001126 (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- /24
' %q '.
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from1he Contractor's License Law,fcthe'"
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a per it to ^
construct, alter, improve, demolish, or repair any structure, prior to its issuance, afro 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 ty 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 theirsole 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 improvemnt issold within oneyearof completion, theowner-builder will have the burdenof 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.).
,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.).
Policy No. Company
0 Certified copy is hereby furnished.
0Certified'copy is filed with the City Building In p ction Dep_arttm^yent'or City Departmmeen�i
Date Applicant>I ✓// / %A
APPLICANT NAME'(L. F, MI) M.D.-Janes
ADDRESS _ -
2950 Airway Avenue
CITY/COMMUNITY/STATE/ZIP
Costa Mesa, CA 92353
JOB SITE ADDRESS/SPACE ..A c A A^ i• .� t
,7
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
BON
PAG
PRC
C
TWN.
RING.
SE-
S
TRACT
18915
LOTMOD
65
Elect. Fee
23,76
3
SB
Bldg.'7
TRACT NAME -
Reflections
OWNER NAME (L. F. MI) Applicant
CONTRACTOR -FIRM NAME
Applicant'
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
above
PHONE N '
345-143fi
UCNC N
DEC 2 7 1984
ARC/ENG FIRM NAME .,.
Carlson, Shleppey & Hezmalhalch
ADDRESS
18002 Skvpark Circle
CITY/COMMUNITY/STATE/ZIP -
Irvine. CA 92714
PHONEN
1,020.68"
LICNC N
7i4-250-06CI7
USE OF PERMIT
condo
BL.
ZON
FSB
SSB.
SSB I
RSB
OFC.
. ZONE ORD N.
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: It; after making this Certificate of Exemption, you should become subject to the Workers'
Compensation provisions of ihe,Labor Code; you must forthwith comply with such provisions or this permit shall
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:.
I71hereby certify thatno excavation five (5) of 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, Sec341, Title8,
' 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.
r
0 Division of Industrial Safety Permit No.
Oate' Applicant
CONSTRUCTION LENDING AGENCY l' hereby affirm that there is a construction lending agency for the performance
of the work for which this perml fis Issued:(Sec. 3097, Civ. C.). ..
Lender's Name
Lender's Address _ v � / 7� % •�— -'r (_,�
I certify that I have read this application and state that the above information is corre 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-'
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.property for which I have applied for this permit for the purpose of making inspections.
Signature of Applicant/or Agent �} Date
Print:A(iplAnl%Agent°Name%
1DA
APOLIPRMT tll 17
L/18Y81 S.F.D.
Permit to construct
763 sq.' ft, of
condo plus 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
SffiI Fee—
3.15
Plumbing Fee
22,00
Prop, Devel. Fee
450,00
PA 10
DEC 2 7 1984
TOTAL,
FEE
1,020.68"
BLDG. DEPT.
VALUATION 1 44, 375.0.0
Ah
Alk
NO.
OPERATION IrATE INSPECTOR
NO.
OP . ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
�Q�
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 eo
16 Water Piping 4
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
PSL PA
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring •
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final