001075 (SATT)PERMIT APPLICATION
City of La Ouinta
• Department of Building and Safety �_• i ''
This permit becomes. void if work not commenced within 180 days from date of issuance, OR, if work has been -suspended or abandonedfor a period of 180 days.
.ICENSED. CONTRACTORS DECLARATION: I. 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
Ind effect.
Acense Class Lic. Number
.. i
)ate -' •' Contractorr.�,,��»ewv
OWNER -BUILDER DECLARATION: I hereby aflirm hatil am exempt from the Contractors License Lays/for the
following reason (Sec. 7031.5• Business 'and Professions Code: Any city'oi county which requires a/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 pursuant to the provisions of the Contractor's License Law
(Chapter 9(commencing with section 7000) of Division 3 of the Business and Professions Code) or that heis exempt
therefrom and the basis for the alleged exemption. Any.y olation 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 thevwork, 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 intendeo or offered for sale: I(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.).
d
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. 81P: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 con•thereof Eec 3800 Lab C )
CERTIFICATE OF EXEMPTION FROM .WORKERS' COMPENSATION INSURANCE: This section need not be completed it
the permit is for one hundred (S100) 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 Applicants
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should be me subject toihe Workers'
Compensation provisions of the Labor Code, you'mu�forlhwith comply with such provisions or this permit shall
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
O l 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, fafse'work, or.
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2; Art 2, Sec341. Title8;
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 AGENCY: I hereby affirm that there is a construction lending'agencyfor the performance
of the4ork for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's
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
Policy. Na. Company CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and stale that
0 Certified copy is hereby furnished.. „ the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
0 Certified copy is filed with the City Building Inspection,Depart merit or City Department. .. construction„and aulhorize•a'representative.of the City of La Ouinta Department of Building and Safety to enter
upon the• ro ert for w 'ch I -have applied for this ermit for the ur ose of makin in ections.
11 A
Date Applicant P D Y D P P 0.
Signature of Applicant or Agent r, _ /� r ` ' Date
�56,
A-
Q�a� Print A�Agent Name
APPLICANT NAME (L, F: MI) .
M.D. Janes Co.
'ADDRESS
2950 Airway Ave. Suite D9
CITY/COMMUNITY/STATE/ZIP
Costa Mesa, CA 92626-
JOB SITE ADDRESS/SPACE 1-11
CITY/COMMUNITY/STATE/ZIP
La Ouinta. CA 92253
BON
PAG
PRC
C
TWN •
RNG
Plan Cheek Fee
240.27'
TRACT
189 5
LOT
��
23.76
MOD
3 .
SB
a
TRACT NAME.. - ♦ `
Reflections
'OWNER NAME (L. f, MI)
Applicant
CONTRACTOR -FIRM NAME. ..
Applicant
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
above
PHONE a
345-1436
:LICNC I
TOTAL
FEE
ARC/ENGfIR�M NAInapp Architect• `
ADDRESS
3400 Irvine Ave. # 205
CITY/COMMUNITY/STATE/ZIP -
Newport Beach, CA 92660
PHONE M;�R�6i.�r�'���
-LICNC
USE OF PERMIT
Single Family Dwelling
SL
ZON
FSB SSB
SSB
RSB
OFC.
ZONE ORD II •,: I
LOT SZ
END •
'SIDE
APPL/PRMTnDATE ,n * ry 7 C
1 2-4_84 S.F.?. ,
Permit to construct 763 sq. ft, of
S.F.D., 160 sq,
ft. of porch and
235 sq, ft. of garage as per
approved plans.
Mech. Fee
21.00
Plan Cheek Fee
240.27'
Const. Fee
260,50
Elect. Fee
23.76
SISI Fee
3.15
Plumbing Fee
22.00
Prop. Devel. Fee
450.00
xr•
DEC
TOTAL
FEE
•1.020.68 '
BLDG. DEPT.
VALUATION 44,375.00
Ah
Ah
NO.
OPERATION ATE
INSPECTOR
NO.
OPE ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
Jay -1,Z
34
Plenums & Ducts
2A
Slab Grade
35
Furnace Compart.
3
Steel
/- —i
�j
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 .ala
10A
fireplace T.O.
❑
NON
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
P/L PyI
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance •
29 Wiring;,._ �
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final