0786 (SATT)PERMIT APPLICATION
City of La Quinta"
• Department of Building and Safety •
ADDRESS • "• - - - - '
P.O. Box 1000
_ -
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. .
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. I certify that in the performance of -the work for which this permit is •, e.
(commencing witfrSection 7000) of Division 3 of the Business and Professions Code, and my license is in full force
issued, I shall not employ any person inanymanner so asto'become subject to the Workers'Compensation Laws 0 •,
and effect.
California.
License Class Lic. Number
Date Applicant
-Dale -'- Contractor.- _
NOTICE TO APPLICANT: If. -after making.this Certificate of Exemption, you should become subject to the Workers"
OWNER -BUILDER DECLARATION: I hereby affirm that 1',6 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 a signed statement that he is licensed pursuant to the provisions oftheContractor'sLicenseLaw ;
0lherebycertify"that noexcavationfive(5)ormorefeelindepthinto which aperson isrequired todescend;willbe
.(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 struclure, scaffolding, fafsework, or
therefrom and the basis for,the alleged.exempfion,Any ,violation of Section 7031.5 by any applicant for a permit :.,t ::
demolition_ or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, An 2..Sec341, Title B,
subjects the applicantto a civil penalty of not.more than five hundred dollars ($500.):
C.A.C.) '
0 I, 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 notemploy anyone to do wofk.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
Safety Permit,No.
through his own employees, provided that such improvements are not intended or offered for sale: If, however, the • .•
,D visionol,ndustrial
'building.orimprovemntissoldwilhinoneyearofcompletion.theowner•builderwill havetheburden ofprovingthat:
Date' " Applicant
• he did not build or improve for the purpose of sale.). ,
a,• •
CONSTRUCTION LENDING AGENCY: I hereby affirm IW -there is a construction lending agency for the performance
0 I, as owner of the property, amexculsively contracting with licensed contractors to construct -the project (Sec: •
•. b 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
Lenders 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 Seca : B. 8 P.C. (Attached Certificate).. '
.. I. certify that I have read thisapplication and state that the above information is correct. I agree to comply with,all -.
Date t ` Owner
city and county ordinances and state laws;relating to building construction, and hereby authorize representatives
.SIDE
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 , ora certified copy thereof (Sec. 3800. lab. C.):.
Signature of Applicant or'Agent " Date
PolfcyNo. Company "
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY. Icertify Ihave read this application and state that
'. 0 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 filed with the City Building: Inspection Department of City' ,Department.
.r"construction„ and authorize a.representattive of the Cityof La Ouinta Department of Building and Safety to enter
Date `Applicant../
upon th property foVwhich I have applied for this permit for the purpose of making inspens
lctio.
i'!. • .�
_J•�
/ Signalure �f•Applicani or Agent ? Date '
I
Print Applicant/Agent Name
PPUOANT NAME (L, F, MI) - �-
AWNTCorp.
ADDRESS • "• - - - - '
P.O. Box 1000
CITY/COMMUNITY/STATE/ZIP
La Qdinta, CA 92253
JOB SITE ADDRESS/SPACE , -
78-136 Calle Norte
CITY/COMMUNITY/STATE/ZIP '• - „ '
La Quintam CA 92253
BOK •
PAG
PRC
C
TWIN
FIND
SE'
S
TRACT
18767
I LOT„
291.20
Construction Fee
MOD
.SB
-
Unit 7
TRACT NAME Quinta Phase II
OWNER Develo pmnt Corp.
CONTRACTOR -FIRM NAME ..
Same
ADDRESS
P.O. Box 1000
CITY/COMMUNITY/STATE/ZIP -
La Quinta, Ca 92253
PHONE .
845-2888
LICNC .
413636
PBop. Development Fee
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP • <
PHONE .
LICNC .
USE OF PERMIT
Comb., -Elect., Plumb., Build..
BL
• ® r F
ZON
-�Nh
FSB
SSB SSB
RSB
ZONE ORD J- f,
- LOT SZ
-•
,END -.
.SIDE
APPL/PRMT
DATE
6-25-84 '
COIF.
Permit to build 2969
Sq. Ft. of
Condominium'
-
Mech. Fee
19.00 .
Plan Check Fee
291.20
Construction Fee
448.00*
Electrical Fed
40.71
SMI Fee
7.39
Plumbing Fee
63.00,
PBop. Development Fee
450.00
• ® r F
-�Nh
'
f
LEH
TOTAL
FEE
. 1 019.30
BLDG. DEPT. 'VALUATION 105,'044.70
•
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
Q
35
Furnace Compart.
3
Steel
o%
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.
r
ADDITIONAL INFORMATION
-4 s ff3
(T ~ �
P
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
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 i Sewer g
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test,4971,7747 Z74
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 gem
29B Bonding
30 Fixtures
31 Service
32 Final