001117 (SATT)PERMIT APPLICATION
City of La Ouinta
• Department of Building and Safety
This permit becomes void if work not co nmenced 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'Lnder provisions of Chapter 9'
'(commencing with Section 7000) ohDivision.3 of the Business and Professions Coda, and my license is in full force
and effect.
License Class Lic. Numbe--r nn
Date ' Contractor - k �� I F /rY ! P
OWNER -BUILDER DECLARATION: I hereby affirm that) im exempt fromlthe Cmtpctor's License Law for the
following reason: (Sec: 7031.5, Business and Professions Code: Any city or cointy which requires a permit10
construct, alter, improve: demolish, or repair any structure, prior to its issuance, also requires the applicant or
• , such permit to file a signed statement that he is licensed pursuant to the provision:: 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 five hundred dollars (1500.):
' 0 I, as owner of the property, or my employees with wages as their sole compersation, 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, anal who does such work himself or
through his own employees, provided that such improvements are not intended on offered for sale. If, however, the
building or improvemnt is sold within one year of completion, the owner -builder wi I have the burden of proving that
he did not buil4.or improve for the purpose of sale.).
0 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 apoly 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.). _ .
0 1 am exempt under Sec. " : B. 8 P.Q. (Attached Certificate).
Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure,'ora '
certificate.of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.)._ '
'Policy No. Company
0 Certified copy is hereby furnished. l ✓y
0 Certified copy is filed with the City Building Inspection(Department or City Department.
Date Applicant ` r�� _ �%i�i� /7
'✓ z/ /47
APPLICANT NAME (l. F. Mn M.D.'
Janes
ADDRESS • -
2950 Airway Avenue
CITY/COMMUNITY/STATE/ZIP Costa Mesa, 'CA 92626
JOB SITE ADDRESS/SPACE '
1
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
BOK
PAG
PRC I
C..
approved plans.
TYMV
PING
SE
I S
TRACT
18915
LOT
56
21,00
_Ti
3
38
Bldg. `6
TRACT NAME -
Reflections
OWNER NAME (L. F. MI) '• •' -
Applicant
CONTRACTOR -FIRM NAME - ••
Applicant
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
above
PHONE • '
LICNG •
345-1436
' TOTAL
FEE
ARC/ENG FIRM NAME •_ .
Carlson. Stl,eovev & Heamalhalch
ADDRESS
18002 Skvpark Circle
CITY/COMMUNITY/STATE/ZIP
Irvinie.- CA/�92714
PNONr14-250-0607
LIGNC.
USE OF PERMIT Condo
BL
I
I ZON
FSB
SSB •
SSB I
R38
OFC
ZONE ORD 11
LOT S2
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need norbe completed it
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 1 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.)
0As owner -builder, I will not employ anyonerto 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.
nate .. Annlirant
CONSTRUCTION LENDING AGENCY: I hereby affirm thatthere is a construction lending agency for the performance
of the work for which this permit is issued (Sec. 3097,:Civ. C.
Lender's Name r� a
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
CERTI FICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I h ave 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 tie pro y for which I have a plied for—this peiml�r the purpose of making inspections.
Signature of Applicap or Agent Date
Print Applicant/Agent Name ��
APPL/PRMTBpi 117 12-•E17-84 S.F.D.
Permit to construct
736 sq. ft. of
condo plus 160 sq.
ft. of porch
plus 325 sq. ft. of
garage as per
approved plans.
Mech. Fee
21,00
Plan Check Fee
240.27
Const. Fee
260.50
Elect, Fee
23.76
SMI Fee
3.15
Piumbinq Fee
22.00
Prop. Devel. Fee
450.00
BE p W
' TOTAL
FEE
.31L. 0
BLDG.DEPT.
VALUATION 44, 375.00
Ah
Ah
NO.
OPERATION ATE
INSPECTOR
NO.
OP rtATION 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.
❑
NPON
ADDITIONAL INFORMATION
$
SEWAGE SYSTEM SIZE &LOCATION
11 Exterior Lath A
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick RSI C
Value
7A Walls (Batts)
126Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBINGItAPPROVALS
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 P/I
STREET NAME
26 Power Pole 14, em
27 Conduit •
28 Service Entrance
29 Wiring •
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final