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Building
Address
Owner
:a
Mailing
Address
P•y
I k"
T4hf 414 aubtro
P.O. BOX 1504
78-495 CALLE TAMPICO
LA OUINTA, CALIFORNIA 92253
4
63
Zip Tel.
-' q 57(�,5;r,�2 �S'-
i r
Address
i3ax /oc.3
City Zip Tel.
State Lic. City
& Classlf. Lic. #
Arch., Engr.,
Designer .1,641114 iJ
Address Tel.
- J �
City Zip State
4 4 ati,�('ia �.,. `j2a5 3 Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under prove fdns of Cr+epter 9 (commancing with Section.
7DD6j of Division 3 of.the Business and Profesplons Code, and my license is In full force and
effect. f
OWNER-PILDER DECLARATION
I h7e y affirm that I am exempt from the Contractor's License Law for the iollowlrg
rea0Se fSec 7031-5,BuOesss and fPralessians Code: Any dffy or county whkb ,faquwas a
pe to conslrucf, egar, impfove,/U emoash, or repair 'any ;1ruclure, prior to its issuance also
f rea the applicant for such pafmpf to file a signed sfatarmont Ike? he is ffcenselt pursuanf Io
e provfsrons of the Cenriaclopt License Law. Chapter 9 rcommencing with Spcllen 7000) of
Dtvfsion 3 of the Business an 'IrrWessiuns Code, or th•af ho is exempt rherefrpm, and The basis
for the alleged acemplioa -'Any violation of Secliog'703 r,5 by any applicant for a parmrt
subjects the applicant to a GQponarly of not more thfap' five hundred dollars IS5�0).
! I, as owner of the Iiiporty, or my employees with wages ss their spfe compensation, will
do the work, and thrrsrructure is not inlongdd or oflored for sale. (Sac. 7044, Bulsness and
Professions Code rho Contractor's LcansefiLaw does not appfy to An owner of property who
builds or xnpr _ thereon and who doaa such work hhnoafl or lhfough his own employees,
provided that ch improvemants are nijt inrendnd or offered for sate, fl, however, the building
or fmprovenr + is ro+d within one y�Ar of completion, the ov�7(ar•buikter will have the burden
of proving t I he did not build or i ove for the purpose of sate y
l I, caner of the properly m exclusively conrracltngr with licensed contractors to con-
struc he praJect. fSet 70 Business and Profassion5 Cade. The Contractor's Lipense Law
doe not apply to an owner f property who builds or irnproves thereon, and who contracts for
s projects with a 1.11 a r(s) licensed pursuant to fho•Conlmutor i License Law)
am exempt undes+5ec. -B. 8 P.Cl:'lcr this reason _
WORKERS' 96MPE14SATION DECLARATION
I hereby affirm that I have arcertilicate of consent to,salf-Insure, or a carilficate of
Ifdorker'B Compensation InsuranroA, orator[ d copy Ihere�f- (sec. 3t?00, Labor Coda.J
PolicyNo.Y!�` °Companyr-'s i, '^
,' Copy is filed with the ly- rl Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATION INSURANCE
.
(This section naep� of be completed if the permif is for one hundred dollars (S100) vafuatiwr
or less.) -
I certify ting(fn the performance of�bp .work for which thw permit is issued, I shall not
employ any ppeerson in any manner 5c s fa become subjeel,to the Workers' Campen35llan
Laws a} ttlorq'a.
pal w
HOT; TO ~LiC or rn his fi _ x !d should become
su. 1 to a Workers' Compen5a)fon provisions of flee Labor C3dar you mrisf forthwith
Comply with such provisions or ibis pefmlf shall be doomed invoked- .
CONSTRUCTIOWLENDING AGENCY
I hereby affirm Thal there Is a cons"tlion lending agency for the performance of the
work for which this paulill Is issued- (SaE- 3097. Civil Code.)
Lender's Name"
Lender's Addres
This is a bu' ing permit when property. filled out, signed'and validated, and is sublr,Ct to
expiration if w,prk Ihereunder is suspended for 180 days.
I cerllfy If�i1 1 have read this application and state that the above informatlpn is correct.
• I agree Io.comply with all city and county ordinances and state laws relatog to building
constru Non, and Hereby avrrhorlie represenlalives' -of this city to enter the above-
menlVo ed propertyfprIns llon purposes-
-
Mailing Addre�6 E �k: f a 64
City, Stale,, •tip �� t`•_ - y I _
ra � 's
APPLICATION ONLY
F
BUILDING. TYPE "CONST. OCC. GRP.
A.P. Number �7 V -2 V-S "d U 1 ig y'r� 5 00 .-
Legal Description * j.� d .,5*- U
Project Description �� T.�S1.- r-Aj6G
Sq. Ft.
Size ;2 aq L
No. No. Dw.
Stories units
New r Add ❑
Alter ❑ Repair ❑ Demolition ❑
72 C-I
Estimated Valuation
o�
3�-aav
PERMIT
AMOUNT
Plan Chk. Dep.
[�
Plan Chk. Bal.
f
t i
Const.
Mech.
Electrical
Plumbing
IL
S.M.I.
Grading
Driveway Enc.
Infrastructure
FER
f
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DA
Issued by: —
Validated by:
Validation:
INSPECTOR
Permit
WHITE = FINANCE YELLOW = APPLICANT
PINK = BUILDING DIVISION
Certificate -of Occupancy
Cit of La Quinta
Building and Safety Department Ao,�E°`'�
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS:. ;77-755 CALLE TEMECULA
Use Classification: SFD Bldg. Permit No.: 0103-003
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RC
Owner of Building: LARRY HARTMAN - Address: P.O. BOX 1063
City: PALM DESERT, CA 92261
By: STEVE TRAXEL
Date: 08-27-01
Building Official
POST IN A CONSPICUOUS PLACE