0797 (SATT)PERMIT APPLICATION
City of La Ouinta
• 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 a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law.
(Chapte"r 9 (commencing with section 7000) of Division 3 of 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 dollars ($500:):
0 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
structure is not intended or offered for sale (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 does such work himself or
through his own employees, provided that such improvements are not intended or offered for sale. If, however, the
building or i mprovemnt is sold within one year of completion, the owner -builder will have the burden of proving that
he did not build or improve for the purpose of sale.).
0 I, 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 ofproperly who
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor'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 consent to self -insure, or a
certificate of Workers' Compensation Insurance , or a certified'copy thereof (Sec. 3800. Lab. Q.
rPolicy No. Company
- 0 Certified copy is hereby furnished.
k0 Certified copy is filed with the City Building Inspection Department or City _Department..
Date Applicant
APPLICANT NAME (L. F. MI)
LMD DEVELOPMENT CORP.
ADDRESS
90 Bos 1000
CITY/COMMUNITY/STATE/ZIP
La Quinta„ CA 92253
JOB SITE ADORESS/SPACE '
78-110 Calle Norte
CITY/COMMUNITY/STATE/ZIP
La Ouinta. CA 92253
BOK
'PAG
PRC
C
19.00
TWN
RNGSE
Construction Fee
S
TRACT -
18767
LOT
SMI Fee
9.56
MOD
SB
-
[Tait 18
TRACT NAME
Duna La quiuta Phase II
OWNER NAME (L. F. MI)
Same
CONTRACTOR -FIRM NCTOR�FIR.9M ME .
lai1L Development Corp.
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 .
TFEE
LICNC •
'
USE OF PERMIT.
COMB.- Elect, Plumb. Build
BL I
I ZON
FSB
SSB SSB
RSB
OFC
. ZONE ORD ..
I
LOT S2
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 in any manner so as to become subject to the 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. " tt
f
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:.
0 I hereby certify that'no excavation five (5) or more feet in depth into which a person is required to descend, w ill 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 2, Art 2, Sec341, TilleB,
C.A.C.) 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 E permit to'do such work from that division.
Division of Industrial Safety,Permit No v
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
Lender's Address
: I certify that I have read this application and state that the above information is correct. 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 thisapplication and statethat
the information given is c6rrect. I agree to comply with all state laws and county ordinances relating to buidling
censtruction�and authorize a'representatrive of the City of La Ouinta Department of Building and Safety to enter
upon the prgperty for which I have�pplied for`thispermd lorthe purpose of ma ing inspections..^
,moi' ' � ��r,�� /irr-.C� af
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPLNRMT 'DATE
6-25-84
'
COQ.
Permit to Build 3657 Sq. Ft.
of Coudom3,nuim
Mech. Fee
19.00
Plan Check Fee
341.58
Construction Fee
525.50
Elect. Fee
49.02
SMI Fee
9.56
Plumb. Fee
73.00
Prop. Dev. Fee
600.00
TFEE
4617.66
BLDG. DEPT. VALUATION 136,386.90 '
Ah
Ah
NO.
OPERATION ATE
INSPECTOR
NO. OP ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set'Back
33 Ventilation System
2
Ftgs & Frms
34 Plenums & Ducts 1
2A
Slab Grade
35 Furnace Compart.
3
Steel
S
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'NO. ADDITIONAL INFORMATION
ley c�
J
41
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath Q
12 Internal Lath
12A Drywall 0 ��
13 Finish Grade
INSULATION Thick .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 Wire
2.98 Bonding
30 Fixtures
31 Service
32 Final