001121 (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 aV licensed'unde 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. g
License Class Lic: Number A
Date Contractor• - ken -
OWNER•BUILDER`DECLARATION: I hereby affirm that I am exemptlroIn the Contr)ctor's License Law for 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 tae Contractor's License Law
.(Chapter 9 (commencing with section 7000) o1 Division 3 of the Business and Protessions Code) or that he is exempt.
therefrom and the basis for lhe;alleged exemption. Any.violation of Section 7031.5 b/ any applicant for a permit
subjects the applicant to a civil penalty of not moreAhamfive hundred dollars (S50f.): .
0 I, as owner of the property, or my employees with wagesAs their sole compensaton, 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.).
❑ I, as owner of the property, am exculsively contracting with licensed contractors'.o 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 contractol(s) licensed pursuant to'the
Contractor's License Law.).
0 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 copy thereof (Sec. 3800. Lab. C.).
Policy No. Company.
0 Certified copy is hereby furnished. ?••.
0 Certified copy is filed with the City Building Inspection Department•or City _ Department.
Date Applicant• �}�� l✓l E±i3r�Q. !`
APPLICANTNAME (L, F. MI)
M. 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
S
TRACT
LOT
3.64
Plumbing Fee
MOD
SE
450.00
18915
60
1
Bldg. 7
TRACT NAME
Reflections
OWNER NAME (L. F. MI)
Applicant
CONTRACTOR -FIRM NAME '•
Applicant
ADDRESS '
above
CITY/COMMUNITY/STATE/ZIP -
above
PHONE.
LICNC a
345-1436
ARC/ENG FIRM NAME
Carlson Shlepoev & Hemalhalch
ADDRESS
18002 Skvpark Circle
CITY/COMMUNITY/STATE/ZIP - -• '
Irvine. CA 92714
PHONE a
714-250-060
1 LICNC a.
USE OF PERMIT -
Condo
BL
ZON
FSB
SSB
SSB
.RSB
OFC'
ZONEORDa
•
LOT SZ
r
I "ENO
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.0 mption, 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 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be
made ih 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 (38) feet high. (Chap 3.2, Grp 2, Art 2, Se6341; Tiflell, -
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.
0 Division of Indusgial Satety.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,perIn}t is issued (Sec. 3097, Civ: C.).:,
Lender's Name �� 7 / j/ �� /
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. 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 l have app %d forahispeFmit for the purpo a of making inspections.
Slgnatur'e'or Appl(canT Ar�rr G`' J Date T
Print Applicant/Agent Name
APPL/PRMT { { . i 7 12 ) / IAT
18/U 4 S. F. D •
Permit to construct
926 sq. ft. of
vondo plus 235 sq.
ft. of garage
as per approved plans.
Mech. Fee
24.00
Plan Check Fee
246.00
Const.. Fee
289.00
Elect. Fee
23.50
SMI Fee
3.64
Plumbing Fee
30.00
Prop. Devel. Fee
450.00
PA
« DEC 17 1994
TOTAL':
FEE 11.066-.14
BLDG. DEPT.
VALUATION
•
ih
Ah
NO.
OPERATION
vATE INSPECTOR
NO.
OP RATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
l�
33
34
Ventilation System
Plenums & Ducts •
2 Ftgs & Frms ��
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.
❑
NPN
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick al
Value �
7A Walls (Batts)
126 Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb Jew IL
16 Water Piping OWN
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.
PPROVALS
REAR OF PROPERTY LINE
PSL P/I
STREET NAME
26 Power Pole '
27 Conduit •
28 Service Entrance pill
29 Wiring •
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final