0821 (SATT)APPLICANT NAME�1. F„MIt '
.W11J P.3�V�.1.u�1i l�,iit 00XP• .
ADDRESS BMC 1000 `
PERMIT
APPLICATION
City of La puinla
Department of Building and Safety •
•
;
PAG '•
s 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.
C
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if ' '...
` LICENSED CONTRACTORS TECLARATION: I hereby affirm that I am licensed under provisions of Chapter .9
the permit is for one hundred ($100) o, less. l 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
APPLICANT: 11, after 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
be deemed revoked.
following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to
1
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 tofile asigned staleme'ntthat heislicensed pursuant tothe provisions ofthe Contractor's License Law • -
.. 01 hereby certify that no excavation five (5) or more feet in depth into which a person is required td descend, will be
(Chapter 9(commenting 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 for a permit',.
, ., -demolition or dismantling'thereof, will be'more than thirty-six (36) feet high. (Chap 3.2• Grp•2, Art 2, Sec341, Titlell.
subjects the applicant to a civil•penalty of not more than five hundred dollars ($500.):
-C.A.C.) - -
0 I. as owner of the properly; or my employees with wages as their sole compensation, will do the work, and the
'• 0 As owner -builder, I will not employ anyone to do work which would require a permit from the DivWon 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
v .
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 one year ofcompletion, theowner-builder will havetheburdenotprovingthat...
Date �' Applicants
. he did not build or improve for the purpose of sale.). - •:4j; , r ,- -
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a constructiomlending agency for the performance
0.1, as owner of the properly, 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 foi such projects with contractor(s) licensed pursuant to the
LOT SZ,'
Coniraclor's License Law.).
Lender's Address
'• 0.1 am exempt under Sec. B. 8 P.C. (Attached Certificate).
I certify that Lhave read this application and state that the above information is correct. ) agree to comply with all
Date r'Owiler
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) have read this application and state that' '
0 Certified coDyis hereby furnished. '. - • :•
the information given is correct. I agree to comply,wilh all state laws and county ordinances relating to buidling
' 0 Certified copy is tiled with the City Building Inspection Department or City Department. '
' -
constFuction;-and authorize a lepresentative oV1161City of.La Duinta Department of Building and Safety to enter
upon the property for which I have applied for this permit,for the purpose of;,kking inspections-. -
� ,
Date Applicant
n —nom
• Signature of Applicant or Agent Date
APPLICANT NAME�1. F„MIt '
.W11J P.3�V�.1.u�1i l�,iit 00XP• .
ADDRESS BMC 1000 `
CIjTV/CO ta,C 92253 _
-
JOB SITES 10 ORESS/SPACEE
7t3 - 39 Calle Norte
CITY/COMMUNITY/STATE/ZIP -
La Quinta, CA 92253
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PAG '•
PRC
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TRACT �67
Its
LOT •
SMT Fee,
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MOD
SB
Unit 42
TRACT NAML ( ��.��
OW.;al Quint Phwe II
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CQ14TT,R�AACCTOR-FIRM NAME • '
ADDRESS _ ..
i.u. Bax 1000
CI Y/COMMe �; N„�/S�TA;E/ 92253 _ ...
PHONE,. +
LICNC ..
X636
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ARC/ENG FIRM NAME•
ADDRESS -
CITY/COMMUNITY/STATE/ZIP
PHONE .
LICNC .
USE ��.O�F,yyPERMIT Elect.Plumb. Btd1 w • .
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FSB
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SSB.
RSB
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ZONE ORD..' Vis.
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_END. ,L•LSIDE
Print Applicant/Agent Name
APPL/PRMT•TE
. `P87.1 6LA25-84
COL•ii7 •
Permit to build 2684 Bq. Ft...of
Condominium'
,Medi
Plan Check Fee
313.95
Const. Fee
483.00
' Elect, Fee � `•
40:73
SMT Fee,
•• 8.37
' '
Plumb. Fee
65.50
Prop. Dev. Fee ,. - 450.00
rc ,
TOTAL_•
FEE
4_.398.55,
BLDG. DEPT. VALUATION 1 119,414.40
r1
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.
10
/eSteel
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
fireplace T.O.
❑
OP'NO.
ADDITIONAL INFORMATION
_2 j �� I �l
LA
I o
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath �02
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 42
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
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