001128 (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 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 'Lic. Number
Date' Contractors ` A
�o OWNER -BUILDER DECLARATION: I hereby affirm thatf�/dam exempt from the Contractor's License Law for the.
following reason (Sec. 7031.5. Business and Professidns Code: Any city or count/which requires a permit to
construct, alter, improve, demolish, or repair any slr6cture, prior to its issuance, also requires the applicant for
such permit to file.a signed statement that he is licensed pursuantto the provisions of the Contractor's License Law
(Chapter 9(commencing with section 7000) of Division 3 o1 the Business and Professions Code)orthat 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 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 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 contractor(s) licensed.pursuant to the
Contractors License Law.).
•.• O I 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.). ry.
Policy No. Company - ✓�
.
O.Certified:copy is hereby furnished. � ,
O Certifiedcopy is filed with the City Building Inspection Department
/'or City v� Dep'a�rl,mren .
Date Applicant ` l •b%%/r i s�
• 75,
APPLICANT NAME (L, F. Mot-
M.D. Janes
ADDRESS
2950 Airway Avenue
CITY/COMMUNITY/STATE/ZIP
Costa Mesa, CA 92353
JOBJSIr;1E ADDRESS/SPACE
3
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
SOK
PAG '•
PRC
C
TWN
PING
SE
S
TRACT
18915
LOT_
67
Elect, Fee
26.76
MOD
2
.SB
Bldg. 7
TRACT NAME
Reflections
OWNER NAME (L. F. M1)
Applicant
CONTRACTOR -FIRM NAME
Applicant
ADDRESS -
above
CITY/COMMUNITY/STATE/ZIP .,
above
PHONE •
345-1436
. A A
I LICNC P
'
ARC/ENG FI M NAME '
Carlson, Shleppey a Fezmalhalch
ADDRESS
18002 Skypark Circle
CITY/COMMUNITY/STATE/ZIP .•
Irvine, CA 92714
PHONE N
714-250-0607
TOTAL
FEE
.LICNC •
,
USE OF PERMIT
Condo
81.
ZON
FS8
SSB
SSB
RS8
OFC
ZONE ORD •
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 become subject to the Workers' Compensation 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 must 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, will be •.
made in connectionwith work authorized by this permit, and that no building structure, scaffolding, falsework, or
demolition or dismantling thereof, will be more than thirty-six (36);teet high. (Chap 3.2, Grp 2 Art 2, Sec341, Title B,
C.A.C.)
O Asowner-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: .
O Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION -LENDING AGENCY: I hpfeby affirm that there is a construction lending agency for the performance
of the work for which thispermit is ssued (Sec. 3097, Civ. C.).
Lender's•Name /J -7T_Lender's Address / ,�� ��. / -
V , — 'i v
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 ApplicanYor 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 buidling
construction; and authorize a' representative of the City of La Ouinta Department of Building and Safety to enter
upon the 'pro 'Property for which I have-ayplied'1oi this permit for the purpose of making inspections..
Signatu�ait or Agent` Date
...mutant/Agent Name
APPL/PRMT U01 1 1 ,8
12wAh-84 S.F.D.
Permit to construct 912 sq. ft. of
condo plus 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
Plumbing Fee
27.00
Prop. Devel. Fee 450,00
. A A
1 D 2 1+oo
TOTAL
FEE
1,06640
BLDG. DEPT.
VALUATION 1 51,140.00 .'
M
I'
NO.
OPERATION .,ATE INSPECTOR
NO.
OP ATION DATE 7INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
/
33
Ventilation System
2
Ftgs & Frms
S
34
Plenums & Ducts
2A
Slab Grade
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
"
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 Pll
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
.29._ Wiring ..
29A Grounding Wire
29B Bonding
30 Fixtures
.31 - .Service
32 Final