001110 (SATT)PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
This permit becomes void if work not,corrmenced:within.180 days from date of issuance. OR, if work has been suspended or -abandoned for a period of 180 days.
. . - 1:, • . CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE:' This section need not be completed if ^ -
LICENSED CONTRACTORS •DECLARATION: I hereby affirm that I am licensed urder provisions of Chapter t9 :,.. , the permit is for one hundred ($100) o, less. I certify that in the performance of the work for which this permit is ,
(commencing with Section 7000) of Division 3 of the Business and Professions Code.and.my.license is in full force,- issued; I shall not employ any person inany manner so as to become subject to the Workers°Compensation Laws of
and effect. r California.
License Class Lic. Number ')
Date Contractor+/%J °
OWNER -BUILDER DECLARATION: I hereby aft: that7l am exempt from the Coitractor's License'Law for the
following reason (Sec. 7031.5• Business and Prolessiyss Code: Any city or county which requires a permit,to
construct, alter, improve, demolish, or repair any structure, prior to its issuance,:also requires the applicant for
such permit to file a signed statement that he is licensed pursuant to the provisions A the Contractor's License Law
'
(Chapter 9,(commencing with section7000)ofDivision. 3ofthe Business and Profes:ionsCode) orthat heisexempt
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit;•.•
subjects the applicant to a civil penalty of not more than five hundred dollars ($•500.): ,
0 1, as owner of the property, or my employees with wages as theirsole compensation, will do the work, and the . _ -
structure is not intended -or offered for sale (Sec. 7044, Business and Professions%ode: The Contractor's License
Law does not apply to an owner of property who builds• or improves thereon, add.roho does such work himself or
through his own employees, provided that such improvements are not intended or offered for sale: ll, however, the
,__building or improvemm is sold within one year of completion. the owner -builder will have the burden ofprovingthat
;,he.did not build 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 appy to an owner of property who
builds or.improves thereon, and who contracts for such projects with a contrac:or(s).ficensed pursuant to the.
Contractor's License Law.).
0 I am exempt under Sec. _.,E 8 P.C. (Attached Certificate).
Date Owner• '
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certilicat-: of consent to self -insure, or a
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 I 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
demottion'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.0 j "+
.0 As owner -builder, 4•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 is issued (Sec. 3097, Civ.
Lender's Name r
e
Lender's Address
a
I certify that I have read this application.and state -that the above information is correct.) 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.
'certificate o1 Workers' Compensation Insurance , or a°certified copy thereof (Sec 3800. Lab. C.). Signature of Applicant or Agent ' Date
Policy No. Company CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: 'I certify I have read this application and state that
0 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're esentative of the Cit
❑ Certified copy is filed'with the City Building InspectionDepartment or Cit Depart nt. P y of La Ouinta Department of Building and Safety to enter
Date Applicant--` / upon"the, property for which I•ti veapplied°lorthis permit for th purpose of making inspections.
Signatur of Applican'or Agen Date
77
/ Paint Applicant/Agent Name i
APPLICANT NAME fL. F. MI) I
M.D. Janes
ADDRESS•
2950 Airway Avenue
CITU/COMMUNITY/STATE/ZIP
Costa Mesa, CA 92626
JOB SITE ADDRESS/SPACE
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
BOK
"PAG
PRC '
C
TWN
RNG
SE
S
TRACT
18915
LOTMOO
49
Elect. Fee
23.50
1
s8
Bldg. 5
TRACT NAME -
Reflections
OWNER NAME L. F. MI)- •
Ap licant
CONTRACTOR -FIRM NAME1. . • • •
Applicant
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
above
PHONE •
LICNC 0
345-1436
ARC/ENG FIRM NAME
Carlson. Shlemey & Hezmalhalch
ADDRESS
18002 Skypark Circle
CITY/COMMUNITY/STAT E/ZIP
Irvine, CA 92714
PHONE 0
714-250-0607
LICNC 0
USE OF PERMIT ,
Condo
BL
ZON
FSB
SSB,
SSB
RSS
OFC
ZONE ORD tr
LOT SZ
END
SIDE,,
APPL/PRMT: } 11
n 1G�E11/84 s-
1/ Re
Permft*to construct 926 sq. ft. of
condo plus 235
sq. ft. of garage
as per approved plans.
Mech. Fee
24.00
111an 'Check Fee
246.00
Coast. Fee ' '
289.00
Elect. Fee
23.50
SMI Fee
3.64.
Plumbing Fee
30.00
Prop, Devel. Fee 450.00
DEC 2,1
TOTAL
FEE
1, 06'6.14
BLDG. DEPT. VALUATION 51, 669.00
F --I
NO.
OPERATION ATE INSPECTOR
NO.
O ATION I DATE INSPECTOR
-BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
�`
33
Ventilation System
2
Ftgs & Frms
�S
34
Plenums & Ducts NOT. ,
2A
Slab Grade
FT
35
36
Furnace Compart.
Inlets & Outlets
3 Steel
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.
❑
NON
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
t2A Drywall
t3 Finish Grade
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
'
P/l
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring •
29A Grounding Wire ILPSL
29B Bonding
30 Fixtures
31 Service
32• Final