001103 (SATT)PERMIT APPLICATION
City of La Dg a
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: rhereby 'affirm that I am licen.:ed 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 -U Number
Date ContractJ— �//1�A
OWNER -BUILDER DECLARATION: I hereby affirm thatFl-dm xe pt from he Contractor's License Law for the
following reason (Sec. 7031.5. Business and Professions Code: Any city o county which requires a permit to'
construct, alter, improve, demolish, or repair any stjucture, prior to its issuance, also requires the applicant for
such permit to file asignedstatement that heisliceng'pursuanttotheprovisionsof 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 7031.5 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.ot 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 P(ofessons Code: The Contractor's License
n
Law does not apply to an owner of property who builds, or improves thereoand 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 -builds will have 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 no: apply to an owner of property who
builds or improves*thereon, and who contracts for such projects with a coitraclor(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
O>Certified copyAs hereby furnished. '
0 Certified copy is tiled with the City Building Inspection Departure 1 or Ci,7 !' De art nt.
Date Applicant `W //
APPLICANT NAME (L. F. MAH" M • D. Janes
JJ
ADDRESS -
2950.Airway Avenue
CITY/COMMUNITY/STATE/ZIP Costa Mesa, CA 92626
JOB SITE ADDRESS/SPACE Q' T ; Y
CITY/COMMUNITY/STATE/ZIP LA Quints, CA 92253
BOK
PAG
PRC
C
TWN
'RNC
SE I
S
TLiA8 .0115
LOT4
2
Pian Check Fee
MOf,
SB -
81dg . 5 %
TRACT NAME
Reflections
OWNER NAME (L. F. MI) Applicant
CONTRACTOR -FIRM NAME
Applicant
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
above
PHONE '
345-1436
3,64
L.ICNC a
-
ARC/ENG FIRM NAME ..
Carlson, Shleppey & Hezmalhalch
ADDRESS -
18002 Skypark Circle
CITY/COMMUNITY/STATE/ZIP -
Irvine, CA 92714
PHONE •
714-250-0607
LICNC e
'
USE OF PERMIT
Condo
BL
ZON
FSB
I SSB
SSB
PSB
OFC
TOTAL
FEE
- ZONE ORD 1
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 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 PER CERTIFICATION:
0 1 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, Sec341, Titlell.
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.
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'whichthis permit Wissued (Sec..3097, Civ. C.). ^�
Lender's Name / /
r
Lender's Address _
I certify that I have read IVs 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 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 propertydor which I h C applied o.L this permit for the purpose of making inspections.
�'' Sjgnat re�(�licanMrfAgl`t V Date
Pri� pplicant/Agent Name v _
APPL/PRMT � 312 lAr1 / v 4
D
S.F..
Permit to construct 912 sq. ft. of
condo plus 26 sq,
ft, of
porch and
235 sq. ft. of garage as
per
approved plans.
Mech. Fee
24.00
Pian 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
C
27 1984
`
TOTAL
FEE
1"0 .40
SLOG. DEPT. VALUATION 51, 140.00
• • •
a
r-1
OPERATION DAT
NO.
-ITNO.
OPERATI
OPERI N I DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
1Plenums & 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.
❑
NON
ADDITIONAL INFORMATION
4
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
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
PSL PiI
STREET NAME
26 Power Pole
27 Conduit on -
28 Service Entrance
29 Wiring
29A Grounding Wire d •
29B Bonding
30 Fixtures
31 Service
32 Final