0266 (SATT)PERMIT APPLICATION
City of La Ouinta
1rx Department of Building and Safety
This permit becomes void it work not commenced within 180 days from date of issuance, OR, if work has been suspended or abandoned for a period of 180 days.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
and effect.
License Class Lic. Number
Date Contractor
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the
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
such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
(Chapter 9(commencing with section 7000) of Division 3 of the Business and Professions Code) orthat he is exempt
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than live hundred dollars (5500.):
❑ 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 Contractor's License
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. If, however, the
building or improvemnl is sold within oneyear of completion, theowner-builder will havethe burden of proving that
he did not build or improve for the purpose of sale.).
0 I, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec.
7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon. and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
❑ 1 am exempt under Sec.
B. 8 P.C. (Attached Certificate).
Date Owner
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.).
Policy No.
Company
❑ Certified copy is hereby furnished. J
1,o=Certified copy is filed with the City Building Inspectio Department or CityI� Department.
Date Applicant .7°r r
AFPLLI�CAN� uxrt1t�Il Joint Venture
AJ,.Q• Box 780
CLa MQUI, Ta, Ca 92253
JOB SIET--y 5/sAvenida Vista Bonita
CITY/COMMUNITY/STATE/ZIP
LaQuinta, Ca 92253
BOK
PAG
PRC
C
Patio cover
TWN
RNG
SE
S
TRACT
v144961-2
LOTMOD
37
271.70
Construction Fee
ti-?
SB
36.90
T�ACT Santa Rosa Cove
OWNER NAME (L. F. MI(
CON NAME a
'e'l . FIRflCorpoip Corporation 1
ADDRESS
� Box 780
CIYg M]ifu Y.n {rad Ca7G2S.S '
PHONE619-564-131
. 75762
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ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE w
LICNC w
'
WrTy Te Family Dwelling
BL
ZON
FSB
SSB
SSB
RSB
OFC
ZONE ORD N
LOT SZ
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENS.,TION INSURANCE: This section need not be completed if
the permit is for one hundred (5100) o, less. I certify tha. in the performance of the work for which this permit is
issued, I shall not employ any person in any manner so asto become subject to the Workers' Compensation Laws of
California.
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate -f Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must f rrthwith comply with such provisions or this permit shall
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATI-+N:
❑ 1 hereby certify that no excavation five (5) or more feetin depth into which a person is required to descend, will be
made in connection with work authorized by this permit and that no building structure, scaffolding, falsework, or
demolition or dismantling thereof, will be more than thir-y-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8.
C.A.C.)
❑ As owner -builder, I will not employ anyone to do vork which would require a permit from the Division of
Industrial Safety, as noted above, unless such person ias a permit to do such work from that division.
O Division of Industrial Safety Permit No.
Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that :here is a construction lending agency for the performance
of the work for which this permit is issued (Sec. 3097. Civ. Q.
Lender's Name
Lender's Addre
I certify that I have read this application and state that :he 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 proaerly for inspection purposes.
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION 01 ENTRY: I certify I have read this application and state that
the information given is correct. I agree to comply wiL, all state laws and county ordinances relating to buidling
construction�,and,authho"ize,a representative of the C ry of La Ouinta Department of Building and Safety to enter
upon the propel y forewhicb-1,'have,applied for this p;rmit for the purpose o1 making'ihspections:
'lgnat f Apdngent Date
Print Applicant/Agent Name
APPUPRMT ri V0,5DATE
7--20-83
Permit to construct
Model G -3-A
Dwelling 1,893 Sq. Fta
Garage
433 Sq. Ft.
Patio cover
140 Sq* Fte
Mech. Fee
$ 23.00
Plan Check .Fee
271.70
Construction Fee
418.00
Electrical. Fee
36.90
SMI Fee
6.62
Plumbing Fee
69.00
Property Dev. Fee
450.00
-J U
ix n
U
City of La Q!jIntaTFEE` .
S1, 275.22
W VALUATION 594, 617. 80
Arrow Printing 250/1$3 White: Finance Canary: Assessor Pink: Applicant Tag: Bldg. Dept.
NO.
OPERATION DATE
INSPECTOR
NO. OPERATION DATE INSPf;f
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.
❑
NOADDITIONAL INFORMATION
2 Q
/ Q
�/�`✓ �•�
L
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywalli2%�
1.3 Finish Grade
INSULATION Thick Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb of
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
PSL P/I
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring .2023 AF
29A Grounding Wire
29B Bonding
30 Fixtures
31 - Service
32 Final
L"