001098 (SATT)PERMIT APPLICATION
City of La Oug a •
Department of Building and Safety
ADDRESS
2950 Airwav Avenue
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.
JOB SITE ADDRESS/SPACE
"CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed.if
LICENSED. CONTRACTORS DECLARATION:' I hereby affirm that I am licersed' 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 Professiors Code, and my license is in full.force
issued. I shall not employ any person in any manner so as to become subject tothe Workers'Compensation Laws of
and effect.
California.
License Class Lic. Number'"
Date Applicant
Date Contractor( • n
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'
OWNER -BUILDER DECLARATION: I hereby affirm that• am exempt. from :he Co Tractor's License Law f r the
Compensationprovisions of the Labor Code, you.musl forthwith comply with such provisions or this permit shall
following reason (Sec. 7031.5. Business and Prolessiq s Code: Any city er county which requires a pE mit to
be deemed7evoked.'
t
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires.the applicant.for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
such permit tofile asigned statement that he is licensed pursuant to the prov, sions of the Contractor's License Law
01 hereby certify that no excavation five (5) or more feit in depth into which a person is required to descend, Will be
(Chapter 9.(commencing with section 7000) of Division 3 o1 the Business and professions Code)or that he is 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 of Sectior 7031.5 by any applicant fora permit
demolition or dislhailtling thereof;will be more than thirty-six (38) feet high. (Chap 3.2, Grp Z Art 2, Sec341, TitleB, i
subjects the applicant to a civil penalty of not more than five hundred dol.ars (Moo.):
'C.A.C.) T" '•
0.1, as owner, of the property, or my employees with wages as their sole compensation. will do the work, and the
❑ 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 Profesaions Code: 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 himself -or
,.
through his own employees, provided that such improvements are not intended -or offered for sale. If, however, the
❑ Division of Industrial Safety Permit No.
building orimprovemntissoldwithinoneyeacofcompletion,theowner-build':rwillhavetheburdenofprovingthat
Date Applicant '
he did not build or improve for the purpose of sale.).
:r,
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 convactors to construct the project (Sec.:
of the work for which this permit is i4sued (Sec. 3097. Civ: C.). .
7044. -Business and Professions Code: The Contractor's License Law does mot apply to an owner of -property who
Lender's Nae
builds or improves thereon, and who contracts.for such projects with a ccntractor(s) licensed pursuant to the
4
f
Contractor's License Law.).
Lender's Address ::%/ •. v
0 1 am exempt under Sec. B. 8 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 Owher v1
city and county ordinances and state laws relating to building construction, and hereby authorize representatives•
PHONE N
of this county to enter upon the above=mentioned property for inspection purposes.
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 thereo' (Sec!3800: Lab. C.). •
Signature of Applicant or Agent Date
Policy No. Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:•1 certify I have read this application and state that '
❑ Certified copy is hereby furnished.
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
O Certified copy is filed with the City Building Inspection Department or Ciy — --�' Department.
construction„and authorize a' representative of the City of, La Ouinta Department of Building and Safety to enter
ZON -
propert
upon y for w ich l.have•apptieil for this permit for the purpose of, making inspections.
Date Applicant � _
{the plied �Ln
RSB
Signature of App1_7"t or %gen % Date
c�
0
Print Applicant /Agent Name 40,
APPLICANT NAME (L, F. MO - '
M. D. Janes
ADDRESS
2950 Airwav Avenue
CITY/COMMUNITY/STATE/ZIP
Costa Mesa CA 92626
JOB SITE ADDRESS/SPACE
ac
CITY/COMMUNITY/STATE/ZIP
La Quinta. CA 92253
80K
. PAG
PRC C
240.27
"I`WN.
PING
SE ...
S
TRACT
3.15
LOTMOD
22.00
Prori. Devel. Fee
S'
1S91S
37
PAID
3
Bldg. 4
TRACT NAME
Reflections
OWNER NAME (L. F. MI)
AUplaican,t
CONTRACTOR -FIRM NAME
o_ T_alicant
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
above
PHONE a
LICNC 0
345-' 436
ARC/ENG FIRM NAME
[` r1nx> �� PutaE?ve aaxllhalch
ADDRESS V
1M12 Rimnark Circle
CITY/COMMUN ITV /STATE/ZI P
T r%Y i inom CA 1 .- 71
PHONE N
LICNC
714-250-0607
1
USE OF PERMIT
-
BL
ZON -
FSB:. SS8,
SSB
RSB
OFC
ZONE ORD.*
, LOT SZ
x
-
END
SIDE. -
APPVPRMT n DATE
! lBi� U90 12/11/84 S.F.D.
Permit to construct 763 sq. ft. of
condo plus 160 sq
ft. of porch
and 235 sq. ft. of
garage as per
approved plans.
Mech. Fee
21.00
Plan Check Fee
240.27
Const. Fee
260.50
Elect. Fee
23.76
SMI Fee
3.15
Plumbing Fee
22.00
Prori. Devel. Fee
450.06
PAID
DEC271984
t
TOTAL
FEE
.929.6Q
BLDG. DEPT.
VALUATION 44,.375.04
Ah
Ah
NO.
OPERATION D INSPECTOR
NO.
OPER. ON DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL PPROVALS
1
Set Back
��
33
Ventilation System
2
Ftgs & Frms
�S _
34
Plenums & Ducts _ •
2A
Slab Grade
35
Furnace Compart. •
3
Steel
36
Inlets & Outlets PIC
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. ❑
NP'N
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 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