0515 (SATT)PERMIT APPLICATION
ADDRESS5 N. matin Averm, Suite 231
CItY/./�COWN I/lSTATE/ZIPp_,T 92705 .
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 suspen3edbr abandoned for a period of 180 days. "
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CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION' INSURANCE! This section need not be completed if - '
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I 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 o1 the Business and Professions Code, and my license is in lull 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
NOTICETO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' '
OWNER -BUILDER DECLARATION:I hereby affirm that I am exempt from the Contractor's License Law for they
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
be deemed revoked.
following reason (Sec,' 7031.5, Business and Professions Code: Any city or county which requires. a permit to
450.00
construct, alter, improve, demolish, or repair any structure, prior -to its issuance, also requires the applicant for,
DIVISION OF INDUSTRIAL SAFETY PERMIT. CERTIFICATION:
such permitlofile .asigned statement that heislicensed pursuanttotheprovisions oftheContractor's License Law
01 hereby certify t8atnoexcavation five(5)ormore feet indepth intowhichaperson isrequired todescend, will be
(Chapter 9(commencing with section 7000) of Division 3 of the Businessand 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 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) feet high. (Chap 3.2, Grp 2, Art 2, Sec341, Title B. '
subjects the applicant to a civil penalty of not more than live hundred dollars ($500.): c'.,!,. .
C.A.C.)
;O, I. as„owner of the property. or my employees with wages as their sole compensation, will do the work, and the
' O'As owner -builder, I will not employ anyone to do work which would require ipermit from the Division of
• structure isnot 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 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. H. however, the
r_. , O Division of Industrial Safety Permit.No.
building or improvemnt is sold within one year of completion. the 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'leliding agency for the performance • '
O I, as owner of the property, am exculsivefy contracting with licensed contractors to construct the project (Sec.-
of the work for which this permit is issued (Sec:3 7, Civ. C.). •
7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of 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. & P.C.-(Attached Certificate)..
I certify that I have read this application and state that the above information is correct. ) agree to comply with all
Date ” ° Owner
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
SIDE
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 ora '
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 City' Department.
is filed with the City Building`Inspectionn:Department— rr
Date e . Applicant L_V .
YPYa ICOT NAM!(LLF`fLs7Mld�i '
ADDRESS5 N. matin Averm, Suite 231
CItY/./�COWN I/lSTATE/ZIPp_,T 92705 .
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T=�=Ih Da La Paz, Ltd.
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CONTRACTOR -FIRM NAME ,
ADDRESS '
CITY/COMMUNITY/STATE/ZIP '
°r i,A) 550-3766 `
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Signature of Applicant or Agent Date
:.CERTIFICATE OF COMPLIANCE AND AUTHORIZATION -OF ENTRY: I certify I have read this application and state That .
the°information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
construction, and authorize a'representative of the City of La Ouinta Department of Building and Safety to enter
upon the property for which I have applied for this permit for the purpose of making inspections. '
Signature of Applicant or Agent
Print Applicant/Agent Name
Date
APPL/PRMT IDLId-�84
Condo .
Pezmit to construct 1.973 Sq. Ft.
of S/F/D and 900 Sq. Ft. of Carar_,a az'
approved Plans
Radhanidal Fe3 $ L3 0 00
Plan Chzdt Fte
Paid
Cianstruc ion Fee
655.50
EIectr� Fee
35QC6
.T,U Fee
7.60
PlmnbirQ Fm
5G,03
Property l a�,amnt Fe3
450.00
ED
100)
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TOTAL_'
FEE
$ 1;022.7(;
BLDG. DEPT. VALUATION $100pC-19.00
•
NO.
OPERATION I _ P;TE
INSPECTOR
NO.
OP ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
l ! (_-yci
`T' G .
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
er40
•
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
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 IL
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 P/I
STREET NAME
26 Power Pole dIRW
27 Conduit 8
28 Service Entrance •
29 Wiring •
29A Grounding Wire _ [ r $y L
29B Bonding
30 Fixtures
31 Service
32 Final