001097 (SATT)PERMIT APPLICATION .•
is
City of La Og a
Department of Building and Safety
This permit becomes void if work no� 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: 1 hereby affirm thatd-am licensed under provisions of•Chapter 9
(commencing with Section 7000) of Division Sof the Business and Professions :ode, and my license is in full force
and effect.
License Class I ic. Number
Date Contractor -� ^A Z97.4v
OWNER -BUILDER DECLARATION: I hereby affirm that Iam exempt from the Contractor's License La for'the
following reason (Sec. 7031.5. Business and Professions Code: Any city orcounty which requires 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 pursuantto the provisions of the Contractor's license Law
,(Chapter 9 (commencing with section 7000) of Division 3 of the Business.and Nofessions Code) or that he is exempt ;
therefrom*and the basis for the alleged exemption. Any violation of Section ;1131,.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dolla-s ($500):
0 I, as owner ofdhe 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 intendeI 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.).,
0 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 nol apply to an owner of property who
builps'or improves thereon, and who contracts for such projects .with a cortractoc(s) licensed pursuant to the
Contractor's License Law.).
0 1 am exempt under Sec. B. 8 P.C. (Attached Certificate).
Date a Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certi icate 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.
0 Certified copy is filed with the City Building Inspection;Deepartment or CO Department.
Date Applicant �/I
APPLICANT NAME (L. F. MI) M.D.'
11 • D . Jane s
ADDRESS ' '
2950 Airway -Avenue
CITY/COMMUNITY/STATE/ZIP '
Costa Mesa CA 92626
JOB SITE ADDRESS/SPACE -
•� . .. .
CITY/COMMUNITY/STATE/ZIP -
La ouinta. CA 92253
BOK
PAG
PRC
C
INN
RNG
SE
S.
TRACT
18915
LOT.
r
36
MOD
3
SB
Bldg. 4
TRACT NAME
Reflections
OWNER NAME (L. F, MI) . •' - . - . .
Applicant
CONTRACTOR -FIRM NAME '
Applicant
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP '
above
PHONE.
LICNC 0
aro. Devei. Fee
345-1436 I
I
ARC/ENG FIRM NAME
f^ , l;iz . Shleppe y & Hezamlhalck
ADDRESS
190 2 S vpark Circle
CITY/COMMUNITY/STATE/ZIP '
Ervine, CA 92714
PHONE�
LICNC 4
'
714--250-0607
USE OF PERMIT
Condo
BL
ZON
FSB
SSB
SSB
RSB
OFC '
ZONE ORD • -
LOT SZ
.•END ••
SIDE'
m.
CERTIFICATE OF -EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section neednot be completed if
the permit is for one hundred ($100) o, less. I certify that in the performance of the work for which this permit is
issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of •
California.
Date 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 must forthwith comply with such provisions or this permit shall.
be deemed revoked. ,
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
0 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be
made in connection 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. Title 8.
C.A.C.)
0 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.
0 Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCI : I hereby affirm that there is a construction lending agency for the performance
of the work for which this perm) Is Issued (Sec. 3097, Civ. C.).
Lender's Name "/
Lender's Address
I certify that I have read this application and state that the above 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. '
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
construction, andauthorize a representative of the City of La Ouinta Department of Building and Safety to enter
upon the •property
for which,l-hbe-appliedlorthis permit for the purpose of making inspections.
i
Y� 1' Sig ature of Applicant o A en r Date
Print,/Applicant/Agent Name
APPL/PRMTDATE
u n i n q 7.
12/11/84
S.F.D..
nA . • t to construct 763 sa. ft. of
condo lus'160 sq. ft. of
porch
and 235 sq. ft. of garage
as per
approved plans.
MKch. Fee
21.00
Flan Check Fee
240.27
Const. Fee
260.50
Elect.. Fee
23.76
SMI Fee-
3.15
lumbina Fee
22.00
aro. Devei. Fee
450.00
P Atop
TFEE
1,020.68
BLDG. DEPT.
VALUATION 44,37.5.00
Ah
Ah
NO.
OPERATION I DATE
INSPECTOR
NO.
OPERATION I DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
��
33
Ventilation System raw
2
Ftgs & Frms
is
34
Plenums & Ducts
2A
Slab Grade
35
Furnace Compart.
3
Steel
36
Inlets & Outlets YIN
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
39
Appl. Clearance
7
Framing
40
1 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.
❑
NDN
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 t
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 ker-
27 Conduit • •
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final