001102 (SATT)PERMIT APPLICATION
. City of La Dg and
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.
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 lull force
and effect. T
License Class. Lic. Number
Date Contractor, 1vioAAu2jw4m111i
OWNER -BUILDER DECLARATION: I hereby affirm that I!am exempt from the ontractor's license Law for the
following reason (Sec. 7031.5. Business and Professions+`Code: Any city or Aunty which requires Aermit 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 provisions of the Contractor'sLicenseLaw
(Chapter 9(commencing with section 7000) of Division 3 of the Business and Professions Code) orthat 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 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 imprg_vemnt 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 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 not apply to an owner of property who
builds or improves thereon, and who contracts for such projects with a cortractor(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 ISec. 3800. Lab. C.).
Policy No. Company
O Certified copy is hereby furnished.
0 Certified copy is filed with the City Building Inspection. Department CiF _ '" Depa tment.
Date Applicant + r'• / ��
7 777
APPLICANT NAME (L. F. MI) M. D. Janes
ADDRESS
2950 Airway Avenue
CITY/COMMUNITY/STATE/ZIP
Costa Mesa, CA 92626
JOB SITE ADDRESS/SPACE 70 541 Indian -Drive--'
CITY/COMMUNITY/STATE/ZIP La Quinta, CA 92253
BOK
PAG
PRC
C
approved pians.
TWN•
RNG
SE
S
TRACTLOT
18915
41
24.00
MOD
�
SB
Bldg. 5
TRACT NAME
Reflections
OWNER NAME (L. F. MI) Applicant
CONTRACTOR -FIRM NAME Applicant
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
above
PHONE A
345-1436
SMI Fee
LICNC -
ACaENG r son, Shleppey & Hezmalhalch
ADDRESS18002 Skypark Circle
CITY/COMMUNITY/STATE/ZIP
Irvine CA 92714
PHONE M
714-250-0607
450.00
LICNC 4
USE OF 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: It, after, making this Certificate of Exemption, you should become subject to the Workers'
Compensation provisions of thea abor Code, you must forthwith comply with such provisions or -this permit shall
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT 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, Sec 341, Title 8.
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 fbr the performance
of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name �- `�+r
Lender's Address
1 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 1 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 tative of the City of La Ouinta Department of Building and Safety to enter
upon the property for which I have a plied i t 's permit for the purpose of making inspections.
% wig a tffre Appill cA fe Date
Print (applicant/Agent Name
APPUPRMT ll
12T1i/84
St7 1V1.
Permit to construct 912 sq. ft. of
condo plus 26 sq. ft. of
porch And
235 sq. ft. of
garage as
per
approved pians.
Mech. Fee
24.00
Plan Check Fee
246.00
Const. Fee
289.00
Elect. Fee
26.76
SMI Fee
3.64
Plumbing Fee
27.00
Prop. D+evel.
450.00
A�
ar-
T�
FEE
BLDG. _DEAF
VALUATION'.
r1
NO.
OPERATION DAT INSPECTOR
NO.
OPERAINIUN DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
`r. -
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. ❑
NO
ADDITIONAL INFORMATION
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 CM IL
17 Rough Plumb X •
18 Vents IL
_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/1
STREET NAME
26 Power Pole
27 Conduit CIL
28 Service Entrance •
29.. Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final