001085 (SATT)' PERMIT APPLICATION � g � S •r• a ;
City of La Ouinta .:
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 of 180 days. .4
x
'LICENSED CONTRACTORS DECLARATION: 1 hereby affirm that I am licensed under provisions of Chapter 9 .
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
and effect.
License.Class Lic. Number
Date Contractor
a �' '. c
' OWNER -BUILDER DECLARATION: I hereby.alfirm thaC�am €tempt from the ontractor's LICee�J1se Law'for the
following reason (Sec. 7031.5. Business and Professions Code: Any city or I unty which regfiires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issu nee, also requires the applicant for
such. per mit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
(Chapter 9 (commencing with section 7000f of Division 3 of the Business and Professions Code) or that 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 ($500.):
0 I, as owner of the.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 whobuilds, 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.
building or i mprovemnt.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.). ,t
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 not apply to an owner of property who
builds or improves thereon, and who -contracts for such projects with a contractor(s) licensed'pursuant to the
Contractor's License Law.).
0 1 am exempt under Sec. B. & 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 (Sec. 3800. Lab. C.): '
Policy No. Company
0 Certified copy is hereby furnished.
0 Certified copy is filed with the City Building Inspection Department or City Department.
Date Applicant4i
APPLICANT NAME (L, F. MI) M. D. Janes
M.
ADDRESS -
2950 Airway Avenue
CITY/COMMUNITY/STATE/ZIP '
Costa Mesa, CA 92626
JOB SITE AOORESS/SPACE r.
CITY/COMMUNITY/STATE/ZIP La Quinta, CA 92253'
BOK
PAG
PRC
C
TWIN
RNG
SE •'
S
TRA1891-5
LOT24
K DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
..
M03
SB
Bldg. 3
TRACT NAME "
Reflections
OWNER NAME (L. F. MI) '.
Applicant
CONTRACTOR -FIRM NAME •.
Applicant
ADDRESS
Above
CITY/COMMUNITY/STATE/ZIP
Above
PHONE 4 -
345-1836
3.15
LICNC A
Plumbing Fee
ARC/ENG FIRM NAME
Carlson, Shleppey & Heamalhalch
A18002 Skypark Circle
CITY/COMMUNITY/STATE/ZIP
Irvine, CA 926;4
PHONE.
714-250-0607
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lehding agency for the performance
LICNC N
of the work for which this permit its issued (Sec. 3097, Civ. C.). . ' . .
USE OF PERMIT
Condo
BL
ZON
16
FSB
SSB
SSB
RSB
I certify that I have read this application and state that the above information is correct: I agree to comply with all
OFC
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
' ZONE ORD N • '
•
c LOT SZ
I
END
SIDE
F ..
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section neednot be completed if
.. A
the permit is for one hundred ($100) o, less. I certify that in.the performance of the work for which this permit is ;
-3
issued, I shall not employ any person inany manner so asto become subject to the Workers'Compensation Laws of
r
California. '
as per
Date Applicant
NOTICE TO:APPLICANT: It, 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 revoke0.
21.00
K DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
Plan Check Fee
.'0 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will b;
made in connection with'work'authorized by this permit, and that no building structure, scaffolding, falsework, or
260.50
Aemolitionbr dismantling thereof, will be more than thirty-six (38) feet high: (Chap 3.2, Grp 2. AA 2, Sec 341, Title 8,
'
23.76
0 As owner -builder, I will not employ anyone to do work which would require a permit from the Division of
3.15
Industrial Safety, as noted above, unless such person has a permit to do such work from that division:
Plumbing Fee
0 Division of Industrial Safety Permit No.
Date Applicant
4
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lehding agency for the performance
of the work for which this permit its issued (Sec. 3097, Civ. C.). . ' . .
•
Lender's Name % n _,
16
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.
,A
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, and authorize a,represenl live of the City of La-0uinta Department of Building and Safety to enter
upon the^pioptertyfor w ich I ha a applied for this per. 1 r the purpose of making inspections.
_
Sigh ur of Apoica or Agent Date
Print Applicant/Agent Name
APPL/PRMT
nl W,
DATE
12/11/84
S.F.D.
Permit to construct 763 sq. £t. of
condo lus'160 sq. ft. of
porch
and 235 sq. ft. of garage
as per
approved plans.
7
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
i4ron. Devel. Fee
450.00
16
Qrt 2
TFEE
1020.68
BLDG. DEPT. VALUATION 44,37.5.00-1-
- -
NO.
OPERATION MTE
INSPECTOR
NO.
OP TION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL PPROVALS
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
10
Fireplace P. L.
❑43
♦
Final ' X&-, ��`I
10A
Fireplace 'T.O.
❑
OP'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 coo
17 Rough Plumb
18 Vents
19 Sewage. Disposal. ab•
20 Sewer
21 Water Heater
22 Water Softener
23Water Service
24 Gas Test
25. Final +1i.- C. e
Tank Pit L. Line
-
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
P/L P/I
STREET NAME
26 Power Pole
27-lronduit
28 Service Entrance
29 Wiring
29A Grounding Wire
296 Bonding "
30 Fixtures
31 Service
32 Final