001101 (SATT)PERMIT APPLICATION
City of La Ouinta
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: I hereby'affirm that I am.licensed under provisions "of Chapter 9
(commencing with Section 7000) of Division 3of the Business and -Professions Code, and my license is'in full force
and effect.
License Class Lic. Number
Date Contractor d'¢4
OWNER -BUILDER DECLARATION: I Hereby affirm that�am exempt from fh onlractor's License Law for the
following reason (Sec. 7031.5. Business and Professions Code: Any city or >ounty which requires ✓permit to
construct, alter: improve. demolish, or repair any structure. prior to its issuaice, 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 Pr3fessions Code) or that heis exempt
therefrom and, the basis for the alleged exemption: Any violation of Section 7331.5 by applicant fora permit
subjects the applicant to a civil penalty of not more than five hundred dollars (5500.): :,%! ti
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,.rnd who does such work himself or
through his own employees, provided that such improvements are not intendec or offered forsale. 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 I, as owner of the property am exculsively.contracting with licensed cont*ctors 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 con ractor(s) licensed pursuant to the
Contractor's -License Law.).
•0 1 am exempt under Sec. . B. B.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 6ec. 3800. Lab. C:f.
Policy No. Company
.0 Certified copy is hereby furnished.,
0 Certified copy is filed with the City Building Inspection Department or City Department.
V Date Applicant���•✓"��Y/ir��l/ �l
APPLICANT NAME (L; F, MI) •'
M. D. Janes
ADDRESS
2950 Airway Avenue
CITY/COMMUNITY/STATE/ZIP
Costa Mesa, CA 92626.
JOB SITE ADDRESS/SPACE
'i
I
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA.92253
BOK
PAG
PRC
C
Const.'Fee
TMN
RNG
SE'
S
TRACT
18915
LOTMOD
40
30.00
Prop. Devel. Fee
O
SB
Rldg. 5
TRACT NAME '
Reflections
OWNER NAME (l. F. MI) Applicant
CONTRACTOR -FIRM NAME '
Applicant
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
above
PHONE A '
LICNC .
1"066.141
345-1436
ARC/ENG FIRM NAME
Carlson, Shleppy-& Hezmalhalch
ADDRESS
18002 Skypark Circle
CITY/COMMUNITY/STATE/ZIP
'Irvine- CA 92714
PHONE N -
LICNC
714-250-0607
USE OF PERMIT .r
Condo
BL
ZON
FSB
SSB
SSB
RBB
OFC
r 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 mannerso 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'
T. 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:
0'1 hereby certify that no excalationfive(5)ormorefeetindepthintowhichapersonisrequiredtodescend,witlbe -
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
demolition or dismantling thereof, will be_mare than thirty-six (36) feet high. (Chap 3.2. Grp 2, Art 2, Sec341, Title B.
C.A.C.)
0 As' owner -builder, I will not employ anyone to do work which would require ar 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 which this permit issued (Sec 3097, Civ. C). /
Lender's Name //r,,,7
n Lender's Address lyS i�Yyl .19
.: 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
'>7 CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
-the �informal ion given is correct. I agree to comply with all state laws and county ordinances relating to buid ling
construction, and authorize a'representative of the City. of La Ouinta Department of Building and Safety to enter
upon the property for which I
r- �rrhavte aIlplied1ittrs permit 6rpose of making inspections.
�Y/ '
Signature of Applic t' r Agen — Date
Print Applicant/Agent Name f
APPL/PRMT No! 1 "1
Permit to construct 926 sq. ft. of
condo plus 235 sq. ft. of garage
as per approved plans.
Mech. Fee
24.00
Plan Check Fee
246.00
Const.'Fee
289.00
Elect. Fee
23.50
SMI Fee
3.64
Plumbing Fee
30.00
Prop. Devel. Fee
450.00
o 10
TOTAL
FEE
1"066.141
BLDG.DEPT.
VALUATION 51,669
a
Ah
NO.
OPERATION DAT INSPECTOR
NO.
OPERA N DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
34
Ventilation System AM
Plenums & Ducts db
2 Ftgs & Frms ��
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
a Garage Fire Wall
%
42
Commercial Hood
10
Fireplace P. L.
XJC43
Final
10A
Fireplace T.O.
❑
NP'N
ADDITIONAL INFORMATION
?�
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath de
12 Internal Lath
12A Drywall
13 Finish Grade
R
INSULATION Thick
Value
7A Walls (Batts) •
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final I
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb •
18 Vents
19 Sewage Disposal
20 Sewer 36
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 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