001073 (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,lf work has been suspended or abandoned for a period of 180 days.
LICENSED 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
and effect.
License Class Lir. Number A
Date • Contractort;�lt
. ��r — —
OWNER•BUILDER DECLARATION: I hereby affirm that'I am exempt from the ContraEtor's License Lam w for the
e
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 structure, prior to its issuance, also requires the applicant for
such permit to file a signed statement that he is licensed pursuant to the provisionsof the Contractor's License 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 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 who builds: or improves thereon, and who -does such work himself or
through his own employees, provided.thatsuch improvements are not intended or offered for sale. If, however, the,
building or improvemnt 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.).
0 1; 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. 8 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
O Certified copy is hereby furnished. •.
0 Certified copy is filed with the City Building Inspection Department or City, Department.
Date Applicant
dal �
17 G, �
APPLICANT NAME (L. F. MI)
M.D. Janes, Co.
ADDRESS
8950 Airway Ave. Suite D9.
CITY/COMMUNITY/STATE/ZIP
Costa Mesa, CA 92626
JOB SITE AOORESS/SPACE h ,
CJ / V
CITY/COMMUNITY/STATE/ZIP ,
La Quinta, CA 92253
BOK
PAG
PRC
C
•
TWN-
.RNG
SE
S
TRACT
915
LOT i
1
SMI Fee
MOD
3
SB
22.00
TRACT NAME
Reflections
OWNERNAME IL. F, M11 '
A li.cant
CONTRACTOR -FIRM NAME .. ,
ApQlLicant
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP '
above
PHONE a �
PAID DEC 51984
LICNC a
345-1436
TOTAL
FEE
1,020.
ARC/ENG FIRM NAME -
A(ban=Snavp Architect
ADDRESS
3400 Irvine Ave. #205
CITY/COMMUNITY/STATE/ZIP
Newport Beach CA 92660
PHONE N
LICNC
714-979-8842
1
USE OF PERMIT
Single Family Dwelling
BL
ZON
FSB
SSB
SSB
RSB
OFC
ZONE ORD
LOT SZ
w
END
SIDE
R CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be:completed if
the permitis for one hundred ($100) o, less. I certify that in the performance of the work for which this permit is
issued. Ishall not employ any person inany manner soastobecome subject tot eWorkers'CompensationLawsof
California. 1 ?
Date Applicant
NOTICE TO APPLICANT:.If. after making this Certificate of,Exemption, you should become subject to thesWorkers'
Compensation provisions of the Labor Code: you must orthwith comply with such provisions or this permit shall
be deemed revoked.
DIVISION OF -INDUSTRIAL SAFETY PERMIT CERTIFICATION:
0 I 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, 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.
0 Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performaAce
otthe work for which this permit is issued (Sec. 3097, Civ. C.). 1 .
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. I
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 lo.buidling
construction, and authorize a'representative of the City of La.Ouinta Department of Building and Safety to enter
upon the property for which,: ave'; p�prll ed�"�of rrThh'I's permit for the purpose of makingsinspecctiflon/s.
i %/;�� /110... �/,IG'-�(lt/,s.Gx,O /`' �1.�/ / �� •
Signature o Applicant o Agent r Date
J� �% s�141 .� i O
Pdat'ApplicanUAg nene t Name
APPL/PRMT U� f l n7DATE
12-4-84
S.F.D.
Permit to construct fit sq. ft. of
U u
S.F.D.,MM sq, ft. of porch and
235 sq. ft. of garage as
per
approved plans.
Mech. Fee 1ZXBR
21.00
Plan'CP&Q Fee MUR
240027
Const. Fee RRRXRR
260.50
Elect. Fee
23.76
SMI Fee
3.15
Plumbing Fee
22.00
Prop. Devel. Fee
450.00
PAID DEC 51984
TOTAL
FEE
1,020.
BLDG. DEPT.
VALUATION 44,375:00
a
Ah
NO.
OPERATION I ISA'TE
INSPECTOR
NO.
OPE ATION I DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL PPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts i •
2A
Slab Grade
—.r, C/
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
XCO
41
Smoke Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P. L.
❑
43
Final
10A
fireplace T.O.
❑
NO.
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 !a
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
P/L P/I
STREET NAME
26 Power Pole
27 Conduit MA
28 Service Entrance •
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final