0254 (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 fon 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 ellect. _
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.):
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, 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 improvemni 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.).
❑ I 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 o1 Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.).
Policy No. Company
o Certified copy is hereby furnished. s r
Certified•copy is filed•wilh/t a City Building Inspection Dep �tr�ent� R !- - epyrtment.
Date �p, Applicant # ! ®'
°.•
APPLICANT NAME (L F, MI)
La Quinta'Joint venture
ADDRESS
P.O. Box .780
CITY/COMMUNITY/STATE/ZIP
La .Qu iota, Ca 92253 -
JOB SITE ADDRESS/SPACE '
49-559 Avenida Vista Bonita-
CITY/COMMUNITY/STATE/ZIP
La Quinta, Ca 92253
BOK
PAG
PRC
I C
Patio Cover.. :140
TWN
RNG
SE
S
TRACT
#:14496-2.
LOT
.49
271',70
Construction Fee
J`D
3
SB
36.90
E
TRACTATE
ban` a Rosa.Cove
OWNER NAME (L. F, MI)
CONTRACTOR -FIRM NAME -
X9 Ancen• Corporation
ADDRESS-
P.U. Box'780
CITY/COMMUNITY/ST TE/ZIP
La Quin�ta, .Ca 92253_
P O E N
V.Lg-56Q-1315
=•
LICNC N- `
333762
TUI'
ARC/ENG FIRM NAME'
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE N
LICNC N
a
^
USE OF PER IT •-
bYng a Family r,wellinq
BL
ZON
FSB
SSB I
SSB
,RSB
- '
OFC'
f
ZONE ORD N
'LOT SZ-
END �•
SIDE -
,..:Arrow Printing 250/1-83- White: Finance ,Canary: Assessor
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
the permit is for one hundred ($100) o, less. I certify tit in the performance of the work for which this permit is
issued, I shall not employ any person in any manner so. s to become subject to the Workerg'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 musGforthwith comply with such provisions or this permit shall .
be deemed revoked. -
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: f+,
❑ 1 hereby certify that no excavation five (5) or more feE tin depth into which a person is required to descend,'w ill be
made in connection with work authorized by this perm�i, 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, Sec341, Title8, ;
C.A.C.) �• ! t ( `
❑ 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.
❑ Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm tha. there is a construction lending agency for the performance •
of the work for which this permit is issued (Sec. 3091 Civ. C.).
Lender's Name
Lender's Address
I certify that I have read this application and state tha- 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 prcperty for inspection purposes. .
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read thisapplication and state that
the information given is correct. l agree to comply wi-h all state laws and county ordinances relating to buidling
construction, aqd authorize a±representative of the Cty of La Ouinta Department of Building and Safety to enter
upon the property.��hich'I5ft"ave appliedJgr this permit for the purpose of making inspections4l ,� r
ignaturerof Applicant'or Agent . Date
�rrint Applicant/Agent Name Vi
APPVPRMT3 ��f
i ➢-
DATE `!
7-26-83'
Permit to construct
model G-3-�C•
Dwelling 1,;893 ,Sqd' Ft.
Garage
433 ,Bch. Ft. _
Patio Cover.. :140
$q, Ft.
McCh -. Pee _ _
23.00.'1,.,. a' • r'
Plan Check fte
271',70
Construction Fee
418.00
Eleettieal`-Fee '
36.90
I MT• Fee
6 A 62
Plumbing' Fee
' 69.00*. ,
Liroperty t)ev, `Fee
450, 00,
TUI'
t d
w CI ,OI L� QWl�ta
TOTAL
FEE ^
sl,, 275.
T'
Pink:'Applicant Tag: Bldg;'b' t: .
VALUATION y9'��,'�y`/•�L 0-
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
�j
'r s
39
Appl. Clearance
7
Framing
a
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
/
0512B
�% „4 qfi ✓
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick Value
7A Walls (Batts)
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
P/L 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
S