001120 (SATT)PERMIT APPLICATION
City of La Duinta
• 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 under provisions of Chapter 9
(commencing with Section 7000).of Division 3 of the Business and Professions Code, and my license is in lull force
and effect.
License Class "Lic. Number
• DateContractor ••-
••;. - -I/-- r / r X v
OWNER -BUILDER OECUiRATION: I hereby affirm that I am exempt from the Contractor's LicenLaw for the
:
following reason (Sec7031.5, Business and Professions se 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 fife a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
•
(Chapter_9 (commencing with section 0) of Division 3 o1 the Business and Professions Code) or that he is exempt
4herefrom 700
and'Ahe basis for the alleged exemption. Any violatiomof Section 7031.5.by any applicant for a permit
subjecis:lhe applicant to a civil penalty of not more than five hundred dollars (5500.):
0 1, 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 ownerot property who builds; or improves thereon, and who does such work himself or. i
through his own employees, provided that such improvements are not intended or offered for sale. Ifihowever, 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 contractors) 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
O Certified copyis hereby furnished:—�--
0 Certified copy is filed with the_City Building Inspection Department or City `�� Department:
Date - Applicant
APPLICANT NAME (I., F, MI) - . •
N.D. Janes
ADDRESS
2950 Airway Avenue
CITY/COMMUNITY/STATE/ZIP
Costa Mesa, CA 92353
JOB SITE ADDRESS/SPACE
_ A
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 922.53
BOK
PAG
PRC
C
^- •-
TWN
RING
SE
S
TRACT
18915
LOT
59
Plan Check Fee
246.00
MODSS
1
Const. 'Fee
Bldcr. 6
TRACT NAME -
Reflections
OWNER NAME (L. F, MI)
Applicant
CONTRACTOR -FIRM NAME . - -
Applicant
ADDRESS .
above
CITY/COMMUNITY/STATE/ZIP -
above
PHONE .LICNC
30..00
N
Prop. Devel. Fee
345-1436
ARC/ENG FIRM NAME .
Carlson. Shlenpev & Hezmalhalch.
ADDRESS ..
18002 Skvnark Circle
CITY/COMMUNITY/STATE/ZIP -
Irvine.'CA 92714
PHONE •
LICNC •
-
714-250-•060 7
USE OF PERMIT
Cando
BL
ZON
FSB
SSB
SSB
RSB
OFC
ZONE ORD N
LOT SZ
• ENDS
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 certity.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:
` 01 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 thirt9-sik(36) feet high: (Chap 3.Z, Grp 2, Art 2, Sec341, Title B,
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 Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCYsI hereby affirm that there is a construction lending agency for the performance
of the work for which this permit its issued -(Sec. 3097, Civ. C.). A
Lender's Name (--
Lender's Address (/_%
I certify that 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 I have apVfed.for_this-permit•for the purpose of making inspections.
Sign`at re o App ica�� Agent' V Date
Printpplif cant/Agent Name
APPVPRMT ■ _/.�
DATE
12-17-8 A
S.F.D.
Pertit to construct 926 sq
ft. of
condo plus 235 sq.
ft. of
garacre
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
TOTAL
FEE
1 066.14
BLDG. DEPT.
VALUATION 51,669.00
Ah
NO.
OPERATION TE INSPECTOR
NO.
OPWTION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
X
34
Plenums & Ducts •
2A
Slab Grade
r
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
AOO41
Smoke Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P. L.
❑
43
Final `
10A
Fireplace T. 0.
❑
OP'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 41000 Am
16 Water Piping •
006
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 P/1
STREET NAME
26 Power Pole
27 Conduit •
28 Service Entrance •
en•
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32• Final