0791 (SATT)PERMIT APPLICATION
City of La Ouinta
Department Building Safety
of
and
' • This -permit becdmes void if work not commenced within 180 days from date of
issuance. OR, if workhas been suspended or abandoned for a period of -180 days. '
'
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 •'
(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 mannerso asto become subject tothe Workers' Compensation Laws of
and effect.
California.
License Class '.Lic. Number'
Date Applicant
' Date Contractor
NOTICE TO APPLICANT:If; alter making this Certificate.of Exemption, you should become subject to the Workers' '
r
' OWNER -BUILDER DECLARATION: ' I hereby affirm that I am exempt from the Contractor'svLicense Law'tor�the'
Compensation provisions of1i p Labor Code, you must forthwith comply with such. provisions or this permit shall
be deemed' evoked.
following reason (Sec. 7031.5. Business -and Professions Code: Any city or county which requires a permit.to - •
'
Unit '12
construct, alter, improve, demolish, or repair anystructure, prior to its issuance, also requires theapplicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
such permitto fileasigned statement that he is.licensed pursuant to the provisions of the Contractor's License Law ..
OIhereby certify thatnoexcavation five (5)ormore feet indeotfiinto which apersonisrequired todescend, will be"
(Chapter 9(commencing with section 7000) of Division 3 of the Business and Professions Code)or that hers exemptinade
in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
therefrom and the -basis Jor the alleged exemption' Any. violation of Section 7031.5 by any.applicant for a•permit
demolition or dismantlin6thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art'2,Sec341, Title B.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500:):p,t_ <•
• C.A.C.) • "
0 1. 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 not employ anyoneao do work 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 .
e•
?through his own employees, provided Mal such improvements' are not intended or offered for sale. If, however, the - ..
0 Division.of.lndustrial Safety Permit No.—
buildingorimprovemntissoldwithinoneyearofcompletion, the owner -builder will have the burden of -proving that
Date Applicant
he did not build or improve for the purpose of sale.).
CONSTRUCTION LENDING AGENCY: I 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 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
Lender's 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 Sec( _ . B.. B 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 " ' 2
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
.SIDE. .
of this county td 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, or a
... •'
certificate of Workers' Compensation -Insurance , or a certifiedcopy thereof(Sec. 3800. Lab. C.);
Signature of Applicant or Agent Date
Policy No. .Company -
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that ..
• 0 Certified copy is hereby furnished. :.
the•information given incorrect. I agree to Imply with all state laws and county ordinances relating to buidling _
0 Certified copy is filed with the City Building Inspection Department or Citys'' / Department: °•.
- - ..
construction. and authorize a representative of the City of La Quinta Department of Building and Safety to enter
upo�n.the�property for.wAich I have2ppll'ieA for/this permit�for the purpose of making inspections. may^ `
Date Applicant
�C G.�C..•r> ..: � /uY"'S�'�—�--. v. /� "' .� l� /
Signature of'Applicant or Agent F - Date
Print Applicant/Agent Name
-APPLICANT NAME (L. F, MI)
LML DEVELOPMENT CORP,
ADDRESS
P.O. BOX 1000
CITY/COMMUNITY/STATE/ZIP
La Quista, CA 92253
JOB SITE ADDRESSISPACE -
• 78»126 Calle Norte `
CITY/COMMUNITY/STATE/ZIP .'
La Quinta, CA 92253
BOK
PAG
PRC
C
PIAN CHECK FEE
TWN'
RNG '
SE;
S
-TRACTLOT
18767 r
SMI Fee
9,07
Plumb. Fee
MOD
SB
'
Unit '12
TRACT NAME
Duna La Quinta Phase II
OWNER NAME (L. F,I)
tffl Deveropment Corp.
CONTRACTOR -FIRM NAME -•
Same
ADDRESS
P.O. Box 1000
CITY/COMMUNITY/STATE/ZIP
La•Quinta, CA 93253
PHONE .LICNC
345-2888
o
f
•
413636
,
ARC/ENG FIRM NAME -
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE If.
s�i, . r►A'
'LICNC N
.USE OF PERMIT '
COBB. - Elect. Plumb Build.
BL
ZONFSB
SSB
SSB
.RSB
OFC
' ZONE ORDa ••
LOT SZ /
•, END'
.SIDE. .
APPL/PRMT
6_25_84'.
a
COMB
'
Permit to Bui1d.3523 Sq. Ft. of
Condominium-
MECH.FEE
19,00
PIAN CHECK FEE
330:20
CONSTRUCTION -FEE
.508,00
Elect. -Pee
47,27.
SMI Fee
9,07
Plumb. Fee
73,00
Prop. Developme4t Fee
600.00
l
_
o
f
.. r 'TOTAL
FEE • '
s�i, . r►A'
BLDG: DEPT.
VALUATION 129,628.00
,
fik
Ah
NO.
OPERATION ATE
INSPECTOR
NO.
OPWATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
/
T
35
Furnace Compart.
3
Steel
a7
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.
❑
NPON ADDITIONAL INFORMATION
_
�—t/—
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath 3
12 Internal Lath
12A Drywall Qa
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
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
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire % ?
29B Bonding
30 Fixtures
31 Service
32 Final