001093 (SATT)PERMIT APPLICATION i
•
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 wofk has been suspended or abandoned for a period.of 180 days.
` Ic:.1 ...• CERTIFICATE OF EXEMPTION FROM WORKERSTOMPENSATION INSURANCE: This section need not be Completed if
LICENSED CONTRACTORS DECLARATION: I hereby -affirm that I am licensec 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) of:Division Sof the Business and Professions Code, and my license is in full force issued, I shall not employ any person inany manner so as to become subject to the Workers'Compensation Laws of
and effect. �.� �^�"�'� California.
License Class - �Lic Number q Date Applicant
Dale ' Contractor ` y i. +--NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'
r �/ ',Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the. Co% tractor's License Law fo the
. A deemed re
following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a pGUnd 10 voked. -
construcl, alter, improve. demolish, or repair any structure, prior to its issuarce, also'requires the applicant for DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
such permit to file a signed statement that he is licensed pursuant to the provisiensofthe Contractor's License Law " f 0 1 liefiby certify that no excavation five (5) or more feet in depth i nto which a person is required to descend, w ill be
(Chapter 9(commencing with section 7000) of Division 3 of the Business and Prcfessions 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 701.5 by.any applicant for a -permit „t.`�.r ' demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2. Grp 2, Art 2, Sec341, Titleil,
subjects the applicant to acivil penalty of not more than five hundred dollar:. ($500.):' - 1,:3+.• C.A.C.) '
O 1. as owner, o1 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, aid 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 improvemnt is sold within one year of completion; the owner -builder -vill have the burden of proving that,
he did not build or improve for the purpose of sale.).
d3 ,
- 0. 1, as owner of the property, am exculsively contracting with licensed contractors'to construct the project (Sec..
7044, Business and Professions Code: The Contractors License Law does not .epply to an owner of property who
buil(ts or improves thereon, and who contracts'for such projects with a contractor(s) licensed pursuant to the '
Contractor's License taw.). _
"0 I 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 6ec. 3800. Lab. C.).
Policy No. Company
'-0-Certified copy is hereby furnished. •'
0 Certified copy is filed with the City Building Inspection Departme t or City D€partment.
Date -' Applicant
APPLICANT NAME It., F, MI) M.D. • Janes
J.�1
ADDRESS '
2950 Airway Avenue
CITY/COMMUNITY/STATF/ZI P
Costa Mesa, CA 92626'
JOB SITE ADDRESS/SPACE '
CITY/COMMUNITY/STATE/ZIP • " -
La Quinta, CA 92253
BOK
PAG
PRC
C
TWN
PING
'[SE
246.00
TRACT
LOT
Elect. Fee
XIM 26.7E
MOD
.SB -
Plumbing Fee-
18915
1 32
450.00
I 2
Bldg. 4
TRACT NAME
Reflections
OWNER NAME (L, F. MI) I
Applicant
CONTRACTOR -FIRM NAME
AAPlicant
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
above
PHONE a '
1 066.40
LICNC A
345-1.436
ARC/ENG FIRM NAME -
Carlson. Shlelopey & Hezmalhalch
ADDRESS
8002 Skvnark Circle
CITY/COMMUNITY/STATE/ZIP -
ryilne . CA 92714
PHONE N
714-250-0607
LICNC N
USE OF PERMIT
Condo
SL
ZON
FSB
I SSB I
SSB I
RSB
I J
OF
ZONE ORD .
LOT SZ
1, END J
• SIDE.,
O As owner -builder, I willriot employ anyone to do work which would require a permit from the•Oivision'of
Industrial Safety, as noted above, unless such person has a permit to do such work from that division.'
r
O Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that there Wa construction lending agency for the performance
of the work for which this permit is issued (Sec. 3097, Civ. C.). • 1,.
Lender's Name
Lender's Address l T
I certify that (have read this application and state that the above infer ation 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. r
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 giverfis 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 have applied for this perm' for the purpose of making inspections.
71'Signa�e f Appli�rit�n� — Date
Prin(Applicant/Agent Name
APPL/PRMTUnl O"3
1GDA
/ 11/84
Permit to construct 912 sq. €t. of
condo plus'26•sq.
ft. of porch and
235 sq. ft. of garage as per approve
plans.:
Mech. Fee
24.00
/'Plan Check Fee
246.00
Const. Fee
289.00
Elect. Fee
XIM 26.7E
SMI Fee
3.64 "
Plumbing Fee-
27.00
Prop. Devel. Fee
450.00
TOTAL
FEE
1 066.40
BLDG. DEPT. VALUATION 51,140.00
'
a
r�
NO.
OPERATION DATE INSPECTOR
NO.
OP n TION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System 1r
2
Ftgs & Frms
i
34
Plenums &Ducts AftL
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. ❑ N
NON
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE &.LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 -Finish Grade
,.
INSULATION Thick R
Value a
7A Walls (Batts) V.
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
4 Gas Test '
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
PSL 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