0250 (SFD)PERMIT APPLICATION
City of La Quinta
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 f, 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 3of the Business and Professions Code, and my license is in full force
and effect.
License Class
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 9 (commencing with section 7000) of Division 3of 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 fora permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
O I, as owner of the property, or my employees with wages as their sale 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, avid 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 i mprovemnt 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.).
O I, as owner of the properly, 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.).
O 1 am exempt under Sec. B. & 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
O Certified copy is hereby furnished.
O Certified co is filed wit %the•Cit Buildin Ins ection De artment or City
_ pY �Y g P P Y� Department.
Date P - "� v� Applicant
APPLICANT NAME (L. F, MI)
Rx La Uuinta Joint Venture
ADDRESS
P.O. Sox 780
CITY/COMMUNITY/STAT E/ZI P
La Quinta, Ca 92253
JOB SITE ADDRESS/SPACE
49-615 Avenida -Vista Bonita
CITY/COMM UNITY/STATE/ZI P '
La Ouinta, Ca .92253
BOK
PAG
PRC
C
Patio Cover
TWN
RNG
SE
S
TRACT
#14496•-2
LOTMOD
53
305.83
Construction Pee
C-3.
SB
42.16
TRACT NAME
Nanta 1110sa Cove
OWNER NAME (L, F. MI)
Anden FlCorporation
ADDRESS
P.0 . Box 780
CITY/COMMUNITY/STATE/ZIP
La Quinta, Ca 92253
P619-564-1315
`.3 1762
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE N
LICNC N
USE.OF PERMIT
�,xngle j'amily Dwelling
BL
ZON
FSB
SSB
SSB
RSB
OFC
ZONE ORD N
LOT SZ
END
SIDE
N
CERTIFICATE OF OF EXEMPTION FROM WORKERS' COMPEASATION INSURANCE: This section need not be completed if
the permit is for one hundred ($100) o, less. I certify :hat 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.
Applicant
NOTICE TO APPLICANT: I1, after making this Cerlifica: a of Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you muet forthwith comply with such provisions or this permit shall
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
o 1 hereby certify that no excavation five (5) or more I. et 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, An 2, Sec 341, Title 8.
C.A.C.)
O As owner -builder, I will not employ anyone to dx work which would require a permit from the Division of
Industrial Safety, as noted above, unless such perscl has a permit to do such work from that division.
O Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: 1 hereby affirm th:.t there is a construction lending agency for the performance
of the work for which this permit is issued (Sec. 30G3, Civ. Q.
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 )uilding 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 EF ENTRY: I certify I have read this application and state that
the information given is correct. I agree to comply wih all state laws and county ordinances relating to buidling
construction, andiiauthoriz6 a'representative of the City of La Ouinta Department of Building and Safety to enter
upon the property9for which'I have'a"dplied for this tyermit for the purpose of making inspections.;
Signature of Applicant or Agent Date
fr' , 11 �J ejj
Print Applicant/Agent Name !/
APPL/PRMT Zr'
DATE
7-26-83
Permit to construct Model C -1-L
Duelling
21296 Sq. Ft.
C.'arage
462 2 Sq. Ft.
Patio Cover
lib Sq. Ft.
Mech. Fee
$ 23.00
Plan Check Fee
305.83
Construction Pee
470.50
Electrical Fee
42.16
SMI Fee
8.02
Plumbing Fee
71.50
Property Dev. Vee
450.00
MY Of Quinta
TOTAL
S1, 371.01
VALUATION 1114, 066.8(
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
ffireplace T.O.
❑
NADDITIONAL INFORMATION
NO.
O.
_' - �
�/ 7/0/ T j 7"� //
SEWAGE SYSTEM SIZE & LOCATION
.11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
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 IdI16A3
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