0785 (SATT)PERMIT APPLICATION
City of
La Ug
Department of
a
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 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 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
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 fora.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
such permit totileasigned statement thatheis licensed pursuant to the provisions of the Contractor's License Law
b' (hereby certify that no excavation five (5) or more feet in depth into whicha 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 exemptmade
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 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 B,
subjects the applicant to a civil penalty of not more than live hundred dollars ($500.):
C.A.C.)
0 1. as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
❑ 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, or improves thereon, and who does such work himself or
USE OF PERMIT
Comb.- Elect., Plumb., Bldg.
through his own employees. provided that such improvements are not intended or offered fonsale. 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.). t"'
CONSTRUCTION LENDING AGENCY: I 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 N
Contractor's License.Law.).
Lender's Address
.0 1 am exempt under Sec. . B. 8 P.C. (Attached Certificate).
I certify that I haveread.this application and state that the above information is correct. tagree to comply with all
Date Owner
and county ordinances and state laws relating to building construction, and hereby authorize representatives
Icity
of this county to enter upon the abov'e=mentioned property for inspection purposes.
WORKERSCOMPENSATION 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.).
Policy No. Company
•0 Certified copy is hereby furnished.
.0 Certified copy is filed with the City Building Inspection Department or City Department.
Date Applicant
AP„ VLICAI(1e NA_ ME (4, F. MI) t tarp •
1J@Ve•L�'r'�}^}�s',^n�
ADDRESS
P.U. Box 1000
CITY/COMMUNITY/STATE/ZIP
La Quinta,'Ca 92253
JOB SITE ADORESS/SPACE
78-14U Calle Norte
CITY/COMMUNITY/STATE/ZIP
La Quints, Ca92253
BOK
PAG
PRC
C
TWN
RNG
SE
S
TRACT
18767
LOT
341,58
MOD
SB
Unit 6
TRACT NAME
Duna %a Quinta Phase 11
OWNER NAME (L. F. MI)
1M Development Corp.
CONTRACTOR -FIRM NAME ,
Ssme
ADDRESS
P.O. Box 1000
CITY/COMMUNITY/STATE/ZIP
La Qdinta, CA 92253
PHONE N
345-2883
Plumbing,, Fee
LICNC N
413636
73.00
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP '
PHONE N
LICNC N
USE OF PERMIT
Comb.- Elect., Plumb., Bldg.
BL
ZON
FSB
SSB
SSB
RSB
OFC'
ZONE ORD N
LOT SZ
TOTAL .
FEE
1,617.6;_)
END
SIDE
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this applicationand state that
the -information given ii -correct. I agree to comply with all state laws and county ordinances relating to buidling
construc�ion, and authorize a'representative of the City of La Ouinta Department of Building and Safety to enter
upon the property f r which I haVe apptied'lor this permit for the purpose of making inspecti .
G_ �" " f r
Signature of Applicant or Agent Date r
Print Applicant/Agent Name
APPL/PRMT n A ff°
6:"25-84
coria,
Permit to Build 3657
Sq, Ft of
Coadominium
Niech, Fee
19,00
Plan Check Fee
341,58
Construction Fee
525,50
Electrical Fee
49.02
S111 Fee
9.56
Plumbing,, Fee
73.00
Property Development
Fee
600.00
_i
TOTAL .
FEE
1,617.6;_)
1 ., BLDG. DEPT. VALUATION 136,386.90
M
r-1
NO.
OPERATION ATE INSPECTOR
NO.
OPERATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
-7761
35
Furnace Compart.
3
Steel
�%
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5 .
Bond Beams
38
Compressor
6
Roof Deck
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
f=ireplace T.O.
❑
NON ADDITIONAL INFORMATION
� 1
•�
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall �Q
13 Finish Grade
INSULATION Thick Value
7A Walls (Batts)
126 Ceiling (Batts)
126 Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb ,
16 Water Piping
17 = Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer g
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test xvyL�
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
P/L PA
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire ,�� �'7 i
298 Bonding
30 Fixtures
31 Service
32 Final