0529 (SFD)PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
It V N. ` US'tin Avenue, ` Suttle 231
CIT�.Y/YCY M�M,YUNY STATE/ZIP 92705 .. .
This permit becomes void if work not commenced -within •180.days from date of issuance, OR, if work -has been suspendedor,abandoned,for a period of 180 days. '
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE:�This section need not be completed if
' -LICENSED CONTRACTORS DECLARATION: I hereby affirm that 1 am. licensed' under provisions of Chapter 9
the permit is for one hundred ($.100) o, less:l 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 anyperson in any mannerso as'to.become subject to.the Workers'Compensation laws of -
and effect.
California.
License Class . Lic. Number
Date Applicant.
Date Contractor'
NOTICETO APPLICANT: If: after making this:Certificate of -Exemption, you should become subjecl.to the Workers'
' , -
OWNER -BUILDER DECLARATION: I hereby affirm'ihat I 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.perinit to
be 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 to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
13 1 hereby'6ertify that rio excavalion five (5) or more feet indeoth into which a person is required to descend, will be -
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) he is exempt
made in connection with work authorized by this permit, and that no building structure, scaffblding,.falsework, or
therefrom'and. the basis for the 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) feethigh:'(Chap 3.2. Grp 2. Art 2, Sec 341, Title 8.
subjects the applicant to a civil penalty of not more than five hundred dollars (S500.):
C.A.C.)
l: as owner of the property; or my employees with wages as their sole compensation, will do the.work, and the
• 01 '
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 fromdhat division:- .'
Law does not apply to an owner of property who builds, or improves thereon, and who does such work himself or
o,
through his own employees, provided that such improvementsare not intended or offered for sale. Ih however, the
Division of .Industrial Safety Permit.No.
building or improvemni is sold within one year of completion, the owner -builder will have the burden.ofproving 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 agency for the performance-".'
O I, as owner of the property, am exculsively contracting with 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 ownerof property who
'Lender's Name
builds or improves thereon, and who contracts for such projects with'a contractor(s) licensed pursuant to the
.. -• - .. - - -
Contractor:s License Law.).
Lender's Address
• ..O 1 am,exempt under Sec. B. 8 P.C. (Attached Certificate)'.
I certify that I have read this application'aild state that the above information is correct: I agree to comply with all
Date Ownercity
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 1 have a certificate of consent to self -insure; or a
'
' certificate of'Workers' Compensation Insurance., or a certified copy thereof (Sec. 3800. Lab.1C.).
Signature of Applicant or Agent -Date
Policy No. Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that .
•• D Certified copy is hereby furnished..
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
O Certified copy is filed with the City B_ uilding Insp_ection.0epartrrlent:or City A • Department.
construction, and authorize a'representative of'the City of La Ouinta.Department of Building and Safety to enter
yt
upon the property for which•1 have applied for this permit for -the purpose of making inspections. --'
Date Applicant
Signature of Applicant or Agent Date
tP. f ICLAANT NtrM,1L.VF=n
It V N. ` US'tin Avenue, ` Suttle 231
CIT�.Y/YCY M�M,YUNY STATE/ZIP 92705 .. .
JO SITEJ.ES%PACrar1aS
48 � 1
TaC= t ,v EZR 9M53'
BOK
PAG
PRC
C
455.50
r?m
RNG
SE'
S
x3 X90-3
t Gx4'
Property D*acipmt Fee
456.00
M
sB
�JIJCT A
.%a De La Paz, Ltd.
O�t.NAMEE �r(,L. F,. till
CONTRACTOR -FIRM NAME
ADDRESS -
CITY/COMMUNITY/STATE/ZIP'
Pr►°114) 558.3766 1
TOTAL
• •
FEE
LICNC N
ARC/ENG FIRM NAME
ADDRESS -
CITY/COMMUNITY/STATE/ZIP `-
PHONE # -
LICNC II
USE2F� 115 jCando j niu Y�)
/
BL
ZONF„SB
SSB
"SSB
RSB
OFC.
ZONE ORD'S
LOT SZ
END
SIDE
Print Applicant/Agent Name
APPURRMT» q —DATEZU,8 n
Condo
Permit to oonstn=t 1,973 Sq. Ft. of S/F/D
with 400 Sq. Ft. of Garage Per Appmavad PIJans
Mecaniaal Fee $ 18:00
Plan Check Fee
Pard '
Constructian Fee
455.50
Electrical Fee.
.35:66
SMI Fee
?;60
Plumbing Fee
5640
Property D*acipmt Fee
456.00
AR L,C L�:9VJa`
FEB 6.'r983
C' i r
TOTAL
• •
FEE
$1,022.76. ..
BLDGOEPT: VALUATION $108r819.80
.
-} -
r-1
Ah
NO.
OPERATION DATE
INSPECTOR
NO.
OP ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
—.E,(
�j
34
Plenums & Ducts
2A
Slab Grade
35
Furnace Compart.
3
Steel
36
Inlets & Outlets NO L
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
39
1 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
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
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 — (� Y� �G
29B Bonding
30 Fixtures
31 Service
32 Final /