001107 (SATT)PERMIT APPLICATION
City of La Ouinta
O Department of Building and Safety •
This permit becomes void if work not commenced within 180 days from date of issuance, OR, it 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 if
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed. under provisions of Chapter 9 ; the permit is for. one hundred ($100) o, fess. I certify that in the performance of the work for which this permit is.
"(commencing with Section 7000) of Division 3'ot the Business and Professions Code, and my license.is in 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
•:Date • —Contract h'�NOTICE TO APPLICANT: If, after making this Certificate of Exemption.•you.should become subject to the Workers'
l Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit.shall
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the .:
i . be deemed revoked.
following reason (Sec. 7031.5. Business and Professfopps Code: Any city or county which requires a permit to •: -
construct, alter, improve. demolish, or repair any stJcture, prior to its issuance, also requires the applicant for DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
such permit to file a signed statement that heislicensed.pursuanttothe provisions ofthe Contractor's License Law .. 01 hereby certify'thatnoezcavationfive (5)ormore 'feet indepth into whichitpersonisrequiredtodescend,witIbe
'(Chapter 9(commencing with section 7000) of Division.3 of the Business and Professions Code) or that heis exempt made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework: 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, An 2, Sec341, Title B. '
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.): C.A.C.)
❑ 1. as owner of the property, or my employees with wages as their sole,compensation, will do the work, and.lhe '0. As owner -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 af.sale.). -� CONSTRUCTION LENDING AGENCY. I hereby affirm that there is a construction lending agency for the performance
❑ 1, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec:.. of the work for whit '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
builds or improves thereon, and who contracts for such projects with a contra:tor(s) licensed pursuant to the
Contractor's License Law.). Lender's Address
O•I.am exempt under Sec. B. & P.C. (Attached Certificate).. I certify that I have read this application and state that the above information is orrect. I agree to comply with all
Date Owner :I 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.
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. 3900. Lab. C.): - • • -
Signature of Applicant or Agent r Date
Policy No. . Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
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
'O Cerlified-copy is filed with the City Building Inspection Departm nt or City Department'. + • -construction, and authorize.a;rq resentative of the City of La Ouinta Department of'Building and Safety to enter
1 upon tl a property for which I ve applied for this permit for the -purpose of making inspections.
Date Applican� f r 1 A
S gnature o Applican of3Agen( Date •
( /7 .7 Pri�Applicant/Agent Name
APPLICANT NAME (L, F. MI) M • D . Janes'
lit
ADDRESS '
2954'Airway Avenue
CITY/COMMUNITY/STATE/ZIP
Costa Mesa, CA 92626
JOB SITE ADDRESS/SPACE
n,� i erinl i a
CITY/COMMUNITY/STATE/ZIP
La Quintal CA 92253
BOK
PAG
PRC
C
,
TWIN -
RNG-
• SE
S
TRACT
1891S
LOTMOD
46
23.76
SMI Fee
3
SB
.
Bldg.- S'
TRACT NAME
Reflections
OWNER NAME (L. F. MI)••
Applicant'
CONTRACTOR -FIRM NAME' ..
Applicant
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP -
above
PHONE •
345-1436
• 1
LICNC II
ARC/ENG FIRM NAME '
Carlson, ShJleppey & Hemmalhaich
ADDRESS
18002 Skvrtark Circle
CITY/COMMUNITY/STATE2IP
Irvine CA 92714
PHONE N
LICNC
714-250-0607
USE OF PERMIT ,
condo
BL
ZON
FSB
I SSB I
SSB
'RSB
OFC
ZONE ORD N
LOT SZ .
M
END -
'. SIDE.
APPL/PRMT �> 1 n7 12A7E11,G74 s.F.D.
Permit to construct
736 sq. ft. of
condo plus 160 sq.
ft. of porch
plus 235 sq. ft.. of
garage as per
approved plans,
Mech. Fee
21.00
Plan Chhck Fee
240.27
Const. Fee
260.54
Elect. Fee
23.76
SMI Fee
3.15
Plumbing ~Fee
22.00
Prop, Devel. Fee
45.0.00
• 1
wwC
TOTAL
FEE
1, 020.68
BLDG. DEPT. VALUATION 44,375.00
Ah
NO.
OPERATION ATE INSPECTOR
NO.
O PIEKATION DATE INSPECTOR
BUILDING APPROVALS
ME CHAN I CALjkPPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
X15>1
34
Plenums & Ducts •
2A
Slab Grade
S
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.
❑
OPINO.
ADDITIONAL INFORMATION
_
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R"
Value
7A Walls (Batts)
12BCeiling (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