0241 (SATT)PERMITAPPLICATION U'
Cityof La Duinta t ` I O r - ,
Department of Building and Safety.
- This permit becomes void it work not commenced within 180 days from date of issuance, OR," if work has been suspended or abandoned hr a period of 180 days.-
CERTIFICATE
ays'CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under• provisions of Chapter 9 the permit is for one hundred ($100) o, less. I certify that in the performance of the work for which this permit is
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in lull force issued, I shall not employ any person in any manner saasto become subject to the Workers' Compensation Laws of
and effect. California.
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 (S500.):
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. 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
0 Certified copy is hereby furnished. �
Ocertified copy is filed'wfth�he.bly Building Inspection Dep ar'�tmmefi orCtiy Department.
Date %`ate � Applicant 31 / 0
APPLICANT NAME (L, F, MI)
La Cuinta Joint Venture
ADDRESS9'80
ryes
•P.Q. Box
CITY/COMMUNITY/STATE/ZIP • .
La Quinta,'Ca 92253
JOB SITE ADDRESS/SPACE -
49-81.0'Avenida Vistas Bonita -
CITY/COMMUNITY/STATE/ZIP
La ft Quints, Ca 9225] '
BOK
PAG
PRCC
-.TWN
Dwelling '2,296
RNG
SE-
"S
.144961-2
TRACT wAC
LOTS
6
'Patios Cover
198 sq: - Ft o .
. GA—D1
SB
TT NAME -
Tr fira Roan• Cove
OWNER NAME L. F. MI)
- t
Ty���p- ���� w�y.
P<FTUrpora4'ibn
SUCKS
A'.E'Ci♦ Boat{ 780
CIIP
L�Ya MUN
""dura/ra�9�Z,
92253!HONE-
yCa
619-56'4-1'315
.•
LIG-1��
•L
470.50' 1
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP - - -
r
PHONE •
LICNC a
,
USEOF PERMIT r
5 angle Family Dwelling
BL
1ZONFSB
SSB
SSB
RSB
•OFC
•'.. I y O .-a uin
.rt. .
ZONE ORO a
$1: 071. 01.
+• LOT SZ
END
,.•SIDE t
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 CERTIFIC..TION:
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 pernit, and that no building structure, scaffolding, falsework, or
demolition or dismantling thereof, will be more than t lirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec341, Title B,
C.A.C.) _ i
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 pers.n has a permit to do such work_ from that divisions
0 Division of Industrial Safety Permit No.
Date Applicant .'
- I
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. 30!7, Civ. C.). I
Lender's Name
Lender's Address
r
I certify that I have read this application and state th it the above information is correct. I agree to comply with all
city and county ordinances and state laws relating tcbuilding construction, and hereby authorize representatives ,
of this county to enter upon the above-mentioned p operty for inspection purposes.
Signature of Applicant or Agent Date .
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION )F ENTRY: I certify l have read this application and state that
the informationgivenis correctl,agree to comply vv th all state laws and county ordinances relating to buidling
construction) ad.duthoriie aire r'esentative of the 'ily of La ouinta Department of Building and Safety to enter
upon theoperty/for whfchave appjied,lor this oermit for the purpose.of aking inpec n
/ Signatyre o . plicant or;Agent ' Date -
Print Applicant/Agent Name v ,
APPL/PRMr '1 oyi
d DATg M�J v
Permit to construct
model G -1 -h' -
Dwelling '2,296
sq. Ft:'
(.
Garage 1
462 5q.': �t,*
'Patios Cover
198 sq: - Ft o .
Mech, Fee
$ 23.00`
Pian • Check Fee
385..83 . -Y
Construction'ree
470.50' 1
Electrical Fee
42-.16"'.
SMI Fee
_ �• .b2
.Plumbing Fee
.. 71••o 56 •
( r
Property Dei%', Flee
4:70.00 �.
tl E Ofr
�•
•'.. I y O .-a uin
.rt. .
TOTAL*:',.
$1: 071. 01.
Arrow Printing , { White: Finarice CanaAssessor'a`~ J -. t ,+• VALUATION
g 250/1-83
� t Canary: Pink.'Applicant - Tag:,Bldg. Dept.' ;, y
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
-r. 14.
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.
_
�21.2— 7/v / AY
2
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath 3
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMB ING.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
PSL 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