0247 (SFD)? PERMIT APPLICATION
City of La Ouinta
y; 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 br 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 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) orthat 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 penally of not more than five hundred dollars (5500.):
❑ 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 oneyear of completion, theowner-builder will havethe 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 contractors) licensed pursuant to the
Contractor's License Law.).
❑ 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
❑ Certified copy is hereby furnished.
'City Building InspectionDepartmentCertified.copy is filed, -with themr iy, �Department.
Date 1��,fv Applicant..,. -
APPLICANT NAME (l. F, MI)
La Quint€ Joint venture
Av.EO. Box 780
CILa Mhouinta# Ca 92253
JOB SITE ADDRESS/SPACE
49--651' Avenida Vista 1�onita
CITY/COMMUNITY/STATE/ZIP Ca 92253
i
SOK
PAG
PAG
PRC
C
2#296
TWN
FIND
SE
S
TRACTLOT
41449E-2
56
Sq. rt.
MOD
GE
SB
Mesh. Fee
TRACT NAME
Nanta xkosa Cove
OWNER NAME (L. F. MI)
CO T RACTOR-FIRM NAME
nden corporation
ADDRESS
P.O. Box 780
clLa MQuTinta; Ca 92253
PHONE N
619-564--3,32
L1333762
Electrical Fee
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE N 1
8.02.
1 LICNC N
USE OF PERMIT
�;ingle family Dwelling
BL
I
I ZON
FSB
SSB
SSB I RSB
11-1;/
TOTAL
OFC
ZONE ORD N
I
LOT SZ
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
the permit is for one hundred (5100) o, less. I certify 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: It, 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:
O 1hereby certify that noexcavation five (5)ormore eetindepthintowhichapersonisrequiredtodescend,willbe
made in connection with work authorized by this per nit, and that no building structure, scaffolding, falsework, or
demolition or dismantling thereof, will be more than nirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341, Title B,
C.A.C.)
❑ As owner-builper, 1 will not employ anyone -to o work which would require a permit from the Division of
Industrial Safety, as noted above,•unless such pers m has a permit to do such work from that division.
O 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. 3147, 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 tc building 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 DF ENTRY: I certify I have read this application and state that
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
constructmn and authorize a;representative of the City of La Ouinta Department of Building and Safety to enter
upon the propertyior whlchrbha appliedor this',permit for the purpose of./ making inspecrtfons. '"►
Signature,of Applicant or Agent Date
Print Applicant/Agent Name i/
APPVPRMT
i live
DAT p .j
/-'6-8 3
Permit to construct
model
G -1-F
Dwelling
2#296
Sq. Ft.
Garage
462
Sq, Ft.
Patio Cover
178
Sq. rt.
Mesh. Fee
$
23.00
Plan Check Fee
305.83
Construction Fee
470.50
Electrical Fee
42.16
SMI Fee
8.02.
Plumbing Fee
71.50
Property Dev. Fee
450.00
RECEIVED
y Of U Quinta
11-1;/
TOTAL
' 1$1,371.01
VALUATION+)Z14, 066. SO
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
fireplace T.O.
❑
NADDITIONAL INFORMATION
O.
NO.
06-)
( 6 oZ w �M
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
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