0788 (SATT)PERMIT APPLICATION t
City of La Ouinta
• Department of Building and Safety • ,
• -This permit becomes:void if work, notcommenced 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 it,
' 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. I
California. +
License Class Lic. Number
Date Applicant
Date Contractor _
"-NOTICE TO APPLICANT: If, after.makingthis 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
r Compensation provisions of the Labor.Code; you must forthwith comply with such provisions or this permit.shall + -
- 4 .r, _ - -
be deemed revoked.
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to.,
Set
construct, alter; improve, demolish, or repair any struclure,.prior to its issuance, also requires the applicant for
DIVISION OF INDUSTRIAL SAFETY. PERMIT CERTIFICATION: ,•
such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law -.
O l hereby certify that n o excavation five (5) or more feet in depth into which a 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 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 exemptioq. Any violation of Section -7031.5 by any applicant for a permit -
.•, demolition or dismantling thereof, will be more than thirty-six (38) feet high. (Chap 3.2, Grp 2, Art 2, Sec 34Y,Title B,'
s ubjects.the applicant to 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-
As ov/ner-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. 7049, Business and Professions Cade: The Contractors 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
.LICNC 1
.•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.
+'f.'building.brimproyemntissoldwithinoneyearofcompletion,theowner-builder will have the burden of proving that
Date- Applicant
F{ he did not build or improve for the purpose of sale.).
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 -thework for which this permit is .issued (Sec. 3097, Civ. C.).-
.).
.7044,
.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 .
OFC.
F Contractor's License Law.).,
Lender's Address '
0 1 am exempt under Sec. B. 8 P.C. (Attached Certificate).
I certify that I have read this application and state that the above information is correct. I agree to comply with all,
Date Owner r '' SI
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
END
of this county to enter upon the above=mentioned property for'inspection purposes:
WORKERS' COMPENSATION DECLARATION: 1 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.):
I
Signature of Applicant or Agent Date
Policy No. Company'
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CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
O Certified copy is hereby furnished. ! - . -�. , �,. +• _ - = . -
.theAnformation given,is correct. I agree to!comply with all state laws and county ordinances relating to buidling
0 Certified co is filed with the Cit Building Inspection Department or Cit De artrnent..'
DY Y 9 D P Y P
construction,rand authorize a'representative of>'the City of La Ouinta Department of Building and Safety to enter
�.
- -
i
uponfthe.p(operty for which I have applied for this permit for the'purpose of making inspections:, . .
Date Applicant
Signature of Applicant or Agent Date
Print Applicant/Agent Name .
1MAN evelopment Corp. .. .
ADDRESS - •••
P.O. BOx 1000
LacDQuinta� SCA 92253
JOB SITE ADDRESS/SPACE .� f
18-134 C: Ile Norte
ainta,. 92253
La CA
BOK ..
.PAG
PRC
C
TWN.:.
RNG
SE,
S
TRACT
18767
LOT
341.58••
MOD
Set
Unit ' 9.
TRACT NAME - - • -
Duna is Quinta Phase II
OWNER NAME (L,e
F. Ml) ,
UAL Deviopment Corp. .
CONTRACTOR -FIRM NAME .. -
same
ADDRESS
P.O. Bos 1000
CITY/COMMUNITY/STATE/ZIP
Wnta E/CA 92253
PHONE 1 •• • .
'345-2888
Plumbing Fee
LICNC
413636
,
ARC/ENG FIRM NAME
ADDRESS ..
CITY/COMMUNITY/STATE/ZIP -
PHONE 11
.LICNC 1
i
USE OF PERMIT
COMB. =CT., PLM(B.,•BUILD.
BL
r • _ � �+
- ZON
.
; FSB
` SSB '-
SSB
RSB
OFC.
' ZONE ORD 1
TOTAL' •
., • FEE
LOT;SZ
END
SIDE ,
APPUPRMT
Permit to
3657
Sq. Ft. of
Conaominium
Meeh Fee _ • -
19.00
Plan Cheep Fee
341.58••
Construction Fee
525.50
-Elect. Fee`
_ 49.02
SMI Fee _
9.56
Plumbing Fee
73,00
Plop, DBvelopaient
Fee
600.00
i
•
r • _ � �+
FFrs��
.
TOTAL' •
., • FEE
1 6l7 56
- VALUATION 136,386.90
BLDG. DEPT.. -
n
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.
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
Fireplace T.O.
❑
NON ADDITIONAL INFORMATION
l ',1 CD
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
t2A Drywall
13 Finish Grade
„R„
INSULATION Thick Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb /7
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/l
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final'