0251 (SATT)PERMIT APPLICATION `L/ /
/
City of La Quinta
Department of Building and Safely
This permit becomes void if work not commenced within 180 days from date of issuance, OR, if work has been suspended or abandoned fr r 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
Lit. Number
late 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 701X1) 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 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.
Date
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. j{f�
<0 Certified copy is filed with the;t tygBuilding Inspection
sD�epa" rrtmeni ortiry s", Department.
Date { ' +� •� Applicant
APPLICANT NAME (L, F. Ml)
La Quinta Joint Venture
ADDRESS
P.O. Boer 780
CITY/COMMUNITY/STATE/ZIP
La Quinta, Ca 92253
JOB SITE ADDRESS/SPACE
49-601 Avenida Vista Bonita
C ITY/COMM UN ITY/STATE/ZI P
La Quinta, Ca 92253
BOK
PAG
PRC
C
Patio Cover 140
TWN
PING
SE
S
TRACT
x.4496 -2
LO
�2
271.70
Construction Fee
MOD
3
SB
36.90
Santa Rosa Cove
OWNER NAME (L. F. MI)
�DnTaerl F'l.oRM A'poration
ADDP, . Box 780
CITY/COMMUNITY/STATE/ZIP
LaQuinta,Ca 92253
PHONE
1-564-1315
CIN
13°:3762
UL
ARC/ENG FIRM NAME '
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE N
LICNC N
usE101hPE% Family towelling
SL
ZON
ii
FSB
SSB
SSB
RSB
OFC
ZONE ORD N
LOT SZ
END
SIDE ,
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPE:4SATION INSURANCE: This section need not be completed if
the permit is for one hundred ($100) o, less. I certify "flat in the performance of the work for which this permit is
issued, I shall not employ any person in any manner sc as to become subject to the Workers' Compensation Laws of
California.
Date Applicant
NOTICE TO APPLICANT: IL after making.this Certificate of Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you muh 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 Waty-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 do 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. 309 , 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 wilding construction, and hereby authorize representatives
of this county to enter upon the above-mentioned pr. perty for inspection purposes.
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION C ENTRY: I certify I have read thisapplication and state that
the information given,is correct. I agree to comply wi h all state laws and county ordinances relating to buidling
construction,,and authorize grepresentative of the C ty of La Quinta Department of Building and Safety to enter
uponth prop''eerty�l�whic'�avetapplied„for,this.permit for the purpose of maki g inspections.
�� ,1 /-��
ySignature of Applicant or Agent Date
Print Applicant/Agent Name
2 � 5 1 OAT,E
APPUPRMT 'N! 0251
.. v jw 7-a6-83
Permit to construct
Model G -3--:A
Dwelling 1,893
Sq. Ft.
Garage 433
Sq. Ft.
Patio Cover 140
Sq. Ft.
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
UL
ity of La
COTAQuinta
TLFEE•
$1,275.22
VALUATION $94,617.80
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
•7—
14
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.
❑
OP'N ADDITIONAL INFORMATION
NO.
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall c�
13 Finish Grade
INSULATION Thick al
Value
7A Walls (Batts)
126 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 /� 3
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