0249 (SATT)PERMIT APPLICATION f/AJ
1 City of La Oug a /4
Department of Building and Safety
i
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: 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.):
O 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, 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 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.).
O 1, 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.).
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 o1 Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.).
Policy No. Company
O Certified copy is hereby furnished.
_Certified
copy is filed with the City Building Inspection Department or C ti yd+ Department.
A
Date ! —,2 " A I' Applicant
r�� ... .
APPLICANT NAME (L, F, MI)
La Quinta Joint Venture
ADDRESS
P.O. Box 780
CITY/COMMUNITY/STATE/ZIP
La Quintal Ca 92253
JOB SITE ADDRESS/SPACE
49-629 Avenida Vista Bonita
`Lam uJ , aZ, Ca 92253
BOK
PAG
PRC
C
L40 Sq. Ft.
TWN
RNG
SE
S
TRACT
114496-2
LOT
54-3
Construction Fee
418.00
MODSB
36.90
SMI Fee
T6anta Rosa Cove
OWNER NAME (L. F. MI)
CONTRACTOR -FIRM, NAME
Anoen corporation
ADDRESS
P.O Box 780
°ILa MQuinta, Ca 92253
PHONE614-564-131.5
L1333762
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE M 1
LICNC N
ui.)1 yMiTe Family Dwelling
BL
ZON
FSB
SSB
SSB
RSB
OFC
ZONE ORD M
LOT SZ
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMF ENSATION INSURANCE: This section need not be completed if
the permit is for one hundred ($100) o, less. I certif , that in the performance of the work for which this permit is
issued, I shall not employ any person i n 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 In ist 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:leet 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, Sec 341, Title 8,
C.A.C.)
O As owner -builder, I will not employ anyone to .o work which would require a permit from the Division of
Industrial Safety, as noted above, unless such perE)n has a permit to do such work from that division.
O Division of Industrial Safety Permit No.
Date 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 Addre
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 tc building 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
CERTIFICATEOF COMPLIANCE AND AUTHORIZATION ]F ENTRY: I certify I have read this application and statethat
the information given is correct. I agree to comply vv th all state laws and county ordinances relating to buidling
construction'and)authoiiie a'representative of the :ity of La Ouinta Department of Building and Safety to enter
upon the pwoperty'Urr which 11haefapplied for this rermit for the purpose of.makking inspectioonns. .i
ISignatufe of Appliccarit or Agent Date
Print Applicant/Agent Name
APPL/PRMT ;• � 0249
7DATE
-Z6-$3
Permit to construct Model G -3-A
Dwelling 1,993 Sq. Ft.
Garage
E433 Sq. lit.
Patio Cover
L40 Sq. Ft.
Tech. 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
City of La Quinta
TOTAL
1$1,275.22
) ALUATIoN $94, 617.8:0]
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
A
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.
❑
NON ADDITIONAL INFORMATION
t�
3 — 15-- 941 JJ A
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 n
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer O
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test a ��
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
PSL P/1
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final