0517 (SATT){
ADDRESS Nwth Mustin AVeaue, Staite 231
NI/$TA' Eralp 92705
JOB'S •ADORESS/SPACE •', 1 - -
t✓ J W A39 u= De Nopal � 48 - 1..+
' ' PERMIT APPLICATION >•
x f-
City o1 La Quinta
A. Department of.Building,and Safety •
PRC
C
NiQCp13Yl7.+la1 Fee'
'
..,
_ .
. This permit becomes void if work not commenced within 180 days from
of issuance; OR; if work has been suspended or abandoned for a period of 180 days:.
S -
_ 1
a ,
CERTIFICATE OF EXEMPTIONv FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed If
LICENSED'
CONTRACTORS DECLARATION: I hereby .affirm- that Iam licensed under provisions of Chapter -9
.d .the'permit is for one hundred. ($100) o, less. I certify that in the performance of the work for which'this'permd 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
.•1)ate� • - Contractor
NOTICE.TO APPLICANT: If, after making,this Certificate of Exemption„you should become subject to the Workers'.
• h
OWNER -BUILDER DECLARATION:- I hereby affirm that Cam exempt from the Contractor's License Law for the' `
Compensation provisions of the Labor Code, you must forthwith comply withsuch 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 •
.'
:
construct, alter, improve. demolish, or repair any structure, prior to its issuance; -also requires the applicant for.
DIVISION,OF. INDUSTRIAL SAFETY, PER CERTIFICATION:
such .permit to file a signed statement that heislicensed pursuanttothe provisions oltheContractor's License Law . •''-
:•, ❑ Iherebycertify that noexcavationfive (5)ormore feet indepthintowhich aperson isrequired todescend,willbe •-
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code)orthat he is exempt. •
i . made in connection %0h wo-rk authorized by this ;permit; and that no building structure, scaffolding, falsework, or '�•
y therefrom and the basis for thealleged exemption. Any violation of Section 7031.5 by. any applicant for a permit
demolition or dismant6i thereof, will be more than thirty-six'(36) feet high. (Chap'3.2, Grp 2, Art 2, -Sec 341:Title8: •"•'
x+.r, subjects the applicant to a civil penalty of not more than five'hundred dollars ($500.): •
C.A.C.) . ' - ' •'''' '
`. O I Tas owner:of.the property, or my employees with wages.as.their sole compensation, will do the work;rand the.-:.
:' ❑ -As owner•ouilder, 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 from that division. '
' -
Law does not apply to an owner of property who builds, or improves thereon, acid who does such work himself or
through his own employees, provided that such improvements are not intended or offeredior sale. If, however, the
• • •
❑ Division of.lndustdal Safety•Permit No.
building orimproverrint is sold within one year of completion. theowner-builder will have theburdenof,provingthat . ,
: Date -Applicant'
he did not build or improve for the purpose of sale.).
' a '
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance t',
0 I!as owmerof the property, am exculsively contracting with licensed contractors to construct the project (Sec:
` I. of the work for which this permit is, issued (Sec. 3097, Civ. C.):
7044. Business and Professions Code: The Contractor's License Lawdoes not apply to an owner of property whos
, .
Lender's Name
.' builps.or improves'thereon; and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.). . ; .
Lender's Address ..
N
0 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 e,
i Y'fe .
Date ` '
city and county -ordinances and state laws relating to building construction, and hereby authorize representatives,' •
.Owner
of this county to enter upon the'above mentioned property for inspection purposes. i
• WORKERS' COMPENSATION DECLARATION:•I hereby affirm that I have a certificate of consent to self -insure; of a' ;.'•'
'•
• ceniticate'of Workers'•Compensation'lnsurance , or a'certified copy thereof (Sec"3800: Lab. C;);:.' ;
•`�; •' ` Signature of Applicant or Agent Date
Policy No Company
_ CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read thisapplicationand statetha •. '
❑ Certified copy,is hereby furnished. t
Certified '
r the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling -•
construction, and authorize &'representative of the City of La ouinta Department of Building and Safety to enter,
O copy is filed with the City Building'Inspection-0epartmenl,or City Department.:
-• —•- -
- •upon the for which I have applied.for this for. the of making inspections.
t... : m�10--
4 Date , Applicant
property permit purpose
.. . .
Signature of Applicant or Agent _ : ' Date
•
Print Applicant/Agent Name N '
t'SAPPLICJU•NAUI�i �IFL.�C�i . .r • .. .. � '..
ADDRESS Nwth Mustin AVeaue, Staite 231
NI/$TA' Eralp 92705
JOB'S •ADORESS/SPACE •', 1 - -
t✓ J W A39 u= De Nopal � 48 - 1..+
CITY/C uNl.i /�STA�TE/Z_ IP,� 92253
BOK -
PAG.
PRC
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NiQCp13Yl7.+la1 Fee'
TWN
RNG'
SE
S -
Ti, 64073 .
LOST
' ` `34.67 •
SM Fee . ' .
MLi1 ' .
SB
'• '61,00-. -
L.wPzQLtd. ,
O.MWME •(L. Fptbw - ..
CONTRACTOR -FIRM NAME - '' • .. -
ADDRESS ` - i - •.. -
CITY/COMMUNITY/STATE/ZIP
`HOii4) - 558-3766 • `
'
LICNC S.
ARC/ENG FIRM NAME ♦ ^' .. i'-
ADDRESS .• y
CITY/COMMUNITY/STATE/ZIP • ,� '
PHONE N
LICNC N
•; •"
U$ OF P. MITI -
b�r/ti tCafndcminium).
Bl
ZON -
FSB
SSB.
SSB'.;
RSB
..
OFC.
-
ZONE ORD N
,
• LOT SZ .,.[END
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SIDE
APPL/PRMT 1 �`AT-_E pp
�� ,,,•,q�,- -
Pendit to construct 1, 894 Sq.
Ft. - of,. S./F/D
with 400 Sq�* Ft. of Garage as "p= . &p . _
..
NiQCp13Yl7.+la1 Fee'
$ `• '18--00---
Platt Check Fbe.
,Paid `-
Constructim' Fee'
X45:50 `
F.Z.ectricai' Fee
' ` `34.67 •
SM Fee . ' .
, ?.32,
'Plimb ng Fee
'• '61,00-. -
Pa operty Dev�elloWent Fee.
450900':':
” -• -
CrLy
', .TOTAL .'
,a FEE
$" 1; 016.49 `
t
.; c y •:
.F BLDG: DEPT. ;
,'
C�
VALUATION `5104',664.40 : .
NO.
OPERATION ATE
INSPECTOR
NO.
OP ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System • -
2
Ftgs & Frms
j / - / _cdk
7- 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
40
Fire Damper
8
Vents
IL
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 R"
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
• PLUMBING APPROVALS
15 Ground Plumb —r -G,
16 Water Piping quo
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/1
j
STREET NAME
26 Power Pole
27 Conduit •Pak
28 Service Entrance
29 Wiring
29A Grounding Wire (_ (_ '��_
29B Bonding
30 Fixtures
31 Service -
32 Final