001069 (SATT)PERMIT APPLICATION Y r
City of La Duinta
• 0- Department of Building and Safety '
This permit becomes void if work not commenced within 180 days from date of issuance, ORJf 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 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, -767
OWNER-BUILDER DECLARATION: I hereby affirm that Ilam exempt from the Contractor's License La or 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 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 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.):
O 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 that such improvementsare not intended or offered for sale. If, however, the
building or improvemntis 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.). .
O 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 conVactor(s) licensed pursuant to the
Contractor's License Law.).
❑ 1 am exempt under Sec. B. 8 P.C. (Attached Certificate).
Date Owner "r
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. G.J.
Policy No. Company
,❑ Certified copy is hereby furnished. .
O Certified copy is filed with the City Building Inspection Department or City -y--•--Department. .
Date Applicant ✓t—
' r --
-� 7 S X 33 VC__
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 '
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
BOM
PAG
PRC •
C
Mech. Fee
TWN
PING
SE'
S -
TRACT '.
189
LOT
,�
26.76
SMI FEE
MOO
2
• SB
2J,00
TRACT NAME
Reflections
OWNER NAME (L. F. MI)
Applicant
CONTRACTOR -FIRM NAME
Applicant
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP -
above
PHONE 1
LICNC e
345-1436
TOTAL .
FEE
i _ n # Q n
-ARC/ENG FIRM NAME '
Alan SnaDD Architect
ADDRESS
3400 Irvine Afire. #205
CITY/COMMUNITY/STATE/ZIP
wl3wnQ t ' Reach CA 92660
PHONE • 1
LICNC •-
14- 79-8841
1
USE OF PERMIT
qi a1e ami1v dwell ina
BL .
ZONFS8
SSB
SS8
RSB
-
OFC
ZONE ORD 0
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, Ishall not employanypersoninany manner soastobecome subjectlot eWdrkers'ComgensationLaws of
California: / //r ///f�,-, /�_`'
Date �+ Applicant
4iwNC/W/.an�r�-"A
/ 7' —
NOTICE TO APPLICANT: If, after making this:.Certificate of.Exemption, you should becomE ubject to he Workers'
Compensatlon provisions of the Labor Code. you mu5'orthwith comply with such provisions or this"permit shall
be deemed.revoked. '
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 hereby Certify that no excavation five (5) or more feet in ilepth 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, Sec341, Title 8. '
•O As owner -builder. I will not employ anyone todo 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.
O Division of Industrial Safety Permit No.
Date Applicant
• CONSTRUCTION LENDING AGENCY: I 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
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 td enter upon the above-mentioned property for inspection purposes.
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 buidfing
construction, and authorize a'representative of the City of La Duinta;Department of Building and Safety to enter
upon the property for whichrl have�app ed for this permit folr the purpose of maakking 'nspecc onnss/ -
Signature of Applicant or Agent W ti ` Date
S
Print Applicant/Agent Name
APPL/PRMT 9
i
DATE -
12-4--84 5:F.D.
Permit to construct 912 sq. ft. of
S.F.D., 26 sq'. ft. of porch and
235 sq. ft. of garage as per
approved plans.
Mech. Fee
24.00
Plan Check Fee
246.00
Const. Fee
289.00
Elect. Fee
26.76
SMI FEE
3.64 V
Plumbing Fee
2J,00
Prop. bevel. Fee
450,00
TOTAL .
FEE
i _ n # Q n
BLDG. DEPT.
VALUATION S1 l 1 An _ 0A
a
Ah
NO.
OPERATION DATE
INSPECTOR
NO.
OP ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL PPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
35
Furnace Compart.
3
Steel
f �1. _ 7y ycy
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
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall 10
13 Finish Grade
INSULATION Thick R"'
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final �• < <3
PLUMBING APPROVALS
15 Ground Plumb �Y L
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 CL'f3 �� C.-
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
P/L P/1
-
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance •
29 Wiring
29A Grounding Wire •
296 Bonding
30 Fixtures
31 Service
32 Final