0265 (SATT)PERMIT APPLICATION r//J/4
/� ^
City of La Ouinta /4 Z
Department of Building and Safety
This permit becomes void if 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) or that 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 five hundred dollars ($500.):
❑ 1, 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 improvemnt is sold within one year of completion, the owner -builder will have the burden of proving that
he did not build or improve for the purpose of sale.).
❑ 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
❑ C,ertified copy is hereby furnished.:
O Certified copy is filed<wi�h thejCily Building Inspection=Deparirtenvo ry� '� �� f'- --.-:.Department.
Date %' f Applicant
APPLICANT NAME (L. F, MI)
11-asuint& Joint Venture
ADDRESS Box 780
CITY/COM MUN I TY/STATE/ZI P
La v�uinta, Ce 92853
JOS�SITE ADDRESS/SPACE
uv -4u3. ven da Histo Bonita
CITY/COMMUNITY/STATE/ZIP P
",A Qurntat Ca 98253
BOK
PAG
PRC
c
140 Sq. Ft.
TWN
AND
SE
S
TRACTLOT
t'r ..4496 -2
38
Construction Fee
418,00
MOD
Cw.--3
SB
SMI Fee
TRACT NAME
vantcu Rosa Cove
OWNER NAME (L. F, MI)
r°cITu11F'V4iiM oration
ADDRESS Box 7,00
CA-UC°uu►iYMcgo 48 92233
a-564-131.3"�'Si62
RECEIVE®
1111 2 1983
City of La Q0_a;nt_a
•
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STAT E/ZI P
'PHONE N
LICNC N
USEOF PERMIT
fr3� :e Family DW lling
8L
ZONFSB
SSB
SSB
RSB
OFC
ZONE ORD N
LOT SZ
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENS ATION INSURANCE: This section need not be completed if
the permit is for one hundred (S100) o, less. 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 aEto become subject to the Workers' Compensation Laws of
California.
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate A Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must firthwith comply with such provisions or this permit shall
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATI IN:
❑ 1herebycertifythatnoexcavationfive(5)ormorefeefindepthintowhichapersonisrequiredtodescend,willbe
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 thiry-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8,
C.A.C.)
o As owner -builder, I will not employ anyone to do -✓ork 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.
❑ Division of Industrial Safety Permit No.
Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm thatlhere 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
I certify that I have read this application and state thaUthe above information is correct. I agree to comply with all
city and county ordinances and state laws relating to wilding construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property 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 win all state laws and county ordinances relating to buidling
construction,tand authorize a'representative of the C;1y of La Ouinta Department of Building and Safety to enter
11
upon thelrpro�jpeiyt'y for which I hive.applied for this permit for the purpose of making inspections:
( fes.
Signature of)Applicant or, Agent Date
Print Applicant/Agent Name
APPL/PRMT w It I6) � 0" e,
f '4-.
DATE
7--20-$3
Permit to construct Model G -3--C
Dwelling 1#893 5q, rt.
Garage
433 Sq. Ft.
Patio Coves
140 Sq. Ft.
Mach, Fee
$ 23.00
ys
Plan Check Fee
271.70
Construction Fee
418,00
>lectrical Fee
36.90
SMI Fee
6.62
.umbirag°ea
69, 00
Property Dev, Fee
00.00
RECEIVE®
1111 2 1983
City of La Q0_a;nt_a
•
1
TOTAL l.a7,
FEE
'VALUATION t 9 I91�. 0
Arrow Printing 250/1-83 White: Finance Canary: Assessor Pink: Applicant Tag: Bldg. Dept.
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
3 -775-1.40
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.
❑
NPON
ADDITIONAL INFORMATION
sb C� `/}J/j 1 ,1� ��'0 7 XX
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
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test JC e 77;//-,
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
PSL PAI
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final