0270 (SFD)~
tt PERMIT APPLICATION'
CITY/COM MUN ITY/STAT E/ZI P
La Quintay Ca 92253
City of La Ouinta
. " Department of Building and Safety., , e _ • • ,
a This permit becomes void if work not commenced within 180 days from date of
issuance, OR, if work has been suspended or abandoned to, a period of 180 days. ,
PRC
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 (SlOO) o, less. I certify Met in the performance of the work for which this permit 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 anymannerso asto become subject,to the Workers'Compensation Laws of
and effect. -'
California: i ' ' ,
I
License Class Lic. Number
•
Date Applicant
Date Contractor
NOTICE TO 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 the '
Compensation provisions of the Labor Code, you mus .forthwith comply with such provisions or this permit shall
following reason,(Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to •
be deemed revoked. _
.,
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICA-ION:
such permit to file a signed statement -that he is licensed pursuant to the provisions of the Contractor's License Law
❑'Ih'erebycertifythatnoexcavationfive(5)ormorefeetindepthintowhichapersonisrequiredtodescend,willbe
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) or that he is exempt .
made in connection with work authorized by this perm t, 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 thali th rty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec341, Title8,
subjects the applicant to a civil penalty of not more than five hundred dollars (MO):
C.A.C.) r
O I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
❑ As owner -builder, I will not employ anyone to dal 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 persoi 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
BL
through his own employees, provided that such improvements are not intended or offered for sale. If, however, the
❑ Division of Industrial Safety Permit No.
building orimprovemntissold within one year ofcompletion, 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 tha_ there is a construction lending agency for the performance
❑ I, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec..
of the work for which this permit is issued (Sec. 309:, 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 -contractors) licensed pursuant to the
Contractor's License Law.).
Lender's Address -
❑ 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. I agree to comply with all
Date Owner
city and county ordinances and state laws relating to t•uilding construction, and hereby authorize representatives ,
of this county to enter upon the above-mentioned pr.perty for inspection purposes. ,
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.).
Signature of Applicant or Agent ., Date '•
+Policy No. Company , r
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION C- ENTRY:IcertifyIhavereadthisapplicationandstatethat
❑Certified copy is hereby furnished. t /•�.y� -
the information given is correct. I agree to comply with all stale laws and county ordinances relating to buidling _
O;Gertilied copy is fit d with the City<Building Inspection ;0 p r m(ent/or<Cityl Department.
/
construction to nd �uthonie aTepresentative of the City of La Ouinta Department of Building and Safety to enter,
? d d 6 •' •"'
Date r� r 2 Applicant - !1 <
upon the property for which J.hav =applied for Ihis;p1mit for the purpose of:making-inspections"
✓q 4.s icA @ay ' m -i , er.'
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Signature of4plicanl,00rr,AAggent Date
4 _ , «t
Print Applicant/Agent Name V
APPLICANT A E (L F, MI)
tea, Qui rata Joint venture
ADDESS
P .RQ. Box 180
CITY/COM MUN ITY/STAT E/ZI P
La Quintay Ca 92253
� BJ''I•'Ts.°°1 Avenida Vista Bonita
CITY/COMMUNITY/STATE/ZIP -
La Quintal, Ca 92253 •
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TRACT NAME
anta Rosa Cove
OWNER NAME (L. F. MI)
CONTRACTOR -FIRM NAME
,nnaen Corporation
ADDRESS
.v.Box 780 "
CITyyY�//CO(M7MUNITYy/�S�pT�A}T�E/ZIP' /-'4p 9 /yq yq
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NC
L_TJ lSIG..
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ARC/ENG FIRM NAME
ADDRESS
.CITY/COMMUNITY/STATE/ZIP
PHONE N ', ,
LICNC a
US&OF PERMIT
S Ingle Faarily., Dwae111 ng
BL
ZON
FSB
-SSB'
SSB
-RSB
OFC r
ZONE ORD •
LOT SZ
+" END
SIDE
Arrow Printing 250/1-83' White: Finance Canary:'Assessor
W
APPUPRMT DATE 6-1yj 7 83' • :.
Permit to consstrucst , Mode1, C -1_'B- _
Dwelling .3,r 296 Sq. ' Ft
Gar ge- 462 _.Sq.�• F�
Patio Cover 178• act. 'Ftr
_Meoh. Fee
Paan Check Fee •305;83 .
Construction Fee 470150 �.
Ue' ctr ical Fede 42.16
SIMI ' Fee 8.02
Ia'lomf5i ng, i"ee '1.50
,.Pros ertDev. -Fee - 450.0.0 ..
_ J
+ TOTAL
' 1 372.0
City of I
FEE
,a
'Pink'.`Appl•jcant, Tag- Bldg. Dept: • `
EVALUATION isiy.066.81{ r
NO.
OPERATION DATE INSPECTOR
NO. OPERATION 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 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'NO. ADDITIONAL INFORMATION
6�
1
(� n ` . 1, _
\ (7/
l
SEWAGE SYSTEM SIZE &LOCATION
1 2 Exterior Lath
12 Internal Lath
12A Drywall 41.
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground. Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 . Sewage Disposal
20 Sewer21L 3 ,
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
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final