001104 (SATT)PERMIT APPLICATION '
City of La Og a
Department of Building and Safety
This permit becomes void if work n•H commenced within 180 days from date of issuance. OR, if work has been suspended or abandoned for a period of 180 days.. • . -.
SLICENSED 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 Profession: Code, and my license is in full force
and effect.
License Class — Lic. Number a
Date ContractorS /14�,10,
OWNER -BUILDER DECLARATION: I hereby affirm that 1'ain'exempt from tie Contractor's License Law for the'
following reason (Sec. 7031.5. Business and Professiohs'Code: Any city o county which requires a per it to
construct, alter, improve, demolish, or repair any structure, prioi to its issuance, also requires the.applicant for
.such permit to file a signed statement that he is licensed pursuant 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 he is exempt ,
.therefrom and the basis for the alleged exemption. Any yiblation.of Section 7031.5 by any applicalit 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 ProfesEions Code: The Contractor's License .
Law does not apply to an owner of property who builds, or improves thereom 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 have the burden of proving that_•,
he did not build or improve for the purpose of sale.).
0 1, 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 apply to an owner of property who
builds or improves thereon, and who contracts for such projects with a coitractor(s) licensed pursuant to the
Contractor's License Law.) _.
❑ 1 am exempt under Sec.. . B. 8 P.C. (Attached Certificate).
Date-I'Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certl7icate of consent to self -insure, or a
certificate of Workers' Compensation Insurance , or a certified copy thereof .(Sec. 3800. tab. C.):
Policy No. Company
O Certified copy is hereby furnished.
O'Certifted copy is filed with the City Building Inspection Department or Cit-' . Department.
Date Applicant
44
S 173
APPLICANT NAME (L. F. MI) M. D. Janes
ADDRESS -
2950 Airway Avenue
CITY/COMMUNITY/STATE/ZIP
Costa Mesa, CA 92626
JOB SITE ADDRESS/SPACE
CITY/COMM UNI TY/STATE/ZIP
La Quinta, f3A 92253
BOK
PAG.-
PRC 1
C
..
TNN
RNG
SE
S
TRACT
18915
LOT
4$3
240.27
Const, Fee
MOD
3
SB
Bldg. 5
TRACT NAME
Reflections
OWNER NAME (L. F. MI) Applicant
CONTRACTOR -FIRM NAME
Applicant
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP - -
above
PHONE w 345-143 '6
-
O
LICNC r
ARC/ENG FIRM NAME
Carlson, Shle ey & Hexmalhalch
ADDRESS18002 Skvpark Circle
CITY/COMMUNITY/STATE/ZIP
Irvine, CA 92714
PHONE .
714-•250-060 i
LICNC •
,
USE OF PERMIT
Condo
BL
ZON
FSB
Sse
ss8
RSB
1.-
OFC
ZONE ORD N
LOT S2
END
'SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not 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 Wcrkers'
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:
O I hereby certify that no excavation five (5) or more feel 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, falsewcrk, or
demolition or dismantling thereof, will be more than thirty, -six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec341, Title B,
C.A.C.)
O 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 Divisign of Industrial Safety Permit No. k
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
i of the work for which this permit is iislued (Sec. 3097, Civ. Q.
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 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 gfppGedJUr hjs.permit for the purpose of making inspections.
ei natiAlf 4lppli��t or A en `'"'* Date
PrinttApplicant/Agent Name
■4' M11/8� S.F. •
APPL/PRMT n_nl 1 n4'
Permit to construct
763 sq. ft. of
condo plus 160 sq.
ft. of porch
plus 235 sq. ft of
garage as per
rapproved plans.
Mech. Fee'
21.00
Plan Check'Fee
240.27
Const, Fee
260.50
Elect. Fee
23.76
SMT Fee
3.15
Plumbing Fee
22.00
Prop. Devel. Fee
450.00
-
O
1
'
• .... . TOTAL .
: FEE
1,026.68
BLDG. DEPT.
VALUATION 44,375.00
r -I
Ah
NO.
OPERATION DAT INSPECTOR
NO.
OPERAI N DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
/�
33
Ventilation System C
2
Ftgs & Frms
!�
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
4L42
Commercial Hood
10
Fireplace } P.L.
❑
43
Final
10A
Fireplace T.O.
❑
NPIN•
ADDITIONAL INFORMATION
e
SEWAGE,SYSTEM SIZE.&'LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
1.2B 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 i
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final