0803 (SATT)PERMIT APPLICATION
• City of
La Duinta
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 completed it.:
'•'LICENSED CONTRACTORS DECLARATION: I hereby affirm that Lam licensed under provisions of Chaptei'9
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•3of the Business and Professions Code, and my license is in full force
issued, l shall not employ any person in any manner so as to become subject to the Workers'CompensalionLaws of t
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 Workets'
i•':• . -' ' �•' , '
OWNER -BUILDER DECLARATION: I hereby affirm that I amexempt from the Contractor's License Law for the
Compensation provisions the Labor Code; you must forthwith comply with such provisions or this permit shall
r
`be
..
• following reason (Sec.'7031.5. Business and Professions Code; Any city or'county which requires a permit to r:
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 permit tofile asigned statement.thatheislicensed pursuant tothe provisions ofthe Contractor's LicenseLaw
Olhereby certify lhatnoexcavatiolifive (5)ormore feet indepth into which aperson isrequiredtodescend;willbe
(Chapter 9(commencing with section 7000) of Division 3 of the Business and Professions Code) o! that heis 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
demolition of dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2. Sec341. Title B, `
subjects the applicant to a civil penalty of not more than five;hundred dollars (5500.):
C.A.C.)
❑ I: 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 Eo 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
through his own employees, provided that -such improvements are not intended or offered for sale. If, however, the
❑ Division of.Industrial Safety Permit. No:,,-
building orimprovemntissold within one year ofcompletionrthe owner -builder will have the burden of proving that
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 agencyforthe performance
❑ I, as owner of the property, am exculsively contractingwith licensed 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 . i
.builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
RSa
Contractor's License Law.).
Lender's Address
' ❑ Pam exempt under Sec. 'B: 8 P.C: (Attached Certificate).
.l certify that I have read this application and state that the above information is correct. I 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, or a
SIDE
—certikate o1 Workers' Compensation Insurance : or a certified copy thereof (Sec. 3800. Lab: C.).'
Signature of Applicant or Agent - - Date
.Policy No. Company
r
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read thisapplicationand state that
O Certified copy is hereby furnished.. .. ., . r.. . . -
the information given is correct.,l•agree to comply with all state laws and county ordinances relating to buidling
O Ce}tilied co is filed with the Cit Buildin Ins ection De artment or Cit De artment.'' `
DY Y 9 p p Y` P
construclfon,and authorize a'representative of the City off La Ouinta Department of Building and Safety to enter _
a J / /
upon the'property for which leave applied for'thiis permit fort € purpose of masking inspections,
,Date Applicant
�. Signature of Applicant aFrAgent Date
Print Applicant/Agent Name
A %iLLIGAN NAME (L F, MI) - ..
1Deveiopment . Corp.
ADDRESS '•
$0. Box' 1000
CITY=MUNITY/STATE/ZIP . .
La Quinta,, CA 9225.3''
JOB SITE ADDRESS/SPACE
780103 Calle Norte.
CITY/COMMUNITY/STATE/ZIP
La Quinta, 8A• 92253
BOK
PAG
PRC
C
TWN
PING
SE
S
TRACT
W767
LOT
291.20'
MOD
1 SB
Unit 24
TRACT NAME _
Duna La Quinti . Phase II
OWNER NAME (L. -F. MI) - •"
L14L Development Corp,
CONTRACTOR -FIRM NAME ,
I
ADDRESS .
P.O. box 10%00
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92293
PHONE a ''L,
Plumb Fee
LICNC
63.00
345-2888
413636
ARC/ENG FIRM NAME
ADDRESS ..
CITY/COMMUNITY/STATE/ZIP - -
PHONE,
LICNC M
-
USE OF PERMIT -
COMB. ELECT, PLUMB„ BUILD '
BL
ZON
FSB
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a sse
SSB -
RSa
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OFC S :-
• , ZONE ORD, . -�'i'
X ;
LOT SZ
• END
SIDE
APPIJ?RMT
DATE
6-25-84
COMB
Permit to Buil 2969
Sq. Ft. of
Condominium.
Mech_Fee
19.00
Plan Cbhek Fee
291.20'
Construction Fee
448.00
Elect. Fee.``
40.71
SMI Fee
7.39
Plumb Fee
63.00
Prop, Dev, Fee
450,00
1
F .
Ju- •.. _
r-
-
+ s,
TOTAL
FEE
+
BLDG.DEPT: VALUATION 105,044,70
• � '
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a
NO.
OPERATION ATE
INSPECTOR
NO.
OPERATION 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
9 /A
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5.
Bond Beams
38
Compressor
6
Roof Deck
S
y f.F
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
�a�(
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath p
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 RougKPlumb
18 Vents
19 Sewage Disposal
20 Sewer low
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 P1
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring S
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final