001113 (SATT)PERMIT APPLICATION
ADDRESS
2950 Airway Avenue
City of La Ouinta
® Department of Building and Safety •
JOB SITE ADDRESS/SPACE %M � Tr aaau.i►yv ✓a.avc
CITY/COMMUNITY/STATE/ZIP'
La Quinta, CA 92253-
BOK
• This permit becomes void it work not commenced within -180 days from date of,issuance, OR, if work has been suspended or abandoned fora period of 180 days.
•
CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE: This section need not be completed if
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed•Lnder 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, ind my license is m.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 Applicant
I1r--
' Date Contractor
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'
�3 61 .1— fro
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt Iron the Gintractor's License Law for the • '
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
following reason (Sec. 7031.5., Business and Professions'Code: Any city or colnty which requires a permit to
be. deemed revoked.
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
' such permit to file a signed statement thathe is licenslib pursuant to the provisions of the Contra ' clor's License Law.
0 1 herebycertify that n6excavation five (5) or m6re'feet in depth into whicha person is required to descend, will be
(Chapter 9(commencing with section 7000) of Division 3 of the Business and Prote>sionsCode)or that he is exempt
made in connection with work authorized by this -permit, and that no building structure, scaffolding, lalsework, or
therefrom and the basis for the. alleged.exemption. Any.violation of Section 7031.5 by any applicant for a permit
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8,
subjects the applicant to a civil penalty of not more -than five hundred dollars (5500.):
C.A.C.)
O I, as owner of the property, or, my employees with wages as their sole compensation, will do the work, and the
O As dwner-builder, I will'not employ anyone to do work which would require a permit from the Division of
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License
Industrial Safety, as noted above, unless such person has a permit to do such work from that division.
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
O Division of Industrial Safety Permit,No.
building orimprovemntissold within one year ofcompletion. the owner -builder will have the burden of proving that
Date Applicant
he did not build or improve for the purpose of sale.).
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
O I, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec.
of the work for whicll, per7l is issued (Sec. 3097, Civ. C.).
7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
Lender's Name
`r/ -n
builds
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
—�. �yl/�
///�
Contractor's License Law.). ..
O 1 am -exempt under Sec. .-.B. & P.C: (Attached Certificate).
Lender's Address
I certify that I have read application and state tha� above formation is correct. I agree to comply with all
Date Owner
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
SSB
of this county to enter upon the above -'mentioned property for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificzte of consent to self -insure, or a
OFC
'- certificate of Workers' Compensation. Insurance , or a certified copy thereof (SEC. 3800. Lab: C.).'
Signature of Applicant or Agent `' Date
Policy No. Company
CERTIFICATEOF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and statethat
O Certified copy,is hereby furnished.�..
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
O Certified copy is filed with the City Building Inspection Department or City Departure t. • ,
•1
iZj�ljy ��
upon the property for which I have appbed for this permit for the purpose of making inspections.
,Date Applicant' Irl �%
' �� %
SgnaT�eaa p licat�o AgeO✓. Date
0 cL—.tLQ / ' —
PrintjApplicant/Agent Name
APPLICANT NAME (L, F. MI) M • 1D. Janes
til
ADDRESS
2950 Airway Avenue
CITY/COM MUN ITY/STATE/ZI P -
Costa Mesa, CA 92626
JOB SITE ADDRESS/SPACE %M � Tr aaau.i►yv ✓a.avc
CITY/COMMUNITY/STATE/ZIP'
La Quinta, CA 92253-
BOK
PAG
PRC
C
TWN
RNG
SE'
S
TRACT
18915
LOT
52
Elect. Fee
26.76
MOO
2
SB
Bldg.- 6 .
TRACT NAME : -
Reflections
OWNER NAME (L. F. MI). '
Applicant
CONTRACTOR -FIRM NAME -.
Applicant
ADDRESS •.
above
CITY/COMMUNITY/STATE/ZIP
above
PHONE a �
LICNC a
345-1431
BEC21- man
ARC/ENG FIRM NAME '
Carlson. Shleppev & Hezmalhalch
ADDRESS
18002 Sk park Circle
CITY/COMMUNITY/STATE/ZIP -
Irvine. CA 92714
PHONE IILICNC
1
714-250-06017
USE OF PERMIT '
Condo
BL
ZON
FSB
SSB
SSB
RSB
OFC
ZONE ORO
, LOT SZ
_
• - .END
SIDE
APPl1PRMT 13
12717/8 4 s . F . 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
Pian 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
PAID
BEC21- man
TOTAL'
FEE
1,066.40
BLDG. DEPT.
VALUATION 51,140.00
r -I
Ah
NO.
OPERATION ATE INSPECTOR
NO.
OP ATION I DATE INSPECTOR
BUILDING APPROVALS
I
MECHANICAL APPROVALS
1
Set Back
\
33
34
Ventilation System
Plenums & Ducts l aw
2 Ftgs & Frms !
2A
Slab Grade
35
Furnace Compart. IL
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
NIL
41
Smoke Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P.L.
❑
43
Final
10A
Fireplace T.O.
❑
OP'N
NO.
ADDITIONAL INFORMATION
1,
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 mom
16 Water Piping *A •
17 Rough Plumb jL4, C
18 Vents 44 •
19 Sewage Disposal VIM .1
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 I L P)
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring •
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final