001094 (SFD)PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
This permit becomes void it work not commenced within .180 days from date of issuance, OR, if work has been.suspended or abandoned for a period'of 180 days.
CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE:,Thls section need not be completed If
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I .am licensee under provisions of Chapter 9. ' ' the permit is for one hundred, ($100) o, less. I certify that in the performance -of the work'for which this permit is
(commencing with Section 7000) ol.Division 3 of the Business and Professions Cide, and my license is in full force -issued, I shall not employany person in any manner so -as to become subject to the Workers'Compensation Laws of
and effect. California.
License Class Lir. Number
Date ' Contractor L.Q11 /1
/.
OWNER -BUILDER DECLARATION: l heieby affirm t exempt from.lie Ciintractor's License L foe the'
following reason (Sec. 7031.5. Business and Professions Code: Any city orunty which requires permit to
construct, alter, improve, demolish, or repair any structure. prior to its iss arse, also requires the pplicant for
such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law -
(Chapter 9 (commenci ng w ith section 7000) o1 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 701.5 by any applicant for a permit
subjects the applicant to a -civil penalty of not more. than five hundred dollar: ($500.):
0 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
structure isnot 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, grid -who does such work himself or,
throuyh.his own employees, provided that such improvements are not intended or offered for sale..lf, 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 contra tors 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 contractor(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.certiftate of consent to self -insure, or a.
certificate of Workers' Compensation Insurance , or a certified copy thereof (3ec. 3800. Lab. C:):'
Policy No. Company
0 Certified copy is hereby furnished. -�
0 Certified copy is filed with the City Building Inspection Department or City' Department.
Date Applicant`
APPLICANT NAME IL MI F
. MI) M. D . Janes
L iiJJ
ADDRESS
CITY/COMMUNITY/STATE/ZIP -
JOB SITE ADDRESS/SPACE fltirl �v
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
BOK
PAG
.PRC.
C
„-' .. .
TWN
RNG
SE- "
S
TRACT
8915
LOT 33
.
3.64
MDD2
. SB
Bldg. 4
TRACT NAME .. .
Reflections
OWNER NAME (L. F, MI) Applicant '
.CONTRACTOR -FIRM NAME '
Applicant
ADDRESS
above
CIOTY/COMMUNITY/STATE/ZI P
above '
PHONE aLICNC
345-1436
U
'
ARC/ENGIRM NAME '
Carlson, Shleppey a Hezmalhalch
ADDRESS
18002 Skypark Circle
CITY/COMMUNITY/STATE/ZIP -
Irvine, CA 92714
PHONE
714-250-0607
1,066.14
LICNC M
USE OF PERMIT '
condo
BL
ZON
FSB
SSB
SSB
IRS8
OFC
ZONE ORD N
LOT SZ
r
END `.
SIDE.
Date Applicant
NOTICE TO APPLICANT: If, after,making,this Certificate'of,Exemption, you should become subject to the',Workers'
Compensation provisid Its 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 I 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 thbreof, will be more than thirty-six (36) feet high. (Chap 3.2. Grp 2, Art 2, Sec 341, Title 8,
.)
C.A.0:{
0 As owner -builder; I will not employ anyone to do work which would require a'permit from the Division of-
Industrial
f '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 thire is a construction lending agency for the performance
of the work for which this permittis issued (Sec. 3097, Civ, C.).
Lender's Namey
Lender's Address—
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
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 representative of the City of La Ouinta Department of Building and Safety to enter
upon the property for which I hae appli'ed`forthis permit for t e purpose of making inspections.
/igQiure of Applicarnt or 40" Dale
Nint'Applicant/Agent Name
'APPL/PRMT- q{ l fl q
n/DA E
Permit to construct 926 sq. ft.
of condo plus.235
sq. ft. of garage
as Der approved Dlans.
Mech. Fee
24.00 24.00
Plan Ck"x Fee
246.00
Const. Eee
289.80
Elect. Fee
23.50
SMI Fee
3.64
Plumbing Fee
30.00
Prop. Devel. Fee
450.00
TOTAL
FEE
1,066.14
BLDG. DEPT.
VALUATION 51, 669.00
Ah
NO.
OPERATION ATE 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
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
4L
42
Commercial Hood
10
Fireplace P. L.
❑
43
Final
10A
fireplace T.O.
❑
NON
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION ThickR,.
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 • do
29 Wiring
29A Grounding Wire •
298 Bonding
30 Fixtures
31 Service .
32 Final