001092 (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, it 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 70001 of Division 3 of the Business and Professions -Code, and my license is in full force
and effect.
License Class-Lic..Number
Date Contractor � I/ 1.4,>14119T R4,w
OWNER -BUILDER DECLARATION: I hereby affirm that jam exempt from the''Oontractor's License La for the
following reason (Sec -7031.5, Business and Professions Code: Any city or county which,requires, 1Tpermit to .
construct, alter, improve, demolish; or repair any structure, prior to its issuan;e, 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 Pro'essions Code) or that he is exempt
.,'therefrom and the. basis for the alleged exemption..Any violation o6 Section 7031.5 by any applicant for a,permit
subjects the applicant to a civil penalty of not more -than five hundred;doilars,($500.):
❑ 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, and 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 improyemnt 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 contractors to construct the project (Sec:
7044, Business and Professions Code: The Contractor's License Law does not apply to an ownerof property who
builds or improves'thereon, and who contracts1or-such projects with'a contractor(s) licensed pursuant to the
Contractor's License Law.).
O 1 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 (Sec. 3800. Lab. C.). • -
Policy No. • _ Company .
❑ Certified copy is hereby furnished. ,
❑ Certified copy is filed with the Ciiy Building Inspection: Department or City'-" Department.
Date Applicant
1.2
APPLICANT NAME (L, F, Ml) - -
M . 1). Janes
ADDRESS '
2950 Airway Avenue
CITY/COMMUNITY/STATE/ZIP
Costa Mesa, CA 92626
JOB SITE ADDRESS/SPACE
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92263'
BOK'
PAG
PRC
C-
246100
TNN.
RNG
SE
S
TRACT .
18915
LOT
31
Plumbing Fee
30.00
MOD
1
SB
Bldct .4
TRACT NAME
Reflections
OWNER NAME L. F. MI) '
Applicant
CONTRACTOR -FIRM NAME
Applicant
ADDRESS -
Above
CITY/COMMUNITY/STATE/ZIP
Above
PHONE 11 '
LICNC •
,
345-1436
by 066.14
ARC/ENG FIRM NAME -
Carlson. Shlenpev Semalhal.ch
ADDRESS
18002 Skvvark Circle
CITY/COMMUNITY/STATE/ZIP ..
Irvine. CA 9271.4
PHONE a
LICNC
714-250-0607
1
USE OF PERMIT
Condo
BL
ZON
FSB
SSB
SSB
RSB
OFC
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 manner so 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'
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:
❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend;w ill be
made in connection wiih 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 2, Art 2, Sec 341, Title 8,
C.A.C.)
❑ As owner -builder, I will not employ anyone to dotwork which would require a permit from the Division of
Industrial Safety, as noted above, unless such person has a permit to do such work from that division.
O Division of Industrial Safety.PerTit No.
Date Applicant'
CONSTRUCTION LENDING AGENCY: .1 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—
Lender's
ame Lender's Address
I certify that thave read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and slate laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above=mentioned property foP 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.Oepartment of Building and. Safety to enter,
upon e p�perty for which 1•haN applied -for s permit for the purpose of making inspections.;
Signature of AIj0n't Agent Date
Print Kppplplicant/Agent Name A
APPVPRMT � A�C.A%Ei3J84 .S.F.D•
Permit to construct 926
scr. ft'. of
condo plus 235 sv. ft.
of garage
as per approved plans.
Mech. Fee.
24900
Plan Check Fee
246100
Const.*Fee
289.00
Elect. Fee
23.50
SMI Fee
3.64
Plumbing Fee
30.00
Prop. bvel. Fee
450.00
�o
TOTAL
FEE
by 066.14
BLDG. DEPT. VALUATION 51, 669.00
r--7
Ah
NO.
OPERATION 4TE :,_ 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
$S
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.
❑
NPON
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 A •
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 P)
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final