12-0411 (RER)i
+ P.O. BOX 1504
78-495 CALLE TAMPICO
� M
LA QUINTA, CALIFORNIA 92253
14»
TAh
t 4 4.Q"
Application Number: 12-00000411
Property Address: 77707 CALLE SONORA
APN: 773-265-001-1 -000000-
Application description: REMODEL - RESIDENTIAL
Property Zoning: COVE RESIDENTIAL
Application valuation: 2500
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
--------------------------------------------------
' LICENSED CONTRACTOR'S DECLARATION -
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with _
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: License No.: `
Date: Contractor:
OWNER -BUILDER DECLARATION
I hereby'affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section'7031.5 by
anyy0plicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
( 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the'work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
1 _ ) I am exempt under Sec. , BAP.C. for this reason
KDate:'
ate Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
"Lender's Name:
Lender's Address:
LQPERMIT
Owner:
UNDERWOOD, JEAN
79835 TORONJA
LA QUINTA, CA 92253
Contractor:
owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760).777-7153
APR 17 zoiz
Date: 4/16/12
-----------------------------------------------
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier Policy Number
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as to become subject to the workers' compensation laws of California,
and agree that, if I should become subject to the workers' compensation provisions of Section
3700 of the Labor Code, I shall forthwith comply with those provisions.
Date: Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,'AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1 . Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnity and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit. .
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this 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-mentioned property for inspection purposes.
Date: Signature (Applicant or Agent):
AppliCati= WWttLer 12-000,00411
------ •Structure Information REMODEL - WINDOW CHANGE OUT/STUCCO -----
Other struct info . . . . . CODE EDITION.
2010
,•��-------------------- ---------------- --------------------------------------
---- ----------------------------Permit
Permit .. . . BUILDING PERMIT -
Additional desc .
Permit -Fee 54.00 Plan Check Fee
35.10
Issue Date . . . . y Valuation . .
. . 2500
Expiration Date 10/13/12
Qty Unit Charge Per
Extension
BASE FEE
45:00
1.00 9.0000 THOU BLDG 2,001-25,000
----------------------------------------------------------------------------
9.00
Permit ELECT - ADD/ALT/REM.
Additional desc .
Permit Fee . . . . 18.00 Plan Check Fee
4.50
Issue Date Valuation
0
Expiration Date 10/13/12
Qty Unit Charge .Per
Extension
BASE FEE
15.00
4.0.0 .750.0 PER ELEC DEVICE/FIXTURE 1ST 20
3.00
-------------------------------------------------
Special Notes and Comments
CHANGE OUT EXISTING WINDOW TO FRENCH
DOORS AT BEDROOM 2, ADD FRENCH DOORS AT
BEDROOM 1 AND STUCCO EXTERIOR PATIO WALL
WHERE UNPERMITTED PATIO ENCLOSURE WAS
REMOVED. CODE CASE: 12-2008 [EE] 2010 `.
CALIFORNIA BUILDING CODES.
April 16, 2012 4:26:22 PM AORTEGA•
-------.---------------------------------------------------------
other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
• ENERGY REVIEW FEE
3.51
Fee summary Charged Paid Credited
Due ,
----------
Permit Fee Total 72.00 .00 .00
----------
72.00.
Plan Check Total 39.60 .00 .00
39.60
Other Fee Total 4.51 .00 .00
4.51
Grand Total 116.11 .00 .00
116.11
LQPERMIT
Bin #
_ • .
Cly, Orb Quin -0 ..:'
.Building q Safety Division '. • ..
Permit #
P.O. Boy, .1504, '78-495 Calle Tampico
La.Quinta, CA 92253 -:(760) 177-7012
Building Permit Application and.Tracking Sheet
Project Address: Q Owner's Name:.
A, P. Number. Address: 7 61 _ Q In 0 h \
Legal Description: City, ST, Zip: t fN
Contractor. r, Telephone -,?w
Address: Project Description:
City, ST, Zip:lot `►-1 d �� v
Telephone: 1-
45 o w^ t h
State Lia # : City Lie C. � a
Arlt, Eng., Designer:
' U t.-� �d 2 � h ci.- � r o
Address: CG $ •, d m: o.. i^
City., ST. Zip:
Telephone: Construction Type:. Occupancy. V 6e.• c, .� .
State Lic. #: Pro'ect c
type Circle one): New Add'a Alter . Repair De mo
Name of Contact Person: w .�. Sq. # S ries: # Unit$:
IA
Telephone # of Contact Person:. u b . ` — Z_ Estimated Value of Proj j^ .(J • f7
APPLICANT: DO NOT WRITE BELOW THIS LINE
it
Submltial
RWd
Recd
TRACMG PERMIT FEES
Plan Sets
Pian Check submitted.Item Amount
Structural Cale&
Reviewed, ready for corrections Plan Check Deposit
Truss Calcs.
. Called Contact Person Plan Check Balance.
Title 24 Cake.
Plana picked up Construction
Flood plain plan
Plans resubmitted.. Mechanical
Grading plan
V Review, ready for correctionemue Electrical
Subcontactor Ila
CaAed Contact Person Plumbing
Grant Deed
Plans picked up SALL
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE:-
''d Review; ready for correetionAssae Developer Impact Fee
Planning Approval
Called Contact Person A.LP,P.
Pub. Wks. Appr '
Date of permit issue
School Fees
Total Permit Fees
P.O. BOX 1504
LA QUINTA; CALIFORNIA .92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
PROPERTY OWNER'S P`ACKA.GE
(760) 777-7012
FAX (760) 777-70.11
Disclosures & Forms for Owner-Buflders ApplyIng fDr Constritcdon Penats
ARM
��� PIQiK`Ii 'iM ttsra�nwu�v c.�zr.mr
fear Itopetty OWv W
An. eagheatiou for a budding permit has been .&ubfttftd to your game UstWg youmelf as the buddet of t8e prnperty
mat
We am YW � an Owner4WIdw Ack nQ dga .aod• Vaffiediorr Form to maT� yne arra .of your
alt liEios and p ordbie cis you cnay by. tfi� t.i=trod iM .Unw as aw
Qx-8+atder. �I►o w Rot kne a
WIdIng untli ym�'have ittld, inlUIed yaw' (reWEdon,
dg'ned, and returned this form to us at ottr. otIldai address Iadlcate& An agent of the owner cannot exeeate ob• notice
unless. you, the Pcnperty owner, obtain the prior approval of &e permitting authority.
bead eta 6 W Qat
34F6 you wohruand orve* dds hVbnnadm
1. I
und=tand a frequent Practice -,of up ioensed persons is 'to have the propotty owner obtain an "Owner -Builder"
building pmt that erroneously implies that the property owaer is providing his or her own labor sad natend ply. I, in
an owner -Builder, may be held liable and subject to serious financial.risk for any igjuries sustained by an unlicensed petaol
and his or her employees while wmking on my P
Willies— I am willfullproperty. 'MY homooarnea•'s. irsura8oc may not patmda oov+ for td�
y acting as an Owner -Builder and am aware of the limits of my insurance�covosage for injuries to worimr;
on my pe+opexty.
h2. I undustand blinding pmts are not required to'bee signed by property owners unless they are respoaaibte for 6
eo on and are not hieing a licensed Coa%w" to assume this MM=Mhv.
23: F nud liS "f)iivrier-WUddei" I am - .
r lie party of raoofd on We pemiL I' a nd thsL f tmEy 1
myself fivrn potential financial nsk by lining a licensed Contractor and bAtie get�t f lad in W of �r tastead of o
ownvft
4. [ understand Contractors are required by law to be licensed and bonded in California and to list their licepae numbers
permits and contracts.
5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and -the total v
f my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "emplo
under state and federal law.
/6. I understand 'if I -am considered an "employer" ceder state and hdaral law, I must register with the moo. and fe
overvinent, withhold payroll taxes, provide woiiaets' compensation disability insurance, and contribute to unemploy
compensation for each "employer." i also understand my Whue Ask to abide by thCse laws may subject me to geriaas 6nr
LITnderstand under California Contractors' State License Law, an Owner -Builder who builds single-family resitcannot legally build them with the intent ' to ' offer them for sale, unless all work is performed by lie
subcontractors and the number of structures does not .exceed four within any calendar year, or all of the w=ork is ped
under contract with a licensed general building Contractor.
Prescriptive Certificate of Compliance: Residential CF -IR -ALT
Residential Alterations age 1 of 5
Project Name: JEAN UNDERWOOD REMODEL Climate Zone #15 # of Stories
1
General Information
Site Address:77-'707 CALLE SONORA
Enforcement Agency:LQ B&S Date:4/16/2012
Building Type [M Single Family ® Multi Family
Circle the Front Orientation: N, E, S, W, or degrees N
Conditioned Floor Area (CFA): 1,200
Project Type: M Alterations
x Envelope[N Fenestration U Roof U HVAC
Table
Replacemen or Change Out
Duct Replacement 13 Water Heater
NOTE: This form is not to be used for Newly Constructed Buildings or Additions
Insulation Values For Opaque Surfaces (for Furring use the Mass and Furring Strips Construction table below)
Assembly Alteration
El Opening of framed cavity alone—Alterations that involve the opening of the framed cavity ofa wall, ceiling, orfoor must install the
mandatory minimum insulation value per §150 for the altered assembly. Fill in Columns A —C and enter mandatory insulation value in Column H.
® Replacement of entire assembly— Replacement of an entire wall, ceiling, orfoor assembly requires the installation of Component
Package- D insulation values in Table 151-C. Fill in Columns A —J.
Opaque Surface Details For the furred portioned of Mass
Walls see Furring Strips Construction Table below.
A B I C D
E
F G I H I I J
Proposed see "
Standard
Values From JA4
Table
Tag/
IDS
Framing Thickness,
Assembly Name Material Spacing,
or Type 2 and Size or Other
U-
factor'
Framed Continuous
JA4 Table Cavity Insulation
Numbers R-value6 R -Value?
JA4 Proposed
Assembly Assembly
Cell Values U -facto?
Joint Appendix Table 4.3.13
v
o
c
Assembly
U
d
j
c a� �
c o ,c°-- F F o an d ° >
o._= d
Final
Mass
Name of
JA4 Table
v dv c2 � o
x h E E o 'E >
Note: For furred assemblies, accounting for Continuous Insulation R -value, see Page JA4-3 and Equation 4-1. For calculating furred walls use the Mass and
Furring Construction table below.
1. For Tag/ID indicate the identification name that matches the building plans.
2. Indicate the Assembly Name or type: Roof/Ceiling, Walls, Floors, Slabs, Crawl Space, Doors and etc ... Indicate in column G the Frame
material and Size: For Wood, Metal, Metal Buildings, Mass, enter 2x4, 2x6, or etc... see JA4 for other possible frame type assemblies.
3. Enter the thickness for mass in inches or Spacing between framing members enter; 16 "or 24 "OC; or Other for all other assembly description
such as Concrete Sandwich Panel, Spandrel Panel, Logs, Straw Bale Panel and etc....
4. Based on the Climate Zone; enter the equivalent U factor found in JA4 Table based on the R -Value from Table 151-B, C, or D
5. Enter the Table number that closely resembles the proposed assembly.
6. Enter the R -value that is being installed in the wall cavity or between the framing; otherwise, enter "0 ".
7. Enter the Continuous Insulation R -value for the proposed assembly; otherwise, enter "0 ".
8. Enter.the row and column of the U factor value based on Column F Table Number and enter the Assembly U factor in Column J
9. The Proposed Assembly U factor, Column J, must be equal to or less than the Standard U factor in Column E to comply.
Furring Strips Construction Table for Mass Walls Onl
A I B I C I D I E
F G H I J K
L
M
Proposed Properties of Masonry and Concrete
Added Interior or Exterior Insulation
Walls From Reference
in Furring Space from Reference
Joint Appendix Table 4.3.5 4.3.6 4.3.7
Joint Appendix Table 4.3.13
v
o
c
Assembly
U
d
j
c a� �
c o ,c°-- F F o an d ° >
o._= d
Final
Mass
Name of
JA4 Table
v dv c2 � o
x h E E o 'E >
Assembly'
Thickness
Type
Number' ¢ >
c c i= ¢ >
U-factorG
Comment
s
Registration Number: Registration Date lime: HERS Provider:
2008 Residential Compliance Forms
August 2009
e
Prescriptive Certificate of Compliance: Residential CF -IR -ALT
Residential Alterations Pa e 2 of 5
Project Name: Climate UNDERWOOD REMODEL Climate Zone #1 5 # of Stories
1
1. Indicate the type of assembly to include; Hollow Unit Masonry Walls, Solid Unit Masonry, Solid Concrete Walls, Etc. Additional assemblies can
e found Reference Joint Appendix JA4.
2. This is the U -Factor based on the thickness of the assembly in inches.
3. The R -value of the insulation to be added on the interior or exterior of the assembly.
4. The Calculated R- Value is the R -value of the f erred out section of the assembly.
-6. The Final Assembly is calculated using Equation 4-2 or Equation 4-4of the Reference Joint Appendix JA4. The equation is the inverse of Column
added to Column I. Column K is the inverse from column J.
7. Insert the calculated U actor value on to the Opaque Sur ace Details in Column J
FENESTRATION PROPOSED AREAS
13 Replacing window alone — Replacement windows shall meet the U -Factor and SHGC Value requirements of Component Package D in
Table 151-C. The Total Fenestration and West facing Area requirements are not applicable.
Ex Adding 50ft2 or less of window area — Newly installed windows shall meet the U -Factor and SHGC Value requirements of Component
Package D in Table 151-C.
® Adding more than 50ftz of window area — Newly installed windows shall meet the U -Factor and SHGC Value and the Fenestration
Area requirements of Component Package D in Table 151-C. Complete the Altered Fenestration Allowed Area Table on Page 2 of the CF -IR -ALT
Orientation
Fenestration Type and Frame .(North, East,
(Window, Glass Door or Skylight) South, West(ft)
PropsedAreal
Maximum Maximum NFRC or Default
U-factor2.3 SHGC2.3. ° Value5
GLASS DOOR (BEDROOM 1) N
24
.40 .35 NFRC
GLASS DOOR (BEDROOM 2) N
24
.40 .35 NFRC
D
E
F
G
Allowed
Existing
(::Fenestration area is the area of total glazed product (i.e. glass plus frame). Exception: When a door is less than 50% glass, the fenestration
area may be the glass area plus a "2 inch fame " around the glass.
2. Enter value from Component Package D Requirements in Table 151-C.
3. Actual fenestration products installed and as indicated in CF -6R -ENV Form shall be equivalent to or have a lower U factor and/or a lower
SHGC value than that specified on the 'CF -I R ALT Form.
4. Submit a completed WS -3R Form if a reduced SHGC is calculated with exterior shading.
5.1fapplicable at this stage enter "NFRC" or NFRC Certified windows or are CEC "Default" valuesfound in Table 116-A or B.
ALTERED FENESTRATION ALLOWED AREAS
(Complete if more than 50jt2
of fenestration is added)
A
B.
C
D
E
F
G
Allowed
Existing
Fenestration
Total Area
CFA of Entire
% of
Fenestration
Area
Fenestration
Allowed
Proposed Areae
Dwellin
CFA
Area
Removed
Area Added
A x B
-D +-C
Total Fenestration Area
(ft)
.20
>
West Fenestration Area
(Required In
.05
>
CZ's 2,4&7-15)-
1. West Fenestration Area includes west -sloping skylights and any skylights with a pitch less than 1:12.
2. West facing glazing area removed cannot be "counted" twice. " In order to distribute the west glazing area removed to the other orientations,
input the west glazing area removed in the Total Fenestration Area row, column D.
3. Include the Proposed Area of the West facing fenestration in both Area columns below.
4. To meet compliance, the Pro osed Area must be less than orequal to the Total Allowed Area or BOTH -the Total and West Fenestration Areas.
Registration Number:
2008 Residential Compliance Forms
Registration Date/Time:
HERS Provider:
August 2009
Prescriptive Certificate of Compliance: Residential CF -IR -ALT
Residential Alterations age 5 of 5
Project Name: JEAN UNDERWOOD REMODEL Climate Zone #15. # of Stories
1
HERS VERIFICATION SUMMARY The enforcement agency should pay special attention to the HERS Measures specified in this
checklist below. A completed and signed CF -4R Form for all the measures specified shall be submitted to the building inspector before final
inspection.
Duct Sealing & Testing HERS verification is required for this measure.
® YES ® NO YES: In Climate Zones 2 and 9-16, if more than 40 linear feet of new or replacement ducts are installed in unconditioned
space, the ducts are to be sealed per §152(b)1Dii and the newly installed ducts are to be insulated per §151(f)10.
® EXCEPTION: Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos.
® YES ® NO YES: In Climate Zones 2 and 9-16, if the existing space -conditioning system (HVAC equipment and ducting) is replaced, the
ducts are to be sealed per §152(b)IDi.
® YES ® NO YES: In Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced (including -the replacement of the air handler,
outdoor condensing unit of a split system, cooling or heating,coil, or the furnace heat exchanger) the ducts are to be
sealed per §152(b)IE.
® EXCEPTION: Duct systems that are documented to have been previously sealed confirmed through HERS
verification in accordance with procedures in the Reference Residential Appendix RA3.
® EXCEPTION: Duct systems with less than 40 linear feet in unconditioned space.
EXCEPTION: Existing ducts stems constructed, insulated or sealed with asbestos.
Refrigerant Charge -Split System HERS verification is required for this measure.
YES [3 NO YES: In Climate Zones 2 and 8-15, when the existing HVAC equipment is replaced (including the replacement of the air
handler, outdoor condensing unit of a split system A/C or heat pump, cooling or heating coil, or the furnace heat
exchanger) a refrigerant charge measurement shall be verified per § 152(b)l F.
Central Fan Integrated (CFI) Ventilation System and Fan Watt Draw
The ventilation requirements of § 150(o) do not apply to existing residential homes.
Ducted Split Systems -Air Conditioners and Heat Pumps: Airflow HERS verification is required for this measure.
;[3 YES [3 NO. YES: In Climate Zones 10 through 15, when the existing space -conditioning system (HVAC equipment and.ducting) is
replaced, the airflow and fan watt draw shall be verified per § 152 b 1 Ci to meet therequirements of §151(07B.
Documentation Author's Declaration Statement
• Isklify that this Certificate of Comnliance documentation is accurate a d co fete.
i
Name:
4-
Signatt%e:
Company:
Dae: .
Address:
If Applicable CEA or®CEPE
(Certification #):
City/State/Zip:
Phone:
Responsible Building Designer's Declaration Statement
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on
this Certificate of Compliance.
• I certify that. the energy features and performance specifications for the building design identified on this Certificate of Compliance conform
to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations.
• The building design features identified on this Certificate of Compliance are consistent with the information to document this
provided
building design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement
agency for approval with this building permit application.
Name:
Signature:
Company:
Date:.
Address:
License:
City/State/Zip:
Phone:
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at. 1-800-772-3300.
Registration Number: Registration Date/Time: HERS Provider:
2008 Residential Compliance Forms
August 2009
APRIL 16, 2012
T0: 'CITY OF LA QUINTA
r BUILDING & SAFETY DEPARTMENT
ATTN: A. J. ORTEGA, BUILDING INSPECTOR II
FROM: JEAN UNDERWOOD, OWNER
RE: 77707 SONORA
LA QUINTA
BUILDING PERMIT
I2,cy�)
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE y 1b x a. BY
—&,—
Per our conversation last Wednesday, April 11, I am submitting a
sketch of the alterations on the alterations on the above as also
itemized below:
1. Change out front bedroom window to double doors.
2. Change out ,adjacent bedroom wall to add double door.
3. Stucco front door wall.
4. Install light next to two double doors and put switch
Inside each door.
Attached is a rough drawing of the front of the house indicating
where these changes are located.
If you need any further information before I proceed to have the
wall of both sides of the doors (both'top and bottom) exposed'for
your inspection, please let me ow. T y
c�j2—
w + ca.r OF
BUILDING & A QUIN7-A
SAFETY DEPT
FOR
CO�v
NSTRUCT/pN
' DArE
. eY�
�a�� �•c-rte• _ _
V
Ixcecuim �
cFM
OF
o
CONSEN IFO INSPECT PRIVATE PROPERTY
Name: p
dTele hone Number:
• Property Address:
PLEASE INDICATE IF YOU ARE: ❑ TENANT OPERTY OWNER
The undersigned herein consents to the City of La.Quinta, Code Compliance Division Inspector(s)
right of entry to inspect all Yard Areas; building exferior(s), and/or interior(s); as needed to determine
whether or not said property complies with local and state codes. +
The undersigned herein states that he/she is in', lzfW,,Ml possession or controh�oflhee property
designated,�or has the author ty to act in the owner(s), tenant(s), and/or occupant(s) behalf and in
their absence:
g
a
e
Signature: at
PERMI O PARA INSPECCIONAR PROPIEDAD PRIVADA -
.4
Nombre: Telefono:
Direccion:
FAVOR DE INDICAR: ❑ INQUILINO' ❑ PROPIETARIO '
-El suscrito por este medio dara permiso a (el) O (los) inspector(es) de Division de Cumpliminews'
con el Codigo de la Ciudad de La Quinta para entrar a esta propiedad con motivoAe inpecciona' itodas ;
las areas de la-yarda,•incluyendo los exteriores de todos los edificios, y/o interiores'como se requiere
para determinar si dicha propiedad esta en acuerdo con las leyes de codigo locales:y.estatales E1 suscrito
por este medio declara que el/ella tiene legal'posesion disenada, o tiene la autoridad o consentimiento de
le propietario(s),'inquilino(s), y/o ocupant(s) si ausente(s).
Firma: 7 Fecha: t:.