0796 (SATT)PERMIT APPLICATION
City of La Duinta
• Department of Building and Safety
LM. Deae1AAment Corn.
ADDRESS
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.
J. - c, • ' + •
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if '
.LICENSED CONTRACTORS. DECLARATION: -I.hereby affirm. that a, am licensed: under -provisions of,Chapter. 9 •.
" the permit is for one hundred ($110) o. less. I certify that in the performance of the work for -which this permit is
(commencing with Section 7000) of Division.3of the Business and Professions Code: and my license is in full force..,
issued, I shall not employ any person inany mannersoas to become subject tothe Workers.Compensation Laws of -•
and effect. i,
California.
License Class ` Lic. Number'
Date Applicant
Date • Contractor
,NOTICE TO APPLICANT: It, after making this. Certificate of Exemption, you should become subject to the Workers'. -
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt,trom.the Contractor's License Law for the
Compensation provisions of the Labor Code, you must forthwith,comply with such provisions or this permit shall -
be,deemed revoked.
following reason (Sec. 7031.5. Business and Professions Code, Any city.or county which requires a permit to
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construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
such.permit to file a signedstatement that he is licensed pursuantio.ithe provisions of the Contractor's License Law
0 1 hereby'certify that no ixcavatio"n'five (5) or more feet in depth into which a person is required to descend, will be .
(Chapter 9(commencing .with seciion,7000) ot. 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 str6cture, scaffolding, falsework, or
therefrom and the. basis for.the alleged exemption. Anyviolation 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, Sec341dTille8r
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.); -
?I" •CA.C.j - w - r •'
0 1. as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
- p 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
., •1• - • '•.-
' through his own employees: provided;that such improvements are not intended oroffered for sale. If, however, the
0 Division of Industrial Safety Permit No.'
building orimprovemntissoldwithinone year ofcompletion, the owner -builder will have the burden ofprovingthat.
Date Applicant
he did not build or improve far the purpose of sale.).,
CONSTRUCTION LENDING AGENCY:I hereby affirm that there is a constroction lending agency for the performance
'p 1, as owner of the property, am ezculsively contracting,with licensed contractors to.constructthe project.ISec.
'of the work for which this permit is issued (Sec. 3097, Civ. C:). - 'r
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.lhe.'
-
Contractor's License Law.).. . _
Lender's Address
0 1 am exempt. under Sec. 4 B. 8 P.C.•(Attached Certificate).
I certify that I have read this application and state that the above information is correct.) agree to comply with all
Date Oviner "''
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
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certificate of Workers' Compensation Insurance : or•a certified copy thereof (Sec. 3800.'Lab. C.).. •
" Signature of Applicant or Agent Date
I
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 is.correct. I agree to complywith 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 representative of the City of La Ouinta Department of Building and Safety to enter
up�o//n'the property for whica l have/applied for t is permmiit•for the purpose of In nl inspections.�j pt
Date Applicant
SIDE
_
Signature of Applicant or Agent Date
'
i Print Applicant/Agent Name
APPLICANT NAME (L, F, MI) - - -'
LM. Deae1AAment Corn.
ADDRESS
Permit to'„Build 3657
CITY/COMMUNITY/STATE/ZIP-
La Quintan► Ca 92253
JOB SITE ADDRESS/SPACE -
78-112 Calle NOxte:
CITY/COMMUNITY/STATE/ZIP
La Ouinta. CA 92253
BOK
I PAG
PRO
C
TWN
RNG.•'.
SE +.
S.
TRACT
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Elect. Fee
MOD
SB
18767
Plumb.. Fee
'73.00
'Poop. Dev. Fee..
Unix 17
TRACT NAME
DIilnDia La Oeltintfta PNAae it
OWNER NAME (L, F. MI), . _ ,
LML Delve lopment Corp. "
CONTRACTOR -FIRM NAME - • '
. Same
ADDRESS
P.O. Box 1000
.CITY/COMMUNITY/STATE/ZIP • ,.
La Quinta, CA 92253
PHONE .
345-2888 `
'LICNC
413636
ARC/ENG FIRM NAME ..
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE .
LICNC .
USE OF PERMIT '
COMB.- Elect., Plumb., Build.-
uild.BL
BL.
1,617.66
-ZON
FSB
SSB... SSB ,
RSB
OFC
. ZONE ORD .' ..
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, ,
.
END ,
SIDE
APPL/PRMT ry
RyA
GATE
6-'25-84
Comb •
Permit to'„Build 3657
Sq. Ft, of,
Condominium •"•
Mech: Fee
19.00
Plan Check Fee
341.58
Constzuctiom Fee
525.50
Elect. Fee
49.02
SMT Fee
9:56'
Plumb.. Fee
'73.00
'Poop. Dev. Fee..
600,00
I
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1T(F((cf(2
1,617.66
;s VALUATION 136,386.90
BLDG.DEPT.
Ah
Ah
NO.
OPERATION
ATE
INSPECTOR
NO. OPPATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33 Ventilation System
2
Ftgs & Frms
34 Plenums & Ducts
2A
Slab Grade
35 Furnace Compart.
3
Steel
36 Inlets & Outlets
4
Grout Blocks
37 Combustion Air
5
Bond Beams
38 Compressor
6
Roof Deck
Z114
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
/
/` ^ 3I'
(g�/r 7
Y '
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
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 WireUFEie 6 �T
29B Bonding
30 Fixtures
31 Service
32 Final