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001119 (SFD)` 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 for a period of 180 days. ' - � CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if LICENSED CONTRACTORS DECLARATION: Thereby affirm that I am licensed under provisions of Chapter 9 the permit is for one hundred ($100) o, less. I certify that in the performance of. the work for which this permit is (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of and effect. California. License Class Lic. Number Date " • Contractors-' OWNER -BUILDER DECLARATION: I hereby affirm that;l ar m exempt, from the Contract's License Law for tl�ie following reason (Sec. 7031.5. Business and Professions Code: Any city or countyriahich requires a permitjto . 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) 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 by any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars ($500.): O I. 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 Cooe: The Contractor's License Law does not apply to an ownerol 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 orimprovemntiss2ldwithinoneyearofcompletion, theowner-builder will havethe burden of proving that . he did not build or improve for the purpose of sale.). A • .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 contractor(s) licensed pursuant to the Contractor's License Law.). O'1 am exempt under Sec. . B. 8 P.C. (Attached Certificate). . Date Owner S WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate cl 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 copy is hereby furnished. ❑ Cert'ilied'c%py is tiled with the City Building Inspection ion Department o CityOep ent. Date Applicani+� o v � • • �1 3 APPLICANT NAME (L, F, MI) ' M.D. Janes ADDRESS '• CITY/COMMUNITY/STATE/ZIP JOB SITE ADDRESS/SPACE ' ft. of porch CITY/COMMUNITY/STATE/ZIP La Quinta, CA 92253 BOK' •PAG PRC C Mech. Fee TWN RNG SE S TRACT 18915 LOT 58 26.76 SMI Fee MOD 2 SB 1 ' BLDG. 6 TRACT NAME Reflections OWNER NAME (L. F. MI) ' Applicant CONTRACTOR -FIRM NAME Applicant ADDRESS above CITY=OMMUNITY/STATE/ZIP - above PHONE •LICNC • 1 ARC/ENG FIRM NAME ' Carlson. Shlerlev & Hexmalhalch ADDRESS 18002 Skypark Circle CITY/COMMUNITY/STATE/ZIP Irvine„ CA 92714 PHONE II 714-250-0607 LICNC 4 ' USE OF PERMIT Condo BL ZON FSB SSB' SSB RSB OFC ZONE ORD •- ., LOT SZ END _ SIDE . 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: , ID I hereby certify that no excavation five (5) or more feel 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 %dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2; Grp 2, Art 2, Sec341, Title B. ' C.A.C.) h7 Y't . O 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. O 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 mi is issued (Sec. 3097, Civ. C.). '� 4 Lender's Name !-- r .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 l 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 Duinta Department of Building and Safety to enter upon the property for' -which I have applied for this permit fdr the purpose of making inspections. Signature of Applicant o Agent } Date PrintA�licanl/Agent Name / {� APPVPRMTn l 119 12- � p A S. Di . D. Permit to construct 912 sq. -ft. of condo plus 26 sq. ft. of porch and 235 sq. ft. of garage as per approved plans. Mech. Fee 24.00 Plan Check Fee 246*:00 Const. Fee 289.00 Elect, Fee 26.76 SMI Fee 3.64 Plumbing Fee 27.00 Prop. Devel. Fee 450.00 7! JQR4t TOTAL FEE 1,066.40 BLDG. DEPT. VALUATION 51,140.001 Ah Ah NO. OPERATION TE INSPECTOR NO. OP ATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS 1 Set Back 33 Ventilation System 2 Ftgs & Frms 34 Plenums & Ducts 2A Slab Grade S 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. ❑ NX 43 Final 10A Fireplace T.O. ❑ all NO -- ADDITIONAL INFORMATION - 1 SEWAGE SYSTEM SIZE .& LOCATION 11 Exterior Lath 12 Internal Lath 12A Drywall X 13 Finish Grade INSULATION Thick "R" Value 7A Walls (Batts) 12B Ceiling (Batts) 126 Ceiling (Blown) 14 Final PLUMBING APPROVALS 15 Ground Plumb eft 16 Water Piping • no 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 P/L PJI STREET NAME 26 Power Pole krof 27 Conduit 28 Service Entrance • 29 Wiring 29A Grounding Wire 29B Bonding 30 fixtures 31 Service 32 Final