001099 (SATT)PERMIT APPLICATION
City of La Og a
Department of Building and Safety
This permit becomes void if work nc•t commenced within 160 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 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.
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be'completed if
the permit is for one hundred (5100) 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.
License Class Lic. Number. -----A-- Date Applicant
Date'— • u • Contractoigszl.N72yl v /t yv 1 i 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
OWNER -BUILDER DECLARATION: I hereby affirm thaUl am exempt from Lie Contractor's License Law for the
r /
following reason (Sec. 7031.5. Business and'Profession's Code: Any city m county which requires a permit to be deemed revoked.
construct, alter, improve, demolish, or repair.any structure, prior to its'issuance, also requires the applicant for DIVISION OF INDUSTRIAL SAFETY PERMIT.CERTIFICATION: '
such permit to file a signed statement that he is licensed pursuanttothe provisions oftheContractor's License Law P !herebycertif . y that no excavation five (5) or more feet in depth into which a person is reqdired to descend, will be.
(Chapter 9 (commencing with section 7000] of Division 3 of the Business and 6afessions Code) or that he is exempt', made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or.
therefrom and the•basis for the alleged exemption. Any violation of Section 7031.5 by any applicant -for a permit demolition or dismantling thereof, will be more than thirty-six (36)"fleet high. (Cha7p;3.2, Grp 2, Art 2, Sec341, Title8,
subjectsthe applicant to a civil penalty of not more than five hundred dollars (S500.): C.A.D) , ` ' • " ' '
❑ I. as owner o1 the property, or my employees with wages as their sole compensation, will do the work, and theta - p As owner= builder, 1 -will not employ anyone to do work which would require'a permit from the Division.of
structure is not intended or offered for sale (Sec. 7044, Business and ProfesEions Code: The Contractor's License Industrial Safety, as noted above, unless such person has a permit to do such work from that division.
Law does not apply to an owner of property who builds, or improves thereon avid who does such work.himself or
through his own employees, provided that such improvements are not intended or offered for sale. If, however, the r ❑,Division of Industrial Safety Permit No.
building or improvemnt 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.).
❑ I, as owner of the property, am exculsively contracting with licensed contactors to construct the project (Sec.
7044. Business and Professions Code: The Contractor's License Law does nce apply 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.).
❑ 1 am exempt under Sec: B. & P.C. (Attached Certificate).
Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a cert ticate 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 copy is hereby: furnished.
❑'Certified copy is tiled with the City Building Inspection Department or Cip ` Departm�lent.
Date Applicant
APPLICANT NAME (L. F. MI)
M. D. dames
ADDRESS
2950 Airwav Avenue
CITY/COMMUNITY/STATE/ZIP -
Costa Mesa, CA 92626
JOB SITE ADDRESS/SPACE
n is ve
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA- 92293
BOK
PAG
PRC
C
_WN
RNG
SE
S
TRACT
LOTOD
246.00
-
M
SB
..
18915
26.76
38
SMI Fee
2
Slda.. 4
TRACT NAME
Reflections
OWNER NAME (L. F. MI)
Applicant
CONTRACTOR -FIRM NAME
Apnl ianht
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP -
above
PHONE a
345-1436
LICNC
ARC/ENG FIRM NAME
Carlson. Shlennev & Hemalhalch
ADDRESS
18002 Skvnark Circle
CITY/COMMUNITY/STATE/ZIP
wine. CA.' 92714
PHONE .
LICNC e
714:-250-0607
1
1
USE OF PERMIT '
Condo
BL
ZONFSB
SSB
SSB.
:ISO
OFC "
ZONE ORD N
LOT S2
END
SIDE;
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction' lending agency for the performance
of the work for which this permJLis iisssued`(Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
I certify that l.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:rr entioned 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 Ye resentative of the City of La Ouinta Department of Building and Safety to enter
upon -the property for which I• le`appl'Id`for this permit for the purpose of making inspections.
f �YYJ Arch
}I ASig7nY1'urto7f AppTi"ca'nt or Agent Date
Print Applicant/Agent Name
APPL/PRMT �' � � � `J�"� i� '
i`Jri
DATE
l2/1.1!84.
.S.F.D..
Permit to construct 912 sa.
ft. of
condo plus 26 sa..
ft.. of noxch and
235 mmgx sa. ft.
of aara.ae
as nex
annroved n1ans.
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. Devel. Fee
450.00
1� DEC
•
'
' • TOTAL�.'1,066.40.
FEE •
/►
1, 066 w 40
BLDG.DEPT
VALUATION 51, 140.00
All
Ah
NO.
OPERATION DAME INSPECTOR
NO.
OPER ON 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
42
Commercial Hood
10
Fireplace P. L.
❑
43
Final
10A
fireplace. T.O.
❑
OWN
ADDITIONAL INFORMATION
""-
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
IWN12 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
P/L P/1
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance •
29 Wiring 0
29A Grounding Wire Ak
29B Bonding
30 Fixtures
31 Service
32 Final