001074 (SATT)PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety •
This permit becomes void if work not :ommenced 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 licensee under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Cade, and my license is in full force
and effect.
License Class Lic. Number
Date `-' Contractor. a-
OWNER•BUILDER DECLARATION: I hereby affirm that Ilam exempt from the: Contra�or's Licens aw for the
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to
construct, alter, improve, demolish, or repair any str eture, prior to its issuarce, also requires the applicant for
such permit to file a signed statement that he is licensed pursuant lone provisic ns of the Contractor's license law
(Chapter 9(commencing with section 7000) of Division 3 of the Business and Prdessions Code)orthat heis exempt
therefrom rand the basis for the alleged exemption. Any violation of Section 701.5 by any applicant for a permit
subjects the.applicant to a'civil penalty of not more than five hundred dollar! ($500.):
❑ 1, 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 who builds, 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 yil I have the burden of proving that
he did not build or improve for the purpose of sale.). P
❑ 1, as owner of the properly, am exculsivefy contracting with licensed contra:tors 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 cont'actor(s) licensed pursuant to the
Contractor's License Law.).
❑ 1 am exempt under Seo. B. 8 P.C. (Attached Certificate).
Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that l have a certifi•:ate of consent to self -insure, or a
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec: 3800. Lab. C.).,
Policy No. Company
❑ Certified copy is hereby furnished.
❑ Certified copy is filed with the City Building Inspection Department -or City Department.
Date Applicant ✓�'1 it + r / 1^
7_7
APPLICY9T LIME .e s, Co.
A°°R x950 Airway Ave. Suite D9,
CITY/COMMUNITY/STATE/ZIP . .
..Costa Mesa, CA 92626
JOB SITE ADDRESS/SPACE,
235 sq. ft. of
'CITY/COMMUNITY/STATE/ZIP '
La Quinta, CA 92253
BOK
PAG
PRC
C
Mech. Fee
TVN
RNG
SE
S
718 915
LDT'
23.76
SMI Fee
3
sB
22.00
TRACT NAME
Reflections
OWNER NAME L. F, MI)
Applicant
CONTRACTOR -FIRM NAME -
Applicant
ADDRESS ..
above
CITY/COMMUNITY/STATE/ZIP - ..
above
PHONE 6
345-1436
LICNC
ARC/ENG FIRM NAME -
Alan Sna p Architect
ADDRESS
3400 Irvine Ave. # 205
CITY/COMMUNITY/STATF/ZI P
Newport Beach, CA 92668
PHONEL/_P�
J
LICNC N
,
USE OF PERMIT
Single familv Dwellinv
81.
ZON
FSB
SSB
SSB
R6B
OFC
ZONE ORD M
LOT SZ
END
SIDE
CERTIFICATE OF EXEMPTION FROM 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 shall not employ any person in any manner so as to
becomesubjectto the Workers' Oompensation 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 mat forthwith comply with such provisions or this permit shall
be deemed revoked. "
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
O 1 hereby certify that no excavation five (5) or more feet in depth into which'a person is required to descend, w ill 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, Sec 341, Title 8,
C.A.C.) ...
O 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.
❑ Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: 1 hereby affirm that 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
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 oe Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:' I certify I have read thisapplication 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 representative of.the City of La Ouinta Department of Building and Safety to enter
upon the property which I•have- pplied fo permit for the purpose of making inspections.
LA
i J SignatuFe of Applica for Agent Date
PrInVApplicant/Agent Name
APPUPRMT
DATE
12-4-84 S.F.D.
Permit to construct 763 sq. ft. of
S..F.D., 160 sq.
ft. of porch and
235 sq. ft. of
garage as per approve
Mans.
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. Devel. Fee 450.00
Y
TOTAL
1,020.68
BLDG. DEPT. VALUATION 44,375.70n
- -
1
26
i'
27
Conduit
28'
AdEL
NO..
OPERATION ATE
INSPECTOR
NO.
OPWATION DATE INSPECTOR
Bonding
30
BUILDING APPROVALS
31
Service
MECHANICAL APPROVALS
Final
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts •
2A
Slab Grade
J �,.—/�
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.O.
❑.
NON.
ADDITIONAL INFORMATION
11
Exterior Lath
12
:Internal Lath
12A
Drywall
13
Finish Grade
INSULATION
Thick al
Value.
7A
Walls (Batts)
12B
Ceiling (Batts)
lf�
12C
Ceiling (Blown)
14
Final
13
PLUMBING APPROVALS
15
Ground Plumb
16
Water Piping
17
Rough Plumb
AV
18
Vents
19
Sewage Disposal
20
Sewer
21
Water Heater
22
Water Softener
23
Water Service
24
Gas Test
25
Final
�i'�3rY's-
�'�(
SEWAGE SYSTEM SIZE & LOCATION
26
Power Pole
27
Conduit
28'
Service Entrance
29
Wiring
29A
Grounding Wire
29B
Bonding
30
Fixtures
31
Service
32
Final
ELECTRIC APPROVALS
Tank Pit L. Line
STREET NAME
REAR OF PROPERTY LINE
1221111111111111111