001112 (SATT)LICENSED, CONTRACTORS 'DECLARATI
(commencing with Section.7000) of Divi
and effect.
License Class Lic. Number _ 1
Date - Contractor t` - .0 �/ n �(— 1
OWNER -BUILDER DECLAfiATIOIV T"I hereby affirm that exempt from the Coptractor's License Law forte
following reason (Sec. 7031.5. Business and Professions 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 file a signed statement that he is licensed pursuan .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 fpr 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 ($500.):
❑ 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, 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 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 contractor(s) licensed pursuant to the
Contractor's License Law.).
O 1 am exempt under Sec. . B. 8 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 copythereof (Sec..3800. Lab. C.).
Policy No. Company•
❑ Certified copy is hereby furnished. /111�
❑ Certified copy is filed with the City Building Inspection'Department or City Department.
Date 'Applicant'
V
�
L ro r
7 b' /5' 7
PERMIT APPLICATION
City of La Duinta
O 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 it
ONa 1 •hereby affirm that I am licensed under. provisions. of Chapter 9 the permit is for one hundred ($100) o, less. I certify that in the performance of the work for which this permit is
sion Sof the Business and Professions Code, and my license is in full force issued) shall not employ any person in any mannerso as to become subject to the Workers'Compensation Laws of
California.
APPLICANT NAME (L: F. MI) M. D. Janes
ADDRESS
2950 Airway Avenue
CITU/COMMUNITY/STATE/ZIP ^ -
Cesta Mesa, CA 92626'
JOB SITE ADDRESS/SPACE
..A C�7 To.A � .. to �_—..✓
v z.
CITY/COMMUNITY/STATE/ZIP
Lq Quinta, nA 92253
BOK±
PAG
PRC
C
IN
TWNG
RsB
SE
S
TRACT
1891$
_ LOT
51
Nonst. Fee
289.00
MDl2
.
Bldg. 5
TRACT NAME '
Reflections
OWNER NAME (L, F. MI) -
Applicant
CONTRACTOR -FIRM NAME
Applicant
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
above
PHONE •LICNC
345-1436
DEC 2 7 try
•
ARC/ENG FIRM NAME
Carlson, Shleppey & Hezmalhalch
ADDRESS • -
18002 Skypark Circle
CITY/COMMUNITY/STATE/ZIP
Yrvin¢, CA 92714
PHONE N -
714--250-0607
TOTAL
LICNC.0
USE OF PERMIT
Condo
BL
ZON
FSB
SSB
SSB
RSB
OFC'
ZONE ORD •
LOT SZ
ENO
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.
DIWSION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1herebycertifythatnoexcavationfive(5)ormorefeetindepthintowhichapersonisrequiredtodescend,willbe
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. (Chap3.2, Grp? Art 2, Sec341, Title 8,
C.A.C.) �r•+Y
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.
c�
❑ 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 permt is issued (Sec. 3097, Civ. C.).
Lender's Name
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�nter 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 applicationand 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'reRresentative•of the City of La Ouinta Department of Building and Safety to enter
. upon the property for which I h v'e applied for this permit for the purpose of making inspections.
le,9na`tu e of Applicant or Agent Date
Print 6pj5licant/Agent Name
APPUPRMT nnl 12122A3L7-84 S.F.D.
Permit to construct 912 sq. ft. of
condo plus '26 wok.
ft. of porch
and 235 sq. ft. of
garage as per
approved plans,
'Meeh. Fee
24,00
Plan Check Fee
246.00--
Nonst. Fee
289.00
Elect. Fee
26.76
SMT Fee
3.64
Plumbing Fee
27.00
Prop,•.Devel. Fee
450,00
DEC 2 7 try
r
r
TOTAL
1,'066.40
BLDG. DEPT.
VALUATION 51, 140.00
Ah
Ah
NO.
OPERATION I InTE INSPECTOR
NO.
OP ATION I 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.
IL
43
Final
10A
fireplace T.O. ❑
NON
ADDITIONAL INFORMATION
L
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade •
INSULATION Thick R.
Value
7A Walls (Batts)
126 Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
Iwo
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
P/L P)
STREET NAME
26 Power Pole ponow
27 Conduit
28 Service Entrance X 41t
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final