001109 (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 period of. 180 days.
-
LICENSED 'CONTRACTORS DECLARATION: I hereby affirm that l am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3of the Business and Professions Code. and my license is in full force
and effect.
License Class "Lic. Number--�----
Date Contractor 'AAA
OWNER -BUILDER DECLARATION: 'I hereby affirm that CA exempt from the C6_Itractor's-License Law for th'
following reason (Sec. 7031.5, Business and Profession's Code: Any city or courtewhich. requires a permit o.
construct, alter, improve, demolish• or repair any structure, prior to itsissuance, also requires the applicant for
such permit to file a signed statement that he is licensed pursuant to the provisions •tf the Contractor's License Law
(Chapter 9 (commencing with section 7000) of Division 3of the Business and Profes!.ions Code) orthat 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 ($500:):
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.tode: 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 lave the burden of proving that
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 contraclor(s) licensed pursuant to the
Contractor's License Law.).
0 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 copy thereof (Sec_ 3800, Lab. C.).
Policy No. Company
0 Certified'copy is hereby furnished. -��
l
0 Certified copy`is filed with the City Building Inspconr'Depvarttm�lent or.City �y Department.
Date Applicants/' t p'T-0�p�
APPLICANT NAME (L, F, MI) '
M. D. Janes
ADDRESS •'
2950 -Airway Avenue
CITY/COMMUNITY/STATE/ZIP Costa Mesa, CA 92626
JOB SITE ADDRESSISPACE
CITY/COMMUNITY/STATE/ZIP j ! — /�uinta> CA 92253
x.
BOK
PAG
PRC
CC
-
TWN -
FIND
SE
S
TT8T915
LOT
48
Mech. Fee
MODS
sE
Bldg.*` 5
TRACT NAME Reflections
OWNER NAME (L, F. MI) Applicant
CONTRACTOR -FIRM NAME Applicant
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
above
PHONE I `
345-1436
•
LICNC e
'
ACarllson, Shieppey & Kezmaihalch
A18002 Skypark Circle
CITY/COMMUNITY/STATE/ZIP -
Irvine, CA 92714
PHONE 0
714-250-0607
1 LICNC
450.00
USE OF PERMIT '
Condo
BL
ZON
.FSB
I SSB I
SSB
RSB
-
OFC ,
. ZONE.ORO o•
LOT SZ
1,066.401
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if,
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 l 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,'
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.
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. C.).
Lender's Name—
'Z
Lender's Address I
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'representative of the City of La Ouinta Department of Building and Safety to enter
upon the -property for which I have applied -for this permit for the purpose of making inspections.
\,,�/J Sigdiurrretot Appli'can or'Agen Date
Print Applicant/Agent Name
APPUPRMT �, l {y12Yi1/84
S.F.D. a
Permit to construct 912 sq, ft. of
condo plus 26 sq.
ft. of
porch
and 235 sq. ft. of garage
as per'
approved pians.
Mech. Fee
24,00
Plan 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
PAIDUt�zl
TOTAL
FEE
1,066.401
BLDG. DEPT. VALUATION 51,140.00
r-1
Ah
NO.
OPERATION ATE INSPECTOR
NO.
ORATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
}.
34
Plenums & Ducts
2A
Slab Grade
G
35
Furnace Compart.
3
Steel
36
37
Inlets & Outlets •
Combustion Air
4 Grout Blocks
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
4L42
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
12A Drywall
13 Finish Grade
INSULATION Thick 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 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