0818 (SATT)PERMIT APPLICATION
City of La Og a •
.' 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.
LICENSED CONTRACTORS, DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
and effect.
License Class • Lic. Number
Date Contractor
OWNER -BUILDER DECLARATION: 1 hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for.
such permit to f ile a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law.
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) or that he is exempt
therefrom and the basis,for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penally of not more than five hundred dollars ($500.):
O 1, as owner of the property, or my employees with wages as their sole compensatio0; will do the work, and the
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License
Law does not apply to an owner of property who builds, or improves thereon, and,who does such work himself or
through his own employees. provided that such improvements are not intended or offered for sale. If, however, the
building or i mprovemnt is sold within one year of completion, the owner -builder will have the burden of proving that
he did not build or improve for the purpose of sale.).
O I. as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec. .
7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
O 1 am exempt under Sec. B. 8 P.C. (Attached Certificate).
Date Owner
WORKERS' COMPENSATION 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
AZLICANTaNAME (L`, F, MI),
SYJ :JC�VC:1fiYai�.Tit 0—m—TD.
ADDRESS�.U. Box 1000
CITY/COMMUNITY/STATE/ZIP
Ta OL>inta. CJA. 92253
JOB SITE ADDRESSISPACE -
78-133 CaUe Norte
CITY/COMMUNITY/STATE/ZIP
La Quints CA 92253
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400.00
LOT
33.54
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OWNER Loe �Mq
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CONTRACTOR -FIRM NAME -
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ADDRESS Box 1000
CITY/COMMUNITY/STATE/ZIP
La Qx=ta, rA 92253
PJ45=2888
`C 4.3636
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE M
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CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if -
the permil.is for one hundred ($100).o, less. I certify that in the performance of the work for which this permit is
issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of
California. -
oat e Applicant t
NOTICE TO,APPLICANT: II, after making this Certificate of Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this.permit shall
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
O I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
demolition 6r dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8,
C.A.C.) IT
O As owner -builder. I will not employ anyone to do work which would require a permit from the Division of '
Industrial Safety, as noted above, unless such person has a permit to do such work from that division.
O Division of Industrial Safety Permit No.
Date Applicant
tCONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Sec. 3097; Civ. C.)
Lender's Name
Lender's Address
I certify that I have read this application and state that the above information is correct. I agree to comply with all
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.
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify l have read this application and state that
the information given is•correct. I agree to comply with all state laws and county ordinances relating to buidling
construction, and authorize a'representative of the'City of La Ouinta Department of Building and Safelyto enter
upon, the,v�opertyforlwhich I have applied for this permit for Fe purpose of making inspections. t
l_
11 Signature of% �Apphcant or AgenNt Date
Print Applicant/Agent Name
APPL/PRMT #� *� DATE
11 1 6-25-84
COM-
O •Permit
Permitto build 2101 Sq. It.of
Condominium
Meech. 'Fee
28.00
Plan Check Fee
260.00
Construction Feel
400.00
• Elect. Fee
33.54
SMI Fee
6.20
Plumb. Fee
53.00
Prop, Dev. Fee
450.00
4•
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TFEEI
2 in
VALUATION 813.472��1Q
BLDG. DEPT, -�..
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Ak
NO.
OPERATION ATE INSPECTOR
NO.
OP ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
Q
34
Plenums & Ducts
2A
Slab Grade35
Furnace Compart.
01
teel
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
S
39
Appl. Clearance
7
Framing
gs
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
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath / 3/ S
12 Internal Lath'/%'N
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts) Uv
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb D
16 Water Piping
17 Rough Plumb Q S
18 Vents
19 Sewage Disposal
20 Sewer 2
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/1
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final