001122 (SATT)PEBMIT APPLICATION
City of La Og a
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 fora period. of*180.days:
LICENSED CONTRACTORS- DECLARATION:,I hereby affirm.that I am licensed unde-provisions of Chapter 9
,(commencing with Section 7000) of Division 3of the Business and Professions Code, and my license is in full force
and effect.
License Class Lic. Number ---
Date Contractor `. !3 A BI'nA YA ,L�7i1'/a A 77
OWNER -BUILDER DECLARATION:. I hereby affirm that7�i
am exempt from the Contr.3ctor's License Law for the •
following reason (Sec. 7031.5, Business and Professions Code:. Any city or county tWich 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) o1 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 tar a:permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
❑ I. as owner ol.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; acid 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 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 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 contractoi(s) 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 of consent to self -insure, or a
,certificate of Workers' Compensation Insurance or a certified cop thereof (Sec 000 Lab C )
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:.
0 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.)
❑ 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 islpissued (Sec. 3097, Civ. C.)...
Lender.'s Name ✓� !1 r,�� 7 '�
_ Lender's Address
I certify that I have read this application and state that the above information is corre�ree 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. s
Y
Signature of Applicant or Agent Date
Policy No. Company CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify l have read this application and state that,
❑ Certified copy is hereby furnished. , - the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
❑ Certified copy is filed with.the City Building Inspection ,Department or City Department. construction, and authorize a representative of the City of.La Ouinta Department of Building and Safety to enter
upori the property for. which I have pplied forthis•permit for the purpose of making inspections.
Date ApplicantAnI
Signature of Applic�� of Agent'. ` Date
�3 r� Print, pplicant/Agent Name
o / ��
APPLICANT NAME (L, F. MI)
_'D Janes
ADDRESS
2950 Airway avenue
CITY/COMMUNITY/STATE/ZIP
.Costa Mesa CA 92353
JOB SITE ADDRESS/SPACE
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
BOK
PAG
PRC
C
TWN
RNG '
SE
245.00
TRACT
LOT
Elect. Fee
26.76
MOD
SB
Plumbing Fee
18915
Prop. Devel. Fee
611-
2 .'
Bldg. 7
TRACT NAME
'Reflections
OWNER NAME If.. F. MI) •. -
Aoo1meant
COaTRACTOR-FIRM NAME .,
Applicant ~�
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
above I
PHONE*
UCNC /
345-1436
ARC/ENG FIR NAME
Carlson, Shleppey & Hezmalhalhh
ADDRESS
18002 Skvpark Circle
CITY/COMMUNITY/STATE/ZIP . . .
Irvine, CA 92714
PHONE M
714-250-0607
LICNC M
USE OF PERMIT -
Condo
BL
ZON
FSB
SSB
SSB
RSB
OFC
.ZONE ORD •
LOT SZ
- END
SIDE
APPUPRMT
„
DAJE
1218/84 S.F.D.
Permit to construct 912 sa. ft. of
condo Alus 26 sa..
£t. of no -c
and 235 ma^ ft. of as aae as ne
a D roved n13 ns _
Mech. Fee
24 -nn
Plan Check Fee
245.00
Const. Fee
289.00
Elect. Fee
26.76
SMI Fee
3.64
Plumbing Fee
27.00
Prop. Devel. Fee
450.00
P A a DEC 2 7 1984
TFEE
11066.40
BLDG. DEPT. VALUATION 51, 140. 00'
r -I
r 1
NO.
OPERATION MTE INSPECTOR
NO.
OP TION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
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
10
Fireplace P. L.
❑
43
Final
10A
Fireplace T.O.
❑
OP'N
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
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
PSL Pel
STREET NAME
26 Power Pole
27 Conduit AW
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final