0808 (SATT)PERMIT APPLICATION
t 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.
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE This section need not be com feted if
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9
p
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 o1 the Business and Professions Code, and my license is in full force
issued, I shall not employ any person in any manner so asto become subject to the Workers'CompensationLaws of
and effect.
California.
License Class. Lic. Number
Date Applicant,
Date Contractor
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for'the
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
following reason (Sec. 7031.5, Business and Professions Cade: 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:
such permittofileasigned statement that heislicensed pursuant tothe provision softheContractor's License Law
01 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, w ill be
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) or that he is exempt
made in connection with work authorized by this permit, and that no building structure, scaffolding, fafsework, or
therefrom and the. basis for the alleged exemption. Any violation of Section 7031.5.by any applicant for -a permit ' ,
demolition or dismantling thereof, will be more than thirty-six (36) feet high: (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8,
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.): . ., ' •
CAC)
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 anyone to do work which would require a�permit from,the Division'ot
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
Prop. Dev. Fee
through his own employees. provided that such improvements are not intended or offered for sale. If, however, the. ..
0 Division of Industrial Safety Permit No.
building orimprovemntissold within oneyearofcompletion. theowner-builder will havethe burden of provingthat
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 1, 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 Cade: The Contractors 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. 8 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 r Owner •
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
• ZONE ORD. •.
of this county to enter upon the above=mentioned property for inspection purposes. I
WORKERS' COMPENSATION DECLARATION: I heieby.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. Q.
Policy No. Company
O Certified copy is hereby furnished.
0 Certified copy is filed with the City Building Inspection Department or City Department.
Date Applicant.
APPLICANT NAME (L F, MI)
12ML Developaent Corp.
ADDRESS
P.O. Boz 1000
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
JOB SITE ADDRESS/SPACE
78-113 Calle Norte
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
SOK
PAG
PRC
C
,
TWIN
FIND
SE
S
TRACT
18767
LOT
260.00
Construction Fee
MOD
s8
unit 29
TRACT NAME
Duna La Quinta Phase 11
OWNER NAME (L. F. MI)
LEL Development Corp.
CONTRACTOWFIRM NAME
Sams
ADDRESS
R.O. Boz 1000
CITY/COMMUNITY/STATE/ZIP
TA ftinta. CA 92253
PHONE .
345-2888
LICNC
413636
Prop. Dev. Fee
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP -
PHONE M
LICNC .
USE OF PERMIT -
MM. Elect. Plumb. Build
BL
ZON
FSB SS8
SSB
RSB
OFC
• ZONE ORD. •.
LOT SZ
TOTAL
FEE
1.230 74
END
SIDE
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
construction, and authorize a representat�e'of the City of La Ouinta Department of Building and Safety to enter
upon the property for which I h ve applied for this permit°for the purpose of making inspections. k
I Signature of Applicant br•Ag nt Date
Print Applicant/Agent Name
APPL/PRMT J3
NO
DATE
6-25-84
Comb.
Permit to build 2101
Sq. Ft. of
Codnominium
Mech. Fee
28.00
Plan Check Fee
260.00
Construction Fee
400„00
1egt. Fee•,, . �,
33.54
SMI Fee `
6.20
Plumb. Fee
53.00
Prop. Dev. Fee
450.00
TOTAL
FEE
1.230 74
BLDG. DEPT. VALUATIONJ 88,672.60
Ahk
NO.
OPERATION 'VATE
INSPECTOR
NO. OP . ATION DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
/b
i
35
' Furnace Compart.
3
Steel
S !
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
S
39
Appl. Clearance
7
Framing
r,�
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
/ q
TT Q
,-A`�
II
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall J.l;
13 Finish Grade
INSULATION Thick "R"
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 , C
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
STREET NAME
P/I
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring D S
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final