0792 (SATT)PERMIT APPLICATION
City of La Duinta
Department of Building and Safety _
This permit becomes void it.work not commenced within. 180 days from date of issuance: OR, it 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 if ,
LICENSED• CONTRACTORS DECLARATION: I hereby affirm that I am licensedunder provisions of Chapter 9 the permit is for one hundred ($100) o, less..) 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.) shall not employany person in any manner so as to become subject to the Workers' Compensation Laws of
and effect. ' California.
License Class ' Lic..Number Date Applicant
• Dale _ Contractor 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
'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 be deemed revoked'.'
• construct, alter; improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for DIVISION OF INDUSTRIAL -SAFETY PERMIT CERTIFICATION:
suchpermittofile asigdedstatement that heislicensedpursuanttothe provisions ottheContractor's License Law 0 hereby certify that noexcavation five (5)ormorefeet indepth into'whichaperson isrequired todescend, will be'
„ . (Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) orthat he is 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,exemption: Any violation of Section 7031.5 by any applicant for a permit, r.. demolition'or dismantling thereof, will be more than thirty-six (36) feethigh. (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8,
subjects the appjicant to a civil penalty of not•more than five hundred dollars ($500.):: C.A.C:j".1h•"
❑ I; as owner of the, property, or my employees with wages,as their sole compensation, will do the work, and the. ❑ As owner -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. 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 v . • . , - 1
. through his own employees, provided that such:improvements are not intended or offered for sale. If, however, the 17 Division, of.lndustrial Safety Permit No.
buiiding orimprovemntissold within oneyearofcompletion. the owner•builderwill have the. burden ofproving that Date' Applicant
he did: not build or improve forthe purpose of sale.). .1.., : . . CONSTRUCTION'LENDING AGENCY.: I hereby affirm that there is a construction lending agency for the performance
-❑ I, as.owner of Ihe,property, am exculsivelycontracting withlicensed 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
'171 I 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. l agree to comply with all
Date Owner '" 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:
WORKERS' COMPENSATION DECLARATION: I hereby affirm,that I have a certificate of consent to self -insure, ora
certificate of Workers' Compensation Insurance , or a certified copy 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
❑ Certified copy is hereby furnished. - • I . , the information given is correct: fagree-to comply.with all state laws and county ordinances relating to buidling
O Certified copy is filed with the City Building Inspection Department or City' Department.: construction, and authorize a'repre tative of.the City of La Duinta Department of Building and Safety to enter
Date Applicant upon the rroperty to swhich I'haJe applied for this permit for the purpose of making inspections.'
cL
Signature of Applicant or Agem V Date
AP 1.0 TL'ir+ifLLIDROl\i COR
ADDRESS BOA 1000•
`ILL Quinta, ZICA 92253
JOB SITE ADORESS/SPACE .
«i-SL6u Calle liortt
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
BOK
-PAG
PRC
C
..
TWN ',
FIND..
SE
S
TRACT
1876i
LOT
341.58
..
MOD
SB
-
Unit 13
TRACT NAME'
DUNA LA QUOTA PBASE II"
OWNER NAME (L. F. MI) ,
LML DEVELOPNM CORP.
CONTRACTOR -FIRM NAME
u7f11i, E
APSS
.O. BOB 1000
CITY/COMMUNITY/STATE/ZIP ..
LA OUINTA'•. CA 02253
PHONE . -
345-2888 -.
LICNC r
413636
-
ARC/ENG FIRM'NAME ,
ADDRESS -
CITY/COMMUNITY/STATE/ZIP - ••
PHONEII
LICNC-e
(
USE OF PERMIT
COMB.- EMM, PLUMB. BUILD
SL
I � 1
ZON • FSB SSB
SSB
RSB
OFC
ZONE ORD •
.. LOT SZ
_
.,EN67
.§IDEi1
Print Applicant/Agent Name
APPUPRMT
n7 9 7
DATE
6-25-84
-
C011B.
Permit to biuld' 3657
Sq. Ft.of
Condominuim
Mech Fee ''
19.00
Plan Check Fee
341.58
Construction Fee
525.50
Electrical Fee
.49,02
SMI FEE,
.9.56
Plumbing Fee
•.73,00
Property Development
Fee
600,00
(
I � 1
•
r
TOTAL
-FEE
BLDG. DEPT.
VALUATION 136,386.90
Ah
Ah
NO.
OPERATION
ATE
INSPECTOR
NO.
oPLIKATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System .
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab- Grade
�p
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. ❑
OP'N ADDITIONAL INFORMATION
NO:
%
t/ g5- 7 /4
J ✓I `��
V= 9
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath Q
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick RIG
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 g 3
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/I
STREET NAME
26 Power Pole
27 Conduit '
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final