0804 (SATT)PERMIT APPLICATIQN,;-
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,l 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
(Chapter 9(commencing with section 7000) of Division 3 of the Business and Professions Code)orthat 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.):
O I, as owner oLthe 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
r through his own employees, provided that such improvements are not intended or offered.for sale. If, however, the .
building or improvemnt 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.).,
O 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 of property who
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
O 1 am exempt under Sec. B. 8 P.C. (Attached Certificate).
Date w ' 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. -
Policy No. Company
O Certified copy is hereby furnished.
O. Certified copy is filed. with the City Building Inspection Department or City Department.
Date Applicant
APPLE I�CA�NT D� o L, MI)pment Cori •
!J
ADDRESS
P.O. boa 1000
CITY/COMMUNITY/STATE/ZIP
La Quinta CA 92253
JOB SITE ADDRESS/SPACE
78-105 Calle Noste
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
BOK
PAG
PRC
C
-
TvM
PING
SE
S
TRACT
19767
LOT
341.58
Construction Fee
MOD
SB
Unit 25
TRACT NAME
Duna La Quinta Phase 11
OWNER -NAME (L. F. MI) .. ,
. vevelopment Corp.
CONTRACTOR -FIRM NAME
Same
ADDRESS
P.O. Boa 1000
CITY/COMMUNITY/STATE/ZIP
Ln Qui#ta, CA 92253
PHONE .
345-28888
LICNC
413636
Prov. Dev. Fee
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE .
LICNC 0
USE OF PERMIT '
Cts. Elect, Plumb Build
BL
jF tom•
ZON
FSB
SSB
SSB
RSB
OFC
TOTAL
FEE
ZONE ORD 0.
LOT SZ
-
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.
DIVISION OF INDUSTRIAL, SAFETY PERMIT CERTIFICATION:
O. I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will 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, Tillell.
C.A.C.)
O 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 a permit to do such work from that division.
O DivisionofIndustrial Safety Permit No.
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. f
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read Misapplication and state that
the,information given is correct. I agree to complyywifh all state laws and county ordinances relating to bufdling
constructionoand authorize a'representative of the City of Laquinta Department of Building and Safety to enter
upon the property for which I have�ap lied for this permit f the purpose of aking inspections! .
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPVPRMT
�
DATE
6-25-84
Comb.
I.
Permit to build 3657 Sq. Ft.
Of Condominium
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
Prov. Dev. Fee
600.00
JN
jF tom•
TOTAL
FEE
1�fil7 AA
VALUATION 136,386.90
BLDG. DEPT.
Ih A
NO.
OPERATION MATE
INSPECTOR
NO.
OP NATION 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
, '
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
NO.
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath �d
12Internal Lath
12A Drywall
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
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)
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
M