001108 (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 under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code and my license is in full force
and effect.
License Class Lic. Number
Date Contractor {
OWNER -BUILDER DECLARATION:' I hereby affirm that iam exempt from the Contractor's License Law for the
following reason (Sec. 7031.5. Business and Prolessiods Code: Any city!or county which requiyes a permit to
construct, alter, improve, demolish, or repair any strutiture, prior to its issuance, also requires the applicant for
such permit to file a signed statement that he is licensed pu rsuant 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 for the alleged exemption. Any violation of Section 7031.; 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 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 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 sate.).
0 I, as owner of the property am exculsively contracting with licensed contractor, to construct the project (Sec. ,
7044, Business and Professions Code: The Contractor's License Law does not appP/ to an owner of property who
builds or improves thereon, and who contracts for such projects with a contracbr(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.
O Certified copy is filed with the City Building Inspection Department or City � �n}ent.
Date�_1Z�Llh/f
Applicant '- L
APPLICANT NAME (L. F. Ml)
M. D. Janes
ADDRESS
2950 Airway Avenue
CITY/COMMUNITY/STATE/ZIP
Costa Mesa, CA 92626
JOB SITE ADDRESSISPACE
CITY/COMMUNITY/STATE/ZIP La Quintal CA 92253
BOK
PAG
PRC
C
TWN
PING
SE
S
T 18915
47
Elect. Fee
26.76
MSD
SB
Bldg. 5
TRACT NAME
Reflections
OWNER NAME (L. F, Ml) Applicant
CONTRACTOR -FIRM NAME Applienwt
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
above
PHONE •
345-1436
LICNC 0
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ARC/ENG FIRM NAME
Carloon Shleppey & Hezmalhalch
ADDRESS
18002 S ark Circle
CITY/COMMUNITY/STATE/ZIP
Irvine. CA 92714
PH71*4-250-060.'
LICNC.
USE OFF PERMIT
Condo
BL
ZON
FSB
SSB
SSB
RSB
OFC
ZONE ORD • -
LOT SZ
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 Certitjcate of Exemption, you should become subject to the Worker_s::r-•..
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
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2,+Art 2, Sec 341, Title BI►
C.A.C.)
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.
4D 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 thi�Permi 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 ordinancesand 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 statethat
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 to which L veapptled for this permi for the purpose of making inspections.
S V`rI
n to . r 1(g%t Date
PrintApplicant/Agent Name U
APPL/PRMTTE
00
11/11/8 S.F*D*
Permit to constn*ct 912 sq. ft*
of condo plus 26
sq. ft. of parch
and 235 sq, ft. of garage as plea
approved plans.
Mech. Fee
24.00
Plan Check Fee
246.0b
Const. Fee
289.00
Elect. Fee
26.76
SMI Fee
3.64
Plumbing Fee
27.00
Prop, Devel. Fee
450.00
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TOTAL
FEE
�0�w40
VALUATION,, ' 0�
I Taft''.i
r_1
Am
NO.
OPERATION ATE
INSPECTOR
NO.
OPPATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
34
Ventilation System
Plenums & Ducts
2 Ftgs & Frms S T
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.
❑
43
Final
10A
Fireplace T.O.
❑
NPON
ADDITIONAL INFORMATION
u
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 .Internal Lath
12A Drywall
13 Finish Grade X OW
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 P/l
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
.29 Wiring •
29A Grounding WireIc
29B Bonding
30 Fixtures
31 Service
32 Final