001089 (SATT)• ' PERMIT APPLICATION ^. ✓� 8
M. D. Janes
ADDRESS
- , , �,
`
CITY/COMMUNITY/STATE/ZIP '
City of La Oumta 7. ' ��• [
Department of Building and Safety.
JOB SITE ADDRESSISPACE -'
CITY/COMMUNITY/STATE/ZIP
' 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.
BOK
• ••
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
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(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force •
issued, I shall,not employ any person in any manliecso asto become subject to the Workers'CompensationLaws of
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and effect. - -
California.
t
License Class Lic. Number -�^"r
Date Applicant
28
Date '• Contractorn n
NOTICE TO APPLICANT: It, after making this Certificate of Exemption, you should become subject to the Workers
[Bldg* 3
OWNER -BUILDER DECLARATION: I hereoyaffirm that I am exempt from the Con actor's License for the
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
be deemed �"
OWNER NAME (L. F. MI)
following reason (Sec. 7031.5, Business and Prolessions46ode: Any city or courtly which requires per to
revoked
Applicant
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: -
CITY/COMMUNITY/STATE/ZIP
such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law •.
❑ 1 hereby certify that no excavation five (5) or more feet in depth into Which a person is required to descend, will be
LICNC •
(Chapter 9(commencing with section 7000) of Division 3 of 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
I
therefrom and the basis'for the alleged exemption. Any violation of Section 7001.5 by any applicant for a permit j , demolition or dismantling thereof. will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2. Art 2, Sec 341. Title 8,
a
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
• %x.C.)
41
O I. 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 hi do work which would require a permit, from the Division 0f
PHONE 1
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License
'Industrial Safety, as noted above, unless such person has a permit to do such work from that division.
714-250-0607
Law does not apply to an owner of property who builds, or improves thereon, and who does such work himself or
USE OF PERMIT
• 'through his own employees, provided that such improvements are not intended or offered for sale. IL however, the
Division of Industrial Safety Permit No.
building orimprovemntissold within one year ofcompletion. the owner -builder will have the burden of proving that
Date Applicant
i
he did not build or improve for the purpose of sale.). y ;1 •
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
RSB
0 I, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec.
of the work for which this permit is issued (Sec. 3097: Civ. C.).
7044. Business and Professions Code: The Contractors License Law does not apply to an owner of property who,
Lender's Name
?
builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the
END
Contractor's License Law.).
Lender's Address
❑ I am exempt under Sec. B. & P.C. (Attached Certificate).
I certify that I have read thissaapplication and state that the above information is correct. ) agree to comply with all
Date Owner "
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
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of this county to enter upon the above-mentioned property for inspection'purposes.'
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WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, oca'
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certificate'o1 Workers' Compensation Insurance' or:a certified copy thereof (Sec. 3800. Lab. C.).
Signature of Applicant or Agent Date
}
Policy No. Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
O Certified copy is hereby furnished. r
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidting'
'-
' O Certified copy:is tiled with the City Building lnspectio Departme/n/too City Department. .;
construction, and authorize a'representative of the City of La Ouinta Department of Building and Safety to enter
upon the property for which I have a lie -this permit for the purpose of making inspections.
Date Applicant
,for
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y
ca
SignalC of 11pp brant ar gent Date
Print Applicant/Agent Name
APPLICANT NAME (L. F. MI) -
M. D. Janes
ADDRESS
2950 Airwav Avertne
CITY/COMMUNITY/STATE/ZIP '
Costa Mesa. CA 92626
JOB SITE ADDRESSISPACE -'
CITY/COMMUNITY/STATE/ZIP
La Oni ta. CA 2253
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PAG
PRC I C
TWN.. RNG
SE
S
TRACT
Plan Chhck Fee
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MOD
SB
18915
Elect. Fee
28
2
[Bldg* 3
TRACT NAME
Reflectdlons
OWNER NAME (L. F. MI)
Aoulicant
CONTRACTOR -FIRM NAME
Applicant
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
above
PHONE •
LICNC •
345-1.436 I
I
2 7 1984
ARC/ENG FIRM NAME
Carlson' Shle nne-v & Bezmalhal.ch .
ADDRESS
1x002 Skvnark Circle
CITY/COMMUNITY/STATE%ZIP '
Irvine. CA 9273-4
PHONE 1
LICNC
714-250-0607
1
USE OF PERMIT
Condo
BL
ZON
FSB
SSB
SSB
RSB
OFC
• ZONE ORD •
LOT SZ
END
SIDE
APPL/PRMT URI nRll 127E11/84
Permit to construct 912 sq.
ft. of
condo plus 26'sq.
and 235 sq. ft. of
ft. of porch
garage as per
approved plans.
Mech. Fee
24.00
Plan Chhck Fee
246.00
Const. Fee
289.00
Elect. Fee
26.76
SMI Fee -
3.64
Plumbing Fee
27.00
Prop, Devel. Fee
450.00
P A
I D -DEC
2 7 1984
TOTAL
FEE
1,06 .40
VALUATION 51,140.00 -
BLDG. DEPT. - - - _ -
A
r-1
NO.
OPERATION ATE
INSPECTOR
NO.
OP ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
(iS,
34
Plenums & Ducts
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
10
Fireplace P. L.
❑
43
Finalia�s
10A
fireplace T.O.
❑
OWN
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 ,- rpr 4i Ca
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 Z —$T �• �..•
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 ,��► g,