001123 (SATT)PERMIT APPLICATION '
• City of La Dg a •
Department of Building and Safety
-• - • This permit becomes void if work not comm.-nced within 180 days from date of issLance, OR, if work has been suspended or abandoned for a period of 180 days.
LICENSED CONTRACTORS DECLARATION: I hereby 'affirm that l am licensed under p-rovisions ol'Chapter 9 '
(commencing with Section 7000) of Division Sof the Business and Professions Code, and my license is in full force. -
and effect.
License Class •Lic; Number
'Date- Contractor{{/ ,-% A/I 16;_ 4 &2, ^1
OWNER -BUILDER DECLARATION: I hereby affirm that jam xempt from the Conractor's License Law for the
following reason (Sec. 7031.5, Business and Professions Cade: Any city or county which requires a permit to
construct, alter, improve. demolish, or repair any structure, prior to its issuance so requires the applicant for
such permit to file a signed statement that he is licensed pursuant to the provisions oftheContractor's License Law
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professi•ms 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 penalty of not more than five hundred dollars IWO.): .
1, as owner of the property, or -my employees with wagesas their sole compensa-ion, will do the work• and the
structure is not intended or offered for sale (Sec. 7044, Business and Professions Cc de: The Contractor's License -
Law does not.apply to an owner of property who builds; or improves thereon• and vno does such work himself or
ihiough his own employees, provided thacsuch improvements are not intended or of ered for sale. If, however, the
building or i mprovemnt is sold within one year of completion, the owner -builder will h eve the burden of proving that
he did not build or improve for the purpose of sale.).
❑ 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 appll, to an owner of property who
builds or improves thereon, and who contracts for such projects with a contractcr(s) licensed pursuant to the
Contractor's License Law.). _.
O 1 am exempt under Sec. B..B 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 Certified copy is hereby furnished..
❑ 'Certified copy is filed with the City Building Inspection Department or City✓ epartm I.
Date Applicant
IV" v
I / %8'/35 !/
APPLICANT NAME (L. F, MI) -
M. D. Janes
'ADDRESS '
2950 Airwav Avtsr+ m
CITY/COMMUNITY/STATE/ZIP y
Costa Mesa, CA 99'2353
JOB SITE ADDRESS/SPACE w
CITY/COMMUNITY/STATE/ZIP,
La Quints CA 92253
'BOK
PAG
PRC
C -
TWN '-,. RNG
SE
S
TR�T$�15
LOT52
"Const. Fee
289.00
Mot
se ,Bidge- 7
TRACT NAME Ref lections
OWNER NAME (L, F. MI) ApI .
plicants
CONTRACTOR -FIRM "AMApplicant '
ADDRESS a '
above
CITY/COMMUNITY/STATE/ZIP
.above
PHONE • 345-1436
LICNC I y '
1
ARC ENG FI. M NAME
Lar son, Shleppey & Hezmalhalch
AD18002 Skypark Circle
CITY/COMMUNITY/STATE/ZIP
Irvine, CA 92714
PHONE .
714-250-0601
1 LICNC I1
USE OF PERMIT -
19ondo
BL
1, 066.40
ZON
FSB I
SSB
SSB -
RSB
OFC
ZONE ORD 4
LOT SZ ,-
.. END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed it
the permit is for one hundred (S100) o. less. I certify that in the performance of the work for which this permit.is
issued, Ishall not employ any person inany manner soastobecome subject 2thWzz;�
nLaws of.
-
California.
Date Applicant "' /7.,�Jy�
NOTICE TO APPLICANT: making this Certificate of Exemptron, you should become subject to the Workers'
Compensation provisions of the Labor Code, you mis t forthwith comply with such prdvisions or this permit shall
be deemed revoked. V
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ,
❑ 1 hereby certify that no excavation five (5) & more feet in depth into which a person isrequired to descend. will be
made in conriection 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; Sec341, Title8,
C.A.C.),
❑ 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 person has a permit to do such' work from that division.
❑ Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for performance
of -the work for which this permit s issued (Sec. 3097, Civ. C.).
Lender's Name—
Lender's
ame Lender's Address r
I certify that I have read this application and state that the .15ove information is correct. I 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=mentioned property for inspection purposes. I•
Signature of Applicant or Agent . ' Date'
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify 1 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
construction, and authorize a'representative of the City of La Ouinta Department of Building and Safety to enter
upon the property for which I haveLappli^ed for�this'permit for the purpose of making inspections.
i, n,A rxt iP.I / /� n --
,'Sig'nature of or Agent Date
Print Applicant/Agent Name
_/3
APPUPRMT M 173
S . F . D •
Permit to construct 912 sq. ft. of
condo plus 26 sq.
ft. of porch
.and 235 sq. ft. .of garage as per
approved plans.
Mech. Fee
24.00
Plan Ch6ck Fee
246.00 '
"Const. Fee
289.00
Elect. Fee
26.76
SMI Fee
3.64
Plumbing Fee
27.00
Prop. Devel. Fee
450.00
PAID DEC 2 7 1994
-TOTAL
FEE
1, 066.40
VALUATION 51140.00
BLDG. DEPT.
Ah
Ah
NO.
OPERATION ATE
INSPECTOR
NO.
OP TION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
34
Ventilation System
Plenums & Ducts
2 Ftgs & Frms
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
10Fireplace
P.L.
❑
43
Final
10A
Fireplace T.O.
❑
NPON
ADDITIONAL INFORMATION
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
PSL PA
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
298 Bonding
30 Fixtures
31 Service
32 Final