001076 (SATT)PERMIt APPLICATION
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.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licenses under provisions of Chapter 9
(commencing with Section 70001 of Division 3 of the Business and Professions Code, and my license is in full force
and effect.
License Class Lic. Number -,---�
Date
Contractor, 11094W -4e
OWNER -BUILDER DECLARATION: I hereby affirm th'at,l am exempt from the Co tractor's Lic�Law for -the rl
following reason (Sec. 7031.5. Business and Professions Code: Any city or sodn y which requires a permit to
construct, alter; improve, demolish, or repair any structure, prior to its issuauce, also requires the applicant for -
such permit to file a signed statement that he is licensed pursuant to the provisi ms of the Contra ctor'sLicense Law
(Chapter 9.(commencing with section 7000) 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 70.91.5 by any applicant�tor a permit:
subjects the applicant to a civil penalty of not more than five hundred dollar, ($500.): 11^A i
0 I, as owner of the property, or my employees with wages as their sole comFensation, 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.; rid who does such work himself or
through his own employees, provided that such improvements are not intendedor offered for sale. If, however; the
building or improvemnt is sold within one year of completion, the owner -builder hill 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 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.).
k- '❑ I am exempt under Sec? B. 8 P.C. (Attached Certificate).
Date V Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certiftate of consent to self -insure: or a '
certificate of Workers' Compensation Insurance ; or a certified copy thereof CDec. 3800. Lab: C.). - ,
Policy No. Company
O Certified copy is hereby furnished.
0 Certified copy is filed with the City Building Inspection Department or City: — --Department.
Date Applicant -� 11
r
APPLICANT NAME (L, F. MI) -= .. .
M.D. Janes. Co.
ADDRESS
2950 Airway Ave. suite D 9
CITY/COMMUNITY/STATE/ZIP
Costa Mesa CA 92626
JOB SITE AODRESS/SPACE
- .v
CITY/COMMUNITY/STATE/ZIP
L a Quints CA 92253
BOK
PAG - PRC
I C
240.27
TIM
RING =
SE •.
S
TTCT
8915
LOT
Plumbing Fee
22.00
MYD
SB
TRACT NAME
Reflections
OWNS
AppE `licant
CONTRACTOR -FIRM NAME ,
A licant
ADDRESS
aboae==
CITY/COMMUNITY/STATE/ZIP
above
PHONE • '
LICNC •
34591436
ARC/ENG FIRM NAME
Alan Snapp Architect
ADDRESS
3400 Irvine Ave. # 205
CITY/COMMUNITY/STATFJZIP ,
Newoort Beach, CA 92660
PY1E4-979-8842
LICNC.
USE OF PERMIT
Sinale family dwellincr
BL
ZON
FSBSSB
SSB
FSB
/
OFC
ZONE ORD N
LOT SZ
END
SIDE
CERTIFICATE OF EXEMPTION FRO M.WORKERS'COMPENSATION INSURANCE:.This section need not 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.shal l not employ any person in any manner so -as to become sub j ect to the lMorkers' Gompensation Laws of
California. '
Date Applicant',-
lo„-�
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should becorr a 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 whichfa 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 AGENCY: I hereby affirm tliat there is a construction lending agency for the performance
of the work for which this permit 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
CERTIFICATEOF 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'represent�tive of the City of La Ouinta Department of ufld, and Safety to enter ,
upon Ike property for whi ave ap lied,for_this permit for the purpose m Iing.inspectionsr
Iig�ture'of Applica��St �N , / / Date
Print A plicant/Agent Name t
APPUPRMT fl n-
DATE
12-4-84 S.F.D.
Peribit to construct 763 sq. ft. of
S.F.D.r 160 sq*
ft, of porch and
235 sq. ft. of garage as per
approved plans.
Mech. Fee
21.00
Pian Check Fee
240.27
Const. Fee
260.50
Elect. Fee
23.76
SMI FEE
3.15
Plumbing Fee
22.00
Prop. Devel. Fee
450.00
TFL
EE
1.020.68
BLDG.DEPT•
VALUATION 44.375:00
r-7
Ah
NO.
op&Ar ION ATE
INSPECTOR
NO.
OP ,ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
S Back
33
Ventilation System
2
tgs & Frms
34
Plenums & Ducts 0
2A
Slab Grade
/-L
17-
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
10A
Fireplace T. 0. ❑
NON
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE &LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick Value
7A Walls (Batts)
12B Ceiling (Batts) •
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping Age
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final — (� — �. G.
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
P/I
STREET NAME
26 Power Pole
27 Conduit 4
28 Service Entrance t
29 Wiring
29A Grounding Wire VjPSL
29B Bonding
30 Fixtures
.31 Service
32 Final 3