001096 (SATT)�. PERMIT APPLICATION
City of La Dg a
Department of Building and Safety
This permit becomes void it work not commenced within 180 days Isom 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 3 of the Business and Professions Code, and my license is in full.force..
and effect.
License Class Lic. Number .
Dale - Contractor C 1
`OWNER -BUILDER DECLARATION: I hereby affirm that I a mpt`lrom the .. tractor's License Law for he
following reason (Sec. 7031.5• Business and Protessions"Code: Any city or-:ou0{y which requires a per�Lyt to
construct, alter, improve, demolish, or repair any structure, prior to its issua ice, also requires the applic01' for
such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
(Chapter 9(commencingwith section 7000)ofDivision 3ofthe Business and Professions Code) orthatheisexempt
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 dollar, ($500.):
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 Certificateof 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 PERMIT CERTIFICATION:
0 1 hereby certify that ho 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.? AA 2, Sec341, Title8,
C.A.C.) "
...0 I. as owner of the property. or my employees with wages as their sole compensation, will do the work, and the
0 As owner -builder, I 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 Protessicns 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, and who does such work himself or
BOK
through his own employees, provided that such improvements are not intended or offered for sale. If, however, the
0, Division of Industrial Wety Permit No.
building orimprovemntissold within one year ofcompletion. the owner -builder will have the burden of proving that
Date Applicant
he did not build or improve for the purpose of sale.).
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
0.1. as owner of.the property, am exculsively contracting with licensed contractors to construct the project (Sec. -
• of the work for which this permit 4 issued (Sec. 3097, Civ: C.). -
7144, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who:
Lender's Name r
builds or improves thereon, and who contracts for such projects with a con-sactor(s) licensed pursuant to the
. Y
Contractor's License Law.).
Lender's Address 4
0 1 am exempt under Sec. B, 8 P.C. (Attached Certificate).
V v
I certify that I have read this application and state that the above information is correct. I agree comply with all
Date Owner
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certif tate of consent to self -insure, ora
certificate of Workers' Compensation Insurance i or a certified copy thereof 6ec. 3800. Lab: C.).
Policy No. Company
0 Certitied•copy is hereby furnished.
0 Certified copy is filed with the City Building Inspection Department or.Cil Department.
Date Applicant
- (T _ J
� F/�?9
APPLICANT NAME (L. F. Ml) M. D. Janes
ADDRESS
2950 Airway Avenue
CITY/COMMUNITY/STATE/ZIP
Costa Mesa, CA 92626'
JOB SITE ADDRESSISPACE n
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
BOK
PAG
PRC
C.
TNN .
RNG
SE I
S
TRACT
18915
LOT
35
Const. Fee
260.50
MOD
3
SB
Bldg. 4
TRACT NAME
Reflections
OWNER NAME (L. F. MI) Applicant
CONTRACTOR -FIRM NAME
AAplicant
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
above
PHONE NLICNC
345-1436
I
ARC/ENG FIRM NAME
Carlson, Shleppey & Hezamihalch
ADDRESS
18002 Skypark Circle
CITY/COMMUNITY/sTATE/ZIP -
Lrvine CA 92714
PHONE N
714-250-0607
•-
LICNC N
USE OF PERMIT
Condo
BL
ZON
FSB
SSB.
SSB
ESB
OFC
ZONE ORD N
I
LOT SZ
IF
END
SIDE
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. 1 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 have4applied fort 's permit for the purpose of making inspections.
( � n.
Si na re of App1id t or Ag -en Date
Print Applicant/Agent Name
APPUPRMT DATE
nl n, 12/11/84 S.F.D.
Permit to construct 763 sq. ft. of
"condo plus 160 sq.
ft. of porch
and 235 sq. ft. of
garage as per
approved plans.
Mech". Fee
•21.00
Pian Check Fee
240.27
Const. Fee
260.50
Elect. Fee
23.76
SMI Fee
3.15
Plumbing Fee
22.00
Prop. Devel. Fee
450.00
•
TOTAL
FEE
1,020.68
BLDG. DEPT.
VALUATION 44.37.5_nn
B
Ih
A&
NO.
OPERATION TE INSPECTOR
NO.
OP TION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
/
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts •
2A
Slab Grade
C
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.N
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
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 IL •
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 fixtures
31 Service
32 • Final