0256 (SFD)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: 1 hereby affirm that I am exempt frorr 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 prcyisions of the Contractor's License Law
(Chapter 9 (commencing with section 7000) of Division 3 of the Business an i Professions Code) or that he is exempt
therefrom and the basis for the alleged exemption. Any violation of Secti, It 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred d, Mars ($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 theri and who does such work himself or
through his own employees, provided that such improvements are not inte rded or offered for sale. If, however, the
building or improvemnt is sold within one year of completion, the owner -but der 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 cr ntractors 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 arcontractor(s) licensed pursuant to the
Contractor's License Law.).
0 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 theii (Sec. 3800. Lab. C.).
Policy
Company
0 Certified copy is hereby furnished. �1�
0 Certified_co y is.filed=with the City Building Inspection'De1�rpa ment or�IC�ity �� Department.
Date�� �{ •� Applicant. -
s
APPLICANT NAME (L F, MI)
Y �,�uinta Joint Venture
ADDRESS
P.O. Box 780
CITY/COMMUNITY/STATE/ZIP
Ya �uinta, Ca 92253
JOB SITE
Vista. Bonita
CITY/COMMUNITY/STATE/ZIP
La Quinta, Ca 92253
BOK
PAG
PRC
C
1,893
T
RNG
SE
S
TRACT ijL4 96 -2
LOT
E;q. Ft.
moc' 3
SB
Neck. Vee
Ti aTr��.a OlE Sia Cove
OWNER NAME (L. F. MI)
Cl"r�YTAC
Yct1L' YlF't efflporation
ADDRESS
r' • �. Box ilox B 780
i'Y' 'P
ug �%Cat 92253
P9 9-564-1313
`: " 762
Electrical Fee
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE M
6.62
LICNC N
5 ng 'e ''ami y r;weilir
BL
I
I ZON
RECEIVE®
FSB
SSB
SSE
RSB
1983
OFC
ZONE ORD
I
LOT SZ
END
SIDE
qio OP
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
the permit is for one hundred (5100) 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 as to become subject to the Workers' Compensation Laws of
California.
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must 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 feet 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 thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Si Title B.
C.A.C.)
0 As owner -builder, I will not employ anyone to do work which would require a permit from the Division of
Industrial Safety, as noted above, unless such persor 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. 3097, 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 to 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 OF ENTRY: I certify I have read this application and state that
the information given is,correct. I agree to comply with all state laws and county ordinances relating to buidling
construction, and autthonze a fepresentative of the City of La Ouinta Department of Building and Safety to enter
upon tf a property for whhiich`l haCee applied-forrthis.permit for the purpose of makiins�ctions. p%
cc � .✓
SignaWre of A plicant or Agent Date
Sig,
t7`? ,Bean
Print Applicant/Agent Name V
APPL/PRMT
DATE
7-26-83
Permit to construct
model
G -3-B
Dwelling
1,893
Sq. Ft.
Garage
433
0q. Ft,
Patio Cover
140
E;q. Ft.
Neck. Vee
23.00
lAan Check Zee
272.70
Construction ree
418.Oti
Electrical Fee
36.90
�Ml ree
6.62
Plumbing f!'ee
69.00
P&operty :"ee
450.00
RECEIVE®
IF
Zr_%XM
1983
City of La Qu*nta
TOTAL
FEE
$l / 2755 . 22
VALUATION $94,617,A-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
3
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
NO.
O.
9• VSAM
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior, Lath T
12 Internal Lathj��r�
12A Drywall
13 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
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 Pel
r.,
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
.29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final