0816 (SATT)PERMIT APPLICATION
City of La Quinta
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� 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 3of 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 dollari,($500.): .
0 1. as owner of the property. or my employees with wages as their sole compensation, will dothework, and the
structure is not intended or offered for sale (Sec. 7D44, Business and Professions Code: The Contractor's -License
Law does not apply to an owner of property who builds, or improves thereon. add who does such work himsellor
through his own employees. provided that such improvements are not intended or offered for sale. If, however. the
building or improvermit is sold within one year of completion, the owner -builder will have the burden of proving that
he flid 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 -contracts for such projects with a contractor(s) licensed pursuant to the
Coniractor's License Law.).
0 1 am exempt under Sec. B_& P.C. (Attached Certificate).
"Date
Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of cx�ns7ent to , ielf-insure, or a
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.).
Policy No
Company
• Certified copy is hereby furnished. :." ..
• Certified copy is filed with the City Building litspection Department or City Department.
Date Applicant
APPLICANT NAME (I., F, MI)
Dil, DM10pa=t CO3:P.
ADDRESS
P.O. B= 1000
CITY/COMMUNITY/STATE/ZIP
la Quinta, CA 92253
JOB SITE ADDRESS/SPACE
78-129 Calle Norte
CITIZON14UNIT STATE/Zf
4 =164AP "Ca 92253
BOK
PAG.
PRC
C
-
TWN
RNG
SE
S
TRACT
1876
LOT
Construction Fee
DO
I"
Unit37
TRACT NAME
Dmia la Quinta Pbaw II
OWNER NAME (L. F. MI)
US Cbm
CONTRACTOR -FIRM NAME
Sam
ADDRESS
P.O. Box 1000
CITY/COMMUNITY/STATE/ZIP
La Quinta, CAL 92253
PHONE 0
345-2888
53.00
LICNC 0
4136636
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATF/ZIP
PHONE 0
LICNC
/AA
USE OF PERMIT
Qgmb. Ellwt. Plumb. Build.
61. 1
1 ZON
FSB
SSEI
S S
RS8
OFC
ZONE ORD
LOT SZ
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE: This section need not be completed it -
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 inany mannerso as to become -subject tothe Workers'Compensation Laws of
California.
Date Applicant
NOTICE TO APPLICANT: If, 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:
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 Z Art 2, Sec 341, Title 8,
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. . I
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
I Lender's
I certify that I have read thisapplication and state that the above information iscorrect. 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 I 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
<c6fi—striu—cti�n, and authorize a:represgtative of tWii Ci , ty of La Quinta Department of Building and Safety to-ent—
Ithis,04
upon'the property for which I have applied for ermit fo"Pthe purpose of making inspections,
Signature of j�pplicanl or Agent Date
Print Applicant/Agent Name
APPUPRMT DATE
Permit to build 2684 Sq, Ft.
of
Condominium
Hech. Fee
37.00
Plan Check Fee
313.95
Construction Fee
483.00
40.73
SHI Fee
8.37
Plumb Fee
53.00
Prop, Dev, Fee
450.00
/AA
I I
TOTAL
FEE
1,230
BLDG.DEPT. VALUATIONI 88,672.6n
Ah
Ah
NO.
OPERATION I ATE
INSPECTOR
NO.
OP ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
0
34
Plenums &Ducts
2A
Slab Grade
35
Furnace Compart.
3teel
O
�•
36
Inlets &Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
p.t!
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
�c
'� V s I a41 6J
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 .Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick al
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 Sewer 14
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./I
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME