0802 (SFD)PERMIT APPLICATION
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.
• wJ CERTIFICATE OF. EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This -section need not be completed it
'. LICENSED' CONTRACTORS DECLARATION: i hereby affirm- that I am' licensed under:provisions of. Chapter ,9. the permit•is for one hundred ($100) o,-lessi I certify that in the performance of the work for which this -permit is
(commencing with Section 7000) of Division 3 of the Business and Professions.Code, and my license is in full.force •: • '- issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of
and effect. California.
License Class. Lic. Number, Date Applicant
Date Contractor NOTICE TO APPLICANT: If, after making this Certificati of Exemption, you should become subject to;the Workers'
OWNER -BUILDER DECLARATION: I hereby affirm That l 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 Code: 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 SAFELY PERMIT CERTIFICATION: '
such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law ' ❑ 1hereby certify that noexcavation five (5)ormorefeet indepth intowhichaperson isrequired todescend, will 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, falsework, or
therefrom.and.the basis.lorthe 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) feel high. (Chap 3.2, Grp:2Art 2, Sec 341, Title 8. '
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):�'C:A C j T�•"
❑ I, as owner of the property. d. , eeswith wages as their sole compensation, will do the -work, and the O As owner-boilder, 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 usiness 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 ves thereon, and who does such work himself or
through his own employees, provided that such improvements are n ' ended or offered to'
sale. If, however, the O Division of Industrial Sat ety Permit No;
building orimprovemntissoldwithinone year ofcompletion, theowner-but illhoeeIheburdenofprovingthat Date Applicant
he did not build or improve for the purpose of sale.). CONSTRUCTION LENDING AGENCY: l hereby affirm that there is a construction lending agency for the performance
0.1„as owner at the. property, am exculsively contracting with licensed contractors t'..c.n wct the project (Sec: - of the work'1or.which this permit is issued (Sec. 3097, Civ. C:).
'
7044. -Business and Professions Code: The Contractor's License Law does not apply to an owne�0 oertywho Lender's Name
• 'builds or improves thereon, and who contracts for.such projects with a contractor(s) licensed P.._1! o the
Contractor's License Law.).Lender's Address
❑ 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 Owner” city and county ordinances and state laws relating to building construction, and hereby authorize representatives
ohthts 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
certificate of Workers' Compensation Insurance., or.a certified copy thereof (Sec. 38Lab. Q. • • 00: � ` Signature of Applicant of Agent Date �
Policy No. Company. CERTIFICATE OF COMPLIANCE'AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that ^ i
O Certified copy is hereby, furnished . the.information given is correct. I agree to comply with all state laws and county ordinances relating to buidling s
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�on�thhee property for which I have♦appt�ted for this pe�rmit�to the purpose of making inspectio s.
Date Applicant ii/fr /5
Signature of Applicant or Agent ' Date
APPLICANT NAM (L F MI)
%t ! b8V SOPA ENT. CORP.
ADDRESS
P.O. BOX 1000 '
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
JOB SITE AODRESS/SPACE
78Wl Calle Norte
'
c La Quinta /ZCA 92253
BOK
PAG
PRC "
C
TWN % .
RNG
SE
S
TR1O 9067
LOT
341:58.
-Construction Fee
MOD
SB
Unit 23
TRACTE
�
UM IA QYi.J.M Phase 11
O ER NAME (L. F. MI) ..... . ..
. Development Corp.
CONTRACT -OR -FIRM NAME . • .. -
APSS
.O: Box 2000
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
PHONE, . •LICNC
345-2888
0 4
413636
-
ARC/ENG FIRM NAME •,' ..
ADDRESS
CITY/COMMUNITY/STATE/ZIP *• .; - - •-
PHONE N
LICNC..
- -
USE OF PERMIT �i1d •
COMB. Elect. Plumb.
BL
ZON
FSB
SSB
SSB
RSB
OFC._
+'
t TFEE
1,617.66
ZONE ORD . • , ,
LOT SZ' ,
'END
SIDE .
' t
Print Applicant/Agent Name
APPL/PRMT .URO
6-A25-84 1
Comb.
Permit to'build 3657
Sq. Ft. of -
Condominium
Lech Fee
19.00
Plan Check Fee
341:58.
-Construction Fee
525;50
-Elect. Fee*-. .
'49.02
SMI Fee
9.56
Plumb. Fee.
73,00 -
Proo. Dev. Fee
600,00
+'
t TFEE
1,617.66
t ks° VALUATION 136,386.9Q
- BLDG. DEPT. ,
.11
Ah
a
NO.
OPERATION DATE
INSPECTOR
NO.
O'PEA ATION I 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
1 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
�� p�� 8J5
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal 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 4P o2 b
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 �� 8
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
296 Bonding
30 Fixtures
31 Service
32 Final