001217 (BLCK)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.
• '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 licen I's th full force
and ettem- I
License Clads -- ic.'Numbef
~ CJ
Date Contractor
OWNER -BUILDER DECLARATION: I hereby of irrn �Ibat, I am exempt from the ContractodsLicense law for the
following reason (Set. 7001.5. 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 Contraetor's License Law
(Chapter 9(commencing with section 7000) of Division 3 otthe Business and Professions Code) orthat he is exempt •
therefrom and the basis.for the alleged exemption. Any,'violation of Section 7031:5 by any,applicantfor.a permit.
subjects the applicant to a civil penalty of not more than five hundred dollars (5500.);
❑ I. as owner of the property, or my employees with wages as thetrsole compensation; will do the work; and the • -
structure is not intended oroffered for sale (Sec. 7044; Business and',Professions Code: The Contractor's License
Taw does not applyto an owner o f property,who builds, or improves thereon, andwho'does such work himselfor
through his own emptoyees,,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 orimprove for the purpose of sale.).
❑ 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 anowner,of property who
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's Ucense Law.).
❑ 1 am exempt under Sec. 8�8 P.C: (Attached Certificate).
Date Owner -
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a'certilicateof consent to self -Insure, or a
certificate of -workers' Compensation. Insurance , or a certified copy thereof (Sec: 38011. Lab. G):
Policy No. Company
o Certified copy is hereby furnished.
❑ Certified copy is filed with the City Building Inspection Departinent'or City Department.
_ Date Applicant
APPLICANT. NAME (L. F„Mi) Clanig Conklin Company
ADDRESS - 73-612 Hwy 111 ”
CITY/COMWINITY/STATE/ZIP Palm Desert, . CA 92260
JOS SITE•ADORESSWACE 78-255 Hacienda La Quini
GT""DOYO,'U"'TyBTATE2'P'p a .Quints, CA 92253
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TRACT NAME La Quinta• V a -
OWNER NAME (L..F, MI) Don Wilson
cor4TRAcroR-FIRM NAME -Applicant- ... .
above
CITr/COMMUNII' m-TvaFI above .
P-ar,
L'S -11.e6634
ARCAM FIRM' NAME •. .
ADDRESS
CIT'/COMa1UNITYMTATE/ZIP - '• -
PHONE•
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'USE OF PERMIT Door
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398
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END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS', COMPENSATION INSURANCE[' This section need"not be ompletedif
the permihis for one hundred ($100) o, less. I certity.that in performance of the work for which this permit is
issued; I shall notemploy ariypereonin any manner so as to become subject to the Workers'' Compensation Laws of
California.
Date Applicant
NOTICE TO APPLICANT: It, after making this Certificate of -Exemption, you should become subject to the Workers'
Compensation provisionsvil the Labor Code, yoomust forthwith compry, with such provisions or this permit shall
be deemed revoked.
DIVISIOKOF INDUSTRIAL:SAFETY PERMIT CERTIFICATION:
❑ 1 hereby'diii-tify 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 dismantlingdhereof, will be more than thirf'y,six (367,feettiigh:,(Chap 32, Grp 2 An 2. Sec341. TitleB, a
CAO .
❑ As. owner -builder; 1 will not employ anyone to;do� Work which would`require•a permit from the Division of
'Industrial'§afety,arnoted above,. unless suchperson has:a permit'te do such work from that division.
❑ Division of Industrial.Satety Permit No.
Date Applicant
- CONSTRUCTION LENDING AGENCY: thereby affirm that there is a construction lending agency for the performance
of the work tot which this permit is issued'(Sec. 3097. Civ. C.).
Lender's Name
Lender's Address
I certify that I,have read tins 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:Mentloned property'for inspection purposes.
Signature,of. Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify l have read thisapplieation and statethat
the information given is correct. I alit coo'mply with all state laws and county ordinances relating to buid(ing
construction, and; authorize,a`representative of the City. of LaQuinta Department of Building and Safety to'enter
upon the property:forvhicfit have applieA for Mrs permit for the purpose of maWhg ins�ecUoriss ..
-_ .`
signature;of Applicant or'Agent Date
Print Applicant/Agent Name
Ammlita1T
e
..Permit to install
a door In
place
of or in addition
o his entrance
-Iron Gate as per
approved p
anso'
Plan Check Fee
21.$x_
-
Const. Fee,
32.50
SMI Fee
.50
1d
-+
TOTAL
FEE
4.12
BLDG. DEPT.
V U . VU
VALUATION
NO.
OPERATION _..TE INSPECTOR
NO.
OPERATION 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
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath,
12A Drywall
13 Finish Grade
INSULATION Thick
Value
7A Wells (Batts)
126 Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMB ING.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
29B Bonding
.30 Fixtures
31 Service
'32. Final
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Villa la uiinta Homeowners Aeeocia
Genera} -He ivery • La Quinta, Califomia 92253
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