0789 (SATT)PERMIT APPLICATION
City of La Ouinta
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 o1 the Business and Professions Code, and my license is in full lofce
and effect.
License Class Lic. Number -
Contractor
OWNER -BUILDER DECLARATION: I 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 file asigned statement that he is licensed pursuant to the provisions of the Contra ' ctor'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 penalty of not more than five hundred dollars ($500.):
O I, as owner -of the property, or my employees with wages as their sole compensation, 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 improvernm 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.).
0 1, 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 contracls'for such projects with a contractor(s).licensed pursuant to the
Coniractor's License Law.).
0 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.). ' v
Policy No. Company
O Certified copy is hereby furnished.
O Certified copy is filed with the City Building Inspection Department or City Department.
Date Applicant
APPLICANT NAME (L F, MI)
Do-7016pn"o t Corp.
ADDRESS
P.O. T3on 1000
CITY/COMMUNITY/STATE/ZIP '
Y.n ¢, CA 92253
JOB / SITEypAOORES,��Svv/SPACyyE t,,�tt
L',—IJ2 Iynllc Zorta
CITY/COMMUNITY/STATE/ZIP
Ln Q4nta, CA 92253
BOK
PAG
PRC '
C
Plan Choc . Fee
TNM
FIND
SE
S
TRACT
13757
LOT
Pliurb. r5ae
MOO
SB
unit 10
TRACT NAMEPznn pp n
OWNER NAME (L. F. MI) '
Corp.
CONTRACTOR -FIRM NAME '
Z=n
ADDRESS
P.O. 1000
CITY/COMMUNITY/STATE/ZIP
Ln Qu�nt:n CA 92253
PHONE .
_238G
L c,N
kM
ARC/ENG FIRM NAME '
ADDRESS
CITY/COMMUNITY/STATE/ZIP '
PHONE .
LICNC •
USE OF PERMIT
BL
ZON
FSB
SSB
SSB
RSB
OFC
ZONE ORD •
LOT SZ
END
SIDE'
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
the permit 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.
Date Applicant
' NOTICE TO APPLICANT^ If, atter 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:
0 1 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 or dismantling thereof• will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec341, Titlell.
C.A.C.)
0 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.
0 Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION 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 abovernentioned property for inspection purposes.
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
the information given js correct. I agree to comply with all state laws and county ordinances relating -to buidling
coristruction, and authorize a'representative of the City of La Ouinta Department of Building,and Safety to enter
upon tfie property for which I have applied for this permit for the purpose of,making inspections: 1 °
Signature of_Applicant or Agent Date
Print Applicant/Agent Name
APPL/PRMT lO� � ATE
6 J__GlT
As'oi':J ♦
Permit to Build 3557 Aq. Est. of
Condeminirm
111 ch. Frx
Plan Choc . Fee
Conctruct3on Pon
525.50
zlect.
S511 17,0n
Pliurb. r5ae
73."0
Prop. D--volop ant rnn
�COa O
c� r
TOTAL
FEE
BLDG. DEPT. VALUATION 135,2E G.
Ah
Ah
NO.
OPERATION ATE
INSPECTOR
NO.
OPt ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
-
2A
Slab Grade
JJ
35
Furnace Compart.
3
Steel
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
S
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
f� g
,[� U
kO
SEWAGE SYSTEM SIZE& LOCATION
J�
/
11 Exterior Lath i
12 Internal Lath
12A Drywall 0p�/
13 Finish Grade
INSULATION Thick al
Value
7A Walls (Batts)
126 Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground, Plumb
16 Water Piping
17 Rough Plumb 77 f7
18 Vents
19 Sewage.Disposa4
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
STREET NAME
P/I
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire U'�� 7 AV
29B Bonding
30 Fixtures
31 Service
32 Final