001125 (SATT);t_ 7?/3/
APPLICANT NAME (L. F. MI)
M..D: Janes
ADDRESS
2950 Airway Avenue
PERMIT APPLICATION
City of La Ouinta
• Department of Building and Safety
This permit becomes void if work not commenced within 180 days from date of
issuance, OR,' IPwork has been suspended or abandoned for a period of 180 days.
•
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
' LICENSED CONTRACTORS DECLARATION:. I hereby affirm 'that I am licensed under provisions of Chapter_ 9
the permit is for one'hundred ($100) o, less. I certify -that in the performance of the work for which this permit is
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
issued, l shall not employ any person in any manner so as'to become subject to the Workers'Compensation Laws of -
and effect.
California.
License Class 6c. Number. _
Date Applicant
--Y�
Date Contractor.`-- -A ^ + �� �'���✓' A
NOTICE TO APPLICANT: If, after making this Certificate,of Exemption, you should become subject to the Workers' .
Y
OWNER DECLARATION: hhereby affirm thaf l am el empt from the Contractor's License Law for the -
Compensation:provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
-BUILDER
be deemed revoked.
following reason (Sec. 7031.5. Business and Prolessions Code: Any city or county,,which requires a permit to
64.
'construct, alter, improve, demolish, or repair.any structure, prior to its issuance, also requires the applicant fo(
• _ DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
such permitto,fileasignedstatementthatheislicensedpursuaNtotheprovisionsoltheContractor'sLicenseLaw
❑ 1 hereby certify that ho excai,ation five (5) or more feet in depth into which a person is required to descend, will be
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) or that heis exempt.:. _
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
therefrom and the basis, for the alleged exemption. Any violation ol:Section 7031.5 by any applicant for a permit
demolition or dismantling thereof, will be more than thirty-six'(38) feet high. (Chap 3.2, Grp 2 Art 2; Sec341, TitleB,
subjects the applicant to a civil penalty of not:more than five hundred dollars ($SOt.);
C.A.C.) ' . '
O 1. as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
p As owner -builder, I will not employ anyone to do work which would require a' permit from the Division of
structure is not intended or offered for sale.(Sec.7044; Business and ProfessionsCode: The Contractor's License'
Industrial Safety, as noted above, unless'such,person has a permit -to do such work from that division.
Law does not apply to an owner of property who builds, or improves thereon, and who does such work himselfor
• • .. ), - .
through his own employees, provided that such improvements are not intended or offered for sale. If however, the
0 Division,pf Industrial Safety Permit,No.
• :building or. improvemntis sold within one.yearofcompletion, the owner -builder will have the burden olprovingthat
Date Applicant
_ he did not build or improve for the purpose of sale.). ;•a
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
❑ 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
of the work for which this perm's is issued (Sec. 3097, Civ. C.)./`
-who
Lender's Name 1.17
builds or improves Hereon, and'who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.). .._ _
Lender's Address
❑ 1 am exempt under Sec. B. d' P.C. (Attached Certificate).
I certify that I have read.this application and state that the above information is correct. I agree to comply with all
Date Owner
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
ZON
of this county to enter upon the above=mentioned property for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate ollconsent to self insure; ora
"!+
certificate of Workers' Compensation Insurance , oria certified copy'thereof (Sec. AOO,LabrB. "
( Y���/�l)�
c
Signature of Applicant or Agent Date
/:-'����!`
Policy No. Company d / �/ L^
i
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CERTIFICATE OF COMPLIANCE AND 'AUTHORIZATIONOFENTRY. ( certify 'Ihave read this application andstatethat .
O Certified copy is hereby furnished. 7 Y»•• v - ./;
'
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
the Cit La Ouinta Department
/r/
O Certified copy is filed with the City Building Inspection DepartmenLoc City Department.
construction, and authorize a (e res mative.of of of Building and Safety to enter
p y _.,.. Y
for I have for for inspections.
Date Applicant (� Il
upon the property which pplied this permit the pur' ose of -making
C
;t_ 7?/3/
APPLICANT NAME (L. F. MI)
M..D: Janes
ADDRESS
2950 Airway Avenue
CITY/COMMUNITY/STATE/ZIP
Costa Mesa, CA 92353-
JOB SITE ADDRESS/SPACE
8-587 indigo PRivis'
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
BOK
PAG
PRC
C
TWN+
RNG
SE I
S
TRACT
LOT-
$lect. Fee 23.76
MOD
•SE
18915
64.
8 3
'Bldg.' 7
TRACT NAME
Reflections
OWNER NAME (L. F. MI) '
Applicant
CONTRACTOR -FIRM NAME --
Applicant
ADDRESS '
above
CITY/COMMUNITY/STATE/ZIP
above
PHONE # '
- 1.020.68 '
LICNC
345-1.436
ARC/ENG FIRM NAME
Carlson Shleppev & Rezmalhalch
ADDRESS
18002 SkyPark Circle
CITY/COMMUNITY/STATE/ZIP
zrvine.-CA 92714
PHONE 0
LICNC 4
..
714-250-06017
1
USE OF PERMIT • '
Condo
BL
ZON
FSB SSB
SSB
RSB
OFC
- ZONE ORD .
LOT SZ
END
,- SIDE
A
�S' nat re of>A)ip icaift or egep3 Date
PriApplicant/Agent Name JV
APPUPRMTDATE
, 11 � 12/18/84
=
S.F.D.
Permit to construct 763 sq. ft. of
condo plus 160 sg. ft. of
porch
and 235 sg. ft. of garage
as per
approved plans.
Aiech. Fee 21..00
Plan Check Fee 240.27
Const. Fee 260.50
$lect. Fee 23.76
SMT Fee 3.15
Plumbing Fee 22.00
Prop. Devel. Fee 450.00
-P A I D
DEC 2 7 198
TFEE
- 1.020.68 '
BLDG. DEPT.
VALUATIONI 44,375.00.],
Ah
NO.
OPERATION ATE INSPECTOR
NO.
OPRATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
A
33
Ventilation System
2
Ftgs & Frmsi�
34
Plenums & Ducts
2A
Slab Grade
35
OM
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
New
42
Commercial Hood
10
Fireplace P.L.
❑ X t
43
Final
10A
Fireplace T.O.
❑
NO.
ADDITIONAL INFORMATION
,
-
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath Is
12 .Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R I •
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping AV
17 Rough Plumb i
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
PSL Pll
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final