0171 (SFDPERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
5-D-vaaU.lS
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 lull 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 penally of not more than five hundred dollars (S500.):
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, 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, theowner-builder will havethe 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
builps 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.
Owner
B. & 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
O -Certified copy is hereby furnished.
O Certified copy is f led with the City Building Inspection De arrtmentt"or Citity� eppLt_ment,
Date - Applicant / +�l? 'tt
APPLICANT NAME (L. F. MI)
,{.
>JIoint Venture
Joint
ADDRESS
P.O. Box 700
CITY/COMMUNITY/STATE/ZIP
La OMrota, Ca D12251
JOB
,gSITE ADDRESS/SPACE f� !♦ (� x + }�`j� r�
CITY/COMMUNITY/STATE/ZIP
7,a ;1,ui n t , Ca 92253
BOK
PAG
PRC
C
TWN
RNG
SE
S
TRACT
LOT
123
Plan d regh FCC
173,00
MOD
7-2
SB
Property nov. rea
TRACT NAME
Enntiz Roca gave
OWNER NAME (L. F. MI)
CONTRACTOR -FIRM NAME
Encn Ctwroration
ADDRESS
P.C. nor, ry �q 80
CITY/COMMUNITY/STATE/ZIP
T- ,",Uinta, Ct 32253
P��§- 564. 1315
L133k3i62
ARC/ENG FIRM NAME
ADDRESS
CITY/CO M M UN ITY/STATE/ZI P
PHONE*
LICNC N
USE OF PERMIT
BL
ZON
FSB
I SSB
SSB I
RSB
OFC
ZONE ORD M
LOT SZ
I
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' CON PENSATION INSURANCE: This section need not be completed if
the permit is for one hundred ($100) o, less. I cert ty that in the performance of the work for which this permit is
issued, I shall not employ any person in any mannE- so as to become subject to the Workers' Compensation Laws of
California.
Date Applicart
NOTICE TO APPLICANT: If, after making this Certitcate of Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you nust forthwith comply with such provisions or this permit shall
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFCATION:
O 1 hereby certify that no excavation five (5) or mo :e feet in depth into which a person is required to descend, will be
made in connection with work authorized by this p;rmit, 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. Sec341, Title 8,
C.A.C.)
O 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 pE-son has a permit to do such work from that division.
O Division of Industrial Safety Permit No.
Applicart
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. 5097, Civ. C.).
Lender's Name
Lender's Address
I certify that I have read this application and stateslhat the above information is correct. l agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above-mentionec property for inspection purposes.
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF 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
canstructioh andkauthoriie a;rep�dsentative of tie City of La Ouinta Department of Building and Safety�to enter
rN.
upon thpr�pe�y fpwhichfaappliedAar t_ h ,permit for the purpose of making mspections�
Signature of Applicant or Agent Date
`r." 'Ili
Print Applicant/Agent Name
APPL/PRMT 0 +1 71 6&A25-83
Dt9e11im, I F 390
^q. rt#
Carago -Us
e Pt.
Patto Cover 120
C', Vt.
.1Stoch. roa
r1cotric Fco
2`x..2
rluar.biwg Fas
11 9 5 01
Plan d regh FCC
173,00
Building Fa-:
3730.9A,
Property nov. rea
300,00
JUN 2 83 FIAN
U
City of La Quinta
TOTAL
FEE
VALUATION ^70 r 7047;,
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
D
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.
OK
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath /-0/9/
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 PA
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire .
296 Bonding
30 Fixturesr;r y '�
31 Service
32 Final