorize a'represe tative o�the City of La Ouinta;Department of Building and Safety to enter
uponrthe property for'iwhich I -have applied this pe_rm�it,,fyoff�t,he purpose making inpections, C
Date Applicant,
'of
rfoddr .`.Y,
. • A �t �'i —s
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Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPLICANT NAME (L,� F. MI)
1J -1 Deveibramt ' C&p•
ADDRESS
P.O. ' Box 1000
CITY/COMMUNITY/STATE/ZIP '
La Quinta, Ch 92253
JOB SITE ADDRESS/SPACE '
MM EX 78-141 Chlle Norte
CITY/COMMUNITY/STATE/ZIP
La Quinta, Ca 92253
BOK
PAG
PRC
C
28.00 '
TWN .'
RNG
'SE.,.
'S
TRACT
18767
LOT •
r_
SMI hEE
7.11
MOO
SB
Unit 43
TRACT NAME '
Dana La Quinta Phase II
OWNER NAME (L. F. MI) • _
IM Dwelolanant Corp.
CONTRACTOR -FIRM NAME -
same
ADDRESS '
P.O. B= 1000
CITY/COMMUNITY/STATE/ZIP '
La'Quinta, CA 92253
PHONE . '
34-9-2888
..
LICNC.
413636
-.
ARC/ENG FIRM NAME
ADDRESS- 4
CITY/COMMUNITY/STATE/ZIP
PHONE M
TOTAL'.
FEE
LICNC
USE �OF PERMIT yy��,� �,..,a
4A�1[StJw Gree.. PluTb. BmUd.
8L
ZON'
FS8
SSB
SSB
RSB
OFC
ZONE ORD . ,.
LOT SZ
„
END
SIDE-
APPL/PRMT n 8 1?OATS
6-15-84
,
Comb..
Permit to build 2349 S$. FT.
of
Condominium-
Mech. =fee
28.00 '
Plan Check Fee
284.70
Construction Fee
438.00
36' 54
r_
SMI hEE
7.11
PLUMB Fee
55.50
Prop.Ded.`Fee
-450,00
Via..
TOTAL'.
FEE
r 1,299.$5
BLDG. DEPT.
VALUATION 101,037;40
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.
3/),
Steel 31
ZD4
36 Inlets & Outlets
4
Grout Blocks
37 Combustion Air
5
Bond Beams
38 Compressor
6
Roof Deck /o� %
�-
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. ❑
NON ADDITIONAL INFORMATION
� ,j � -7)9
((
I c
5I p1 L41 �J
•
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
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer —6oj�-AC
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