0178 (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 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 •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 o1 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 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.).
O 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 sell -insure, or a
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.).
Policy No. Company
O ertified copy is hereby furnished. ( _
O Certified copy is filed withtheCity Building Inspection DepartA 6QCiiye� .✓ Department.
Date 6� �y .'� APPlicant !r/ �°�-�t p....�
APPLICANT NAME (L, F. MI)
La Quinta Joint Venture
ADDRESS
P.O. Box ! q 80
CITY/COMMUNITY/STATE/ZIP
La Quinta, Ca 92253
JOB SITE ADDRESS/SPACE
49-941. Avenida Vista Bonita
CITY/COMMUNITY/STATE/ZIP
La Quinta, Ca 92253
BOK
PAG
PRCC
Patio Cover 140
5q. Ft.
TAN
RNG
SE
S
T14496-1
`138
Plumbing Fee
52..50
P
3 SB
Building Fee
TRACTN ME
r>aAa jRosa Cove
OWNER NAME (L, F. MI) ,
CONTRACTOR-FIRNAME
linden Corporation
AP.ESS
O. Bax 780
CYITY�/�CD xiYntap Ca 9225:3
PHONE
-564-'1315
LICNC
3.137622
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE N
$1,198.371
LICNC N
USingU Family Dwelling
SL
ZON
FSB
SSB
SSB
RSB
OFC
ZONE ORD
I
LOT SZ
END
SIDE
qq - FL11 0.6.
CERTIFICATE OF EXEMPTION FROM WORKERS' COMFENSATION INSURANCE: This section need not be completed if
the permit is for one hundred (5100) o. less. I certif^ that in the performance of the work for which this permit is
issued, I shall not employ any person in any manner :o as to become subject to the Workers' Compensation Laws of
California.
1Oat e 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 /st 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/eet in depth into which a person is required to descend, will be
made in connection with work authorized by this pe:mit, and that no building structure, scaffolding, falsework, or
demolition or dismantling thereof, will be more than hirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8,
C.A.C.)
O As owner -builder, 1 will not employ anyone to to 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.
O Division of Industrial Safety Permit No.
Date
Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm t rat there is a construction lending agency for the performance
of the work for which this permit is issued (Sec. 3(37, Civ. C.).
Lender's Name
Lender's Address
I certify that I have read this application and state t[ at the above information is correct. I agree to comply with all
city and county ordinances and state laws relating t - 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 AUTHORIZATI ONIOF ENTRY: I certify I have read this application and state that
the information given is correct,.) agree to comply with all slate laws and county ordinances relating to buidling
construction`andyautho� iera �esentative of the�City of La Ouinta Department of, Building ;and Safety,to enter
upon the ,prope ty forif �wh�h-I°have°applied.for,t�iis ermit for the purpose of ma g f sp�Iions,
�S'gnature of Applicant or=Agent Date
G'�iN1C
Print Applicant/Agent Name b' ^
APPUPRMT `/ 1�°'I DATE
x.. 8 6-1_83
Permit to construct Model P -3-•B
Dwelling 101616
Bq. Ft,
Guest .Room 277
Sq. Ft.
Garage 433
5q. Ft.
Patio Cover 140
5q. Ft.
Metuh, Fee
31.00
Electric Fee
31..25
Plumbing Fee
52..50
Plan Check Fee
209.003
Building Fee
424.62
Property Dev, Fee
450.00
JUU lut" IF b=;a
U I uy
city,of La Quinta
TOTAL
EL
$1,198.371
VALUATION r94, 617. $0
Arrow Printing 250/1$3 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 DeckQ
39
Appl. Clearance
7
Framing
3
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'NO. ADDITIONAL INFORMATION
�✓�%`"��" ��'/f( f �"7
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath T,
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick Value
7A Walls (Batts)
12B Ceiling (Batts)
126 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
PSL
STREET NAME
OF PROPERTY LINE
P/I
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures'
31 Service
32 Final
Ck Am Czuo D
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