001095 (SATT)PERMIT APPLICATION
• City of La Og a •
Department of Building and Safety
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 ot•180 days.
LICENSED 'CONTRACTORS DECLARATION: I'hereby affirm, that I am licensed under provisions of Chapter 9
(commencing with Section 700) of Division -3 of the Business and Professions Cade, and my license.is in full force
and effect.
License Class. Lic. Number.
Date Contractor' n fs►+A' D
r.v.
OWNER -BUILDER DECLARATION: �l hereby affirm that�l/am exempt from theme ontractor's License aw for the
following reason (Sec. 7031.5, Business and Professions Code: Any city or` county which require a permit to
'construct, alter, improve. demolish• or repair any structure, prior to its issuan-e, 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 Pro`essions Code) or that heis exempt .
;therefrom and_the basis for the alleged exemption: Any violation of Section 7131.5 by any applicant for a permit.
subjects the applicant to a civil penalty of not more than five hundred dollarE (5500.):
O 1, as owner of the property, or my employees with wages as their sole comp;nsation, will do the work, and the
structure is not intended or offered for sale (Sec. 7044, Business and Professio•is 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 :)r offered for sale. If, however, the
building or i mprovemnt is sold within one year of completion, the owner -builder vil I 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 contra:tors to.construct the project (Sec.
7044, Business and Professions Code: The Contractor's License Law does not zpply to an owner of property who..
builds or improves thereon, and who contracts for such projects with a contactor(s) licensed pursuant to the
Contractor's License Law.).
0 1 am exempt under Sec. B. 8 P.C. (Attached Certificate).
Date ' "` Owner
' 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 (:;ec: 3800. Lab: C.).
Policy No. Company
0 Certified copy is hereby furnished
0 Certified copy is filed with the City Building Inspectiion'Department or City Department.
Date Applicant ` J.
APPLICANT NAME (L, F. MI) - -
M.D. Janes
ADDRESS .
2950.Airwav Avenue
CITY/COMMUNITY/STATE/ZIP
Costa Mesa :A 92626
JOB SITE• ADDRESSISPACE -
J~
CITY/COMMUNITY/STATE/ZIP '
La Quinta, CA 92253
BOK
PAG
PRC
C
TWN
PING
SE
S
TRACT'LOT
Plan Check Fee
240.27
MOD SB
'
]_�9 5
34
23.76
3
Bldg.9
TRACT NAME '
Reflections
OWNER NAME (L. F. M1)
A plicani
CONTRACTOR -FIRM NAME
Applicant
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP '
above
PHONE • '
LICNC
345.1436
P A
ARC/ENG FIRMlNAME
CarFShleppev & Hezmalhalch
ADDRESS
18002 Skvpark Circle
CITY/COMMUNITY/STATE/ZIP
Irvine. CA 92714
PHONE .
714-250-0607
LICNC
USE OF PERMIT
Condo
BL
1,020.68
ZON
FSB
-SSB
SSB
RSB
OFC' '
ZONE ORD II ;...
. LOT SZ
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need dot 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:
❑ 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'Z Art 2, Sec 341', Title 8;'
C.A.C.)
% • 0 As owner -builder, 'l 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 AGENCY: I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit isr issued (Sec. 3097, Civ. C.). -
Lender's Name—
Lender's
ame Lender's Address
I certify that I have read this application and state that the above information is correct. Iagree to c�ith all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of t1iis 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.] 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. A.
upon'ttiit property for whirl have appfied.for.this per it for the purpose of making inspections.
—T -.p...
�j Signa ure of Applic ntrorfAgrn j Date
PrinVApplicant/Agent Name U
APPUPRMT u i n95
12711/84 S.F.D.
Permit to construct 763 sq.
ft.
of condo plus 160
sq. ft. of
parch
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
Prop. Deviel Fee 450.00
P A
I D DEC 2 7
1984
.
TOTAL
FEE
1,020.68
BLDG. DEPT. VALUATION 44,375.00
-'
A A&
NO.
OPERATION I DATE INSPECTOR
NO.
OP TION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts •
2A
Slab Grade
�g
35
36
Furnace Compart. ICW
Inlets & Outlets
3 Steel
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.
❑
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 6
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