001124 (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• anJ my license is in full force
and effect.
License Class 1-�Lic. Number
- —
Date . Contractor`s i+ 1 A—A.4.. AA.s2/1,1
OWNEhi BUILDER DECLARATION: I hereby affirm.that 1 am exempt from the Contr2ctor's License Law for,the
following reason (Sec. 7031.5. Business and Professions Code: Any it or county which requires•a permit to
construct, alter, improve, demolish• or repair any;'stiucture, prior to its issuance, alsarequires-the applicant f¢r
such permit to file a signed statement that he is licensed pursuant to the provisions of 1 ie Contractor's License Law:
(Chapter 9 (com mencing w ith section 7000) of Division 3 of the Business and Prof essio is Code) o r that he is exempt
„y,therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 b•, any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($SOC.):
❑ I. as owner of the properly: 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 Coce: 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 offrred 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.).
❑ 1, as owner of the property, am exculsively contracting with licensed,contractors'o construclthe project (Sec.
7044. Business and Professions Code: The Contractor's License Law does not apply :o an owner of property who
builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to.the
Contractor's License Law.).
❑ 1 am.exempt under Sec. B. & P.C. (Attached Certificate). .
Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate cf 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,
O Certified copy is filed with the City Building Inspection Depart mmeennt, r-CCifity., V� Department
.p
Date Applicant �EiJ/1%..a+m /l%vv lfll 4-1 ft
J
%&' 3 3
APPLICANT NAME (L. F. MI)
M.D. Janes.
ADDRESS '
2950 Airway Avenue
CITY/COMMUNITY/STATE/ZIP
ro-qta Mesa._ rA 92353
JOB SITE ADDRESS/SPACE
CITY/COMMUNITY/STATE/ZIP .
La Ouinta. CA 92253
BOK
PAG..,
PRC IC
Mech. Fee
21.00
TWN
RNO
SE
S'
TRACT
LOT
.SMT Fee
3.15
MOD
SE
_
18915
I 63
3
DEC 2 1914
sldcr. 7
TRACT NAME
Reflections
OWNER NAME (L. F. MI) ,.
r nlicaant '
CONTRACTOR -FIRM NAME
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP -
'above
PHONE 0
LICNC ..
345-14361
1
ARC/ENG FIRM;ME .
Carlon Shleppev & Hezmalhalch
ADDRESS
18002 Skvnark Circle
CITY/COMMUNITY/STATE/ZIP
Irvine. CA 92714
PHONE]
7i4 -250-06Q7
LICNC 0
-
USE OF PERMIT
Condo.-
ondo'BL
BL
I
I ZON
FSB
SSB•
SSB
R58
OFC
ZONE ORD»-
LOT S2
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 workJor 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 70 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:
❑ ]hereby certify that no excavation five (5) or -more feet in depth into which a person is required todescend,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.) ;:I r•, •
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..
❑ 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— -I
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.
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..] agree to comply with all state laws and county ordinances relating to,buidling
construction, andauthorize a'representative of the City of La Ouinta Department of Building and Safety -to enter
upon the property for which I have applied forethis ermit for tl*purpose of makingtinspections.
\gnatgre of Aepi t�o'yAgeDate
Print Applicant /Agent Name `.
APPL/PRMT�
12LA.L . 4r S.F.D.
Permit to construct 763 sq. ft. of
condo Plus.160 sq.
ft. of porch
and 235 ser. ft,
of para a as per
armroved xalans .
Mech. Fee
21.00
Plan Check Fee
240.27
Const. Fee
260.50
Elect. Fee
23.76
.SMT Fee
3.15
Plumbi.na Fee
22.00
Pron. bevel. Fee 450.00 `
DEC 2 1914
I
r7l
TOTAL'•
FEE
BLDG. DEPT. VALUATION 44 . 37ci —
Ah
Ah
NO.
OPERATION 'TATE INSPECTOR
NO.
OP . ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
A33
Ventilation System
2
Ftgs & Frms
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
10Fireplace
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 AV
17 Rough Plumb
18 Vents dw•
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 P!L
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring •
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final