001116 (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'am licensed Lnder provisions of Chapter 9
(commencing with't,46II0000) of Division 3 of the Business and Professions Coda. al my license is in full force
and effect. 4n`Y:kfi:.k
License Class",f , r Lic ,Number
Date Contractor`s A
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Cmt actor's 1. cense Law for the
following reason (Sec. 7031.5. Business and Profess ons°Code: Any city or cointy which requires a permit Y
construct, alter, improve. demolish, or repair any st ucture, prior to its issuance, also requires the applicant=for.
such permit to file a signed statement that h e is licensed'pursuant to the provision; of the Contractor's License Law • -
•
(Chapter 9 (commencing with section. 7000) of DivisidW3 of the-Businessand Profe;sions 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 lo -a civil penalty of not more than five hundred dollars (W.):
0 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 Code: The Contractor's License ,
Law does not apply to an owner of property who builds; or improves thereon, aric who does such work himself or
'through his own employees. provided that such improvements are not intended or -offered for sale. If, howevervthe
building oi�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.). . ;R
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 apply to an owner,of property who
builds or improves thereon• and who contracts for such projects with a contra:lor(s) licensed pursuant to the
Contractor's License Law.). I-
0 1 am exempt under Sec.. - _ .. 3. 8 P.C. (Attached Certificate). .
Date Owner'
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certifica,e of consent to sell -insure, or a
certificate of Workers' Compensation Insurance , or'a certified copy Ihereof.(Se.. 3800. Lab. C.). '
Policy No. Company
0 Certified copy is hereby furnished. s
0 Certified copy is filed with the City Building Inspection Oepartme t'or City - De alto ent.
Date Applicant \1
�r
APPLICANT NAME (L. F. MI)
M, D. Janes
ADDRESS
2950 Airway Avenue
CITY/COM MUNI TY/STATE21 P
Costa Mesa, CA 92626
JOB SITE ADDRESS/SPACE '
J
CI TWOMMUN ITY/STATE/ZIP
L aQuinta, I4 92253
BOK
PAG
PRC
C
TYyM
-RNG
SE
S
TRACT
18
LOT
1 55
Elect, Fee
23,76
MOD
3
3.15
.Bldg. 6
TRACT NAME
Reflections
OWNER NAME (L. F. MI) ._
Applicant
CONTRACTOR -FIRM NAME r
Applicant
ADDRESS ,
above
CITY/COMMUNITY/STATE/ZIP -
above
PHONE
_P
LICNC •
345-1.436
ARCfENGi R�M.Vii•, Shleppey & Hezmalhalch
ADDRESS
13002 SkvDark Circle
CITY/COMMUNITY/STATE/ZIP '
Trvine. CA 92714
PHONE •,
714-250-0607
IF;;;T;
USE OF PERMIT
Condo
BL
ZON
FSB
SSB
SSB
RSB,
OFC
ZONE ORD 0
LOT SZ
END
SIDE -
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed it
the permit is for one hundred ($100) o, less. I certify that in lhe.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:
❑ 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, falsewoik, or
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec341..Title8,-
C.A.C.) . a..,.i •
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.
0 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 Tissued (Sec. 3097, Civ. C.).
Lender's Name.. 17 _ -
_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'representati�e of the City of La Ouinta Department of Building and Safety to enter
upon the property for which I have appliedlor t is permi4for the purpose of making inspections.
sj,& tute of A pd&t or Agefit Date
PrintApplicant/Agent Name G
APPUPRMT _ 11
120 7-84 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
Plumbigg Fee
22.00
Prop. Devel. Fee 450.00
_P
A:- 7 tg�4
TFEE
1,020.68
BLDG. DEPT.
VALUATION 44,375.0'0
Ah
Ah
NO.
OPERATION TE INSPECTOR
NO.
OPWATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
1"
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts•
Is C. I2A
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
1 L
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.
❑
NO.
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
i 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
pI P/I
STREET NAME
26 Power Pole
27 Conduit •
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final