001106 (SATT)PERMIT APPLICATION
City of La Duinta
• 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 notbe 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. 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 in any manner so as to become subject to the Workers'Compensation laws of
and effect. California.
License Class Lic. Number
Date Contractor f
���� it `7
-OWNER-BUILDER DECLARATION: I hereby affirm thal'l2i €xempt from they-ontractor's License Law for the
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 pursuant to the proyisionsolthe Contractor's License Law
(Chapter 9(commencing with section 7000) of Division 3 ot.the Business and Prolessions Code)orthathe is exempt ..
therefrom and the basis for the alleged exemption. Any.violation of Section 70315 by any,applirant for a permit
subjects the applicant to a civil penalty of not more than five hundred %dollars (:500.):
O 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. 709; Business and Professions Code: The Contractor's License
Law does not apply to an owner of property who.builds, or improves thereon, aric who does such work himself or
.through his own employees, provided that such improvements are not intended o.roffered for sale. If, however, the
bu ildiny,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.). ,c
01; as owner of the property, am exculsiyely contracting with licensed contractors to construct the project (Sec:..
• 7044. Business and Professions Code: The Contractor's License Law does not apoly 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.).
❑ I am exempt under Sec. B. 8 P.C..(Attached Certificate).
Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a cerlificate of consent to self -insure, or a.
certificate of Workers' Compensation Insurance , or a.certified copy thereof -(S.c. 3800. Lab. C.). -
Policy No. Company, _
❑ Certified copy is hereby furnished. -
❑ Certified copy is filed with the City Building Inspection,Department or Cit yA--...— De artment.
Date Applicant
APPLICANT NAME (L• F, MI) • • Mattes
`J
ADDRESS
2950 Airway Avenue
CITY/COMMUNITY/STATE/ZIP �(��� �jl"CA1
condo plus 160 sq.
JOB SITE.ADDRESSISPACE _
CITY/COMMUNITY/STATE/ZIP La Quinta, CA. 92253
BOK
PAG
PRC
C.
-
TWN
PING
SE
S
T18915
LOT 45
21.•00
MOD 3 sB
Bldg. 5
TRACT NAME
Reflections
OWNER NAME (L, F. MI) Applicant
CONTRACTOR -FIRM NAME - -
Applicant
ADDRESS -
above
CITY/COMMUNITY/STATE/ZIP I above
PHONE N
345-1436
LICNC 11
3.15
ARC/ENG FIRM NAME
Carlson, Shleppey & Hezmalhalch.'
ADDRESS
18002,Skypark Circle
CITY/COMMUNITY/STATE/ZIP
Irvine, CA 92.714
PHONE NLICNC
714-250-0607
Prop. Devel. Fee
4
USE OF PERMIT
Condo
BL
ZON
FSB
SSB
SSB
RSB
OFC
ZONE ORD#
11020.68
LOT SZ
END
SIDE
Date _ Applicant
NOTICE TOAPP.LICANTa,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:
01 hereby certify that no excavation five (5) or more feet in depth into which a person is requireflo 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,•
CAC.) 7.,.a„- .. -
❑ As owner -builder, I will not employanyone to-do work which would require a permit from tKe.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
Lender's Address �_� a, _ _
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.
r 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'represe native of•lhe•Cityof La Ouinta Departmentof Building and Safety to enter
upon the property for which I have applied for this permit for the purp6se of making inspections.
S gn t re df Abp Icaritr Agen r _ Date
PrintlAppplicant/Agent Name y/
APPUPRMT UU1 1 U6120771/84
S. F. D.
Permit to construct736 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 Check Fee
240.27
Const. Fee
260.50
Elect. Fee
23.76
SMI Fee
3.15
Plumbing''Fee
22.00
Prop. Devel. Fee
450.00
A�10
-
TOTAL
FEE
11020.68
BLDG. DEPT. VALUATION 44,375.00
• -
r-1
F --I
NO.
OPERATION ATE INSPECTOR
NO.
OPWATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
/
33
Ventilation System
2
Ftgs & Frms
i�
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.
❑
43
Final
10A
fireplace T.O.
❑
NOON•.
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 Ilk 1�
16 Water Piping
17 Rough Plumb t
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final
s
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE,
P/I
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance `
29 Wiring
29A Grounding Wire X40P
29B Bonding
30 Fixtures
31 Service
32 Final