0259 (SATT)PERMIT APPLICATION
City of La Ouinta
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
Date Contractor
Lic. Number
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 g (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.):
0 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, add 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.).
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.).
0 1 am exempt under Sec.
Owner
B. 8 P.C. (Attached Certificate).
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
0 Certified copy is hereby furnished. ', e
0,Certified copy is filed.w th the City Building Inspection�Department or Cit
y1 Department.
Date ` < ' Applicant "
APPLICANT NAME (L. F. MI)
. ,a _,,uint.a Joint uR Venture
ADDRESS,�
�' r . Box 780
C I TY/COM MUN ITY/STATE/Z I P
La ��ttRBx Quinta, Ca 92253
JOB. SITE ADD ESS/SPACE
49-- 9 Avenida Vista Benita
CILaMQu n al, C'a 92253
BOK
PAGPRC
21296
C
Garage
TWN
RNG
SE
S
TRACT
q,1449([-2
LOT
44
MOD
G-:_
SB
23.00
TRACT NAME
,5anta �. osa Cove
OWNER NAME (L. F. MI)
CONTRACTOR -FIRM 1�Corporation '
en
ADDRESS
P.U. Box 784
CITLaMQ, ntap Ca 92253
PH,#1"9-5691-l31'.i
lectricsal Pee
333'762
42.16
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE N
LICNC N
Property Dev. Fee
USE;,OF PERM
..Lngle Family Dwelling
BL
Rrr rim F!n
ZON
U 19
FSB
SSB
SSB
RSB
OFC
ZONE ORD N
LOT S2
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
the permit is for one hundred (5100) o, less. I certif, that in the performance of the work for which this permit is
issued, I shall not employ any person i n any manner :o as to become subject to the Workers' Compensation Laws of
California.
Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificotl of Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you no /st forthwith comply with such provisions or this permit shall
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
0 1 hereby certify that no excavation five (5) or more'eet in 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 :hirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8,
C.A.C.)
0 As owner -builder, I will not employ anyone to to work which would require a permit from the Division of
Industrial Safety, as noted above, unless such person has a permit to do such work from that division.
0 Division of Industrial Safety Permit No.
Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Sec. 3(97, Civ. C.).
Lender's Name - —
Lender's Address
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 tc building 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 DF ENTRY: I certify I have read this application and statethat
the information given is,correct. I agree to comply vith all state laws and county ordinances relating to buidling
construction, and auihorize a=representative of the :ity of La Ouinta Department of Building and Safety to enter
property upon the fol which I;,fave applied tor<this;)ermit for the purpose of making inspections
Signatuie�of Applicaht;or Agent Date
Print Applicant/Agent Name 4V
APPL/PRMT f\'�w 192539
ID-Ti66x`63
Permit to constru&t Model G -1-H
Dwelling
21296
Sq. Vt.
Garage
462
Sqo Vt.
Patio Cover
178
Sq. ft.
Neck. uee
$
23.00
,Plan Check Vee
305.83
Construction Fee
470.50
lectricsal Pee
42.16
:SMI Fee
8.82
Plumbing ?ee
71.50
Property Dev. Fee
450.00
Rrr rim F!n
U 19
City 01 Quinta
TFEEL
$l r 371.01
VALUATION 511-4,066.6'
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
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.
❑
NADDITIONAL INFORMATION
O.
NO. '
SEWAGE SYSTEM SIZE & LOCATION
11 ExteriorLath
12 InternalLath
12A Drywall ,
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
Ceiling (Batts)
q126
12C Ceiling (Blown)
14 Final } ,' Ir
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
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
PSL PAY.
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final