001091 (SATT)• PERMIT RPPLICATION
City of La Dg a
Department of Building and Safety
This permit becomes void if work not commenced within 180 days from date of issuance, OR, if work has been'suspended or abandoned for a period of 180 days.
LICENSED CONTRACTORS DECLARATION: I herebyaffirm that 1 am' licensed under provisions of Chapter 9.
(commencing' with Section -7000) of Division3of the Business and Professions 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 ($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.
License Class •Lic. Number _
Date Applicant
Date' <' <• Contractor A Apg+ //1.+.
NOTICETO APPLICANT: IL after making this Certificate of Exemption, you should become subjectto the<Workers'
�1/ .- •IV 5� �p�'
OWNER -BUILDER DECLARATION: I hereby affirm thatVirm exempt from the Contractor's License Law for the
�+
Compensation provisions of the Labor.Code, you must forthwith comply with such provisions or this permit shall
be deemed revoked. n
•following reason (Sec. 70315. Business and Professions Code: Any cityor.county which requires a permit to
PAG -
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires/)I!applicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ,
such permit to file a signed statement that he is licensed pursuant to the provisicnsofthe Contractor's LicenseLaw
Olhereby certify that noexcavation five (5)orInorefeet indepth into which aperson isrequired todescend, will be
.(Chapter 9(commencing with section 7000) of Division 3 of the Business and Professions Code)or that he is exempt . '
made in connection wiih work authorized by this permit; and that no building structure, scaffolding, falsework, or
therefrom;and the basis for the all exemption. Any violation of.Section 7031.5 by.any applicant for a permit
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2; Sec341, Title 8.
subjects the applicant to:a civil penalty of not more than five hundred dollars ($500.):
CAC )- rt
O I, as. owner of the property, or my employees with wages as their sole compensation, will do the work, and the
0 A$ owner -builder, I will •noi 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 Professions 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,
OWNER NAME (L, F. MI( '
Applicant
through his own employees• provided that such improvements are not intended or offered forsale.lf, however, the
❑.Division.of Industrial Safety Permit No.
building or improvemnt is sold within one year of completion, the owner -builder will have the burden ofprovingthat .
Date Applicant
he did not build or improve for the purpose of sale.).; ,
CONSTRUCTION LENDING AGENCY: .1 hereby affirm•that there is a construction lending agency for the performance
0 I, as owner of the property, am exculsively contracting with licensed contractors to construct the project.(Sec:
of the work for which this perm'I is issued (Sec. 3097, Civ. C!).-
:).7044,
7044.Business and Professions Code: The Contractor's License Law does not apply to an owner of property:who
Lender's Name
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the ' .
...
��1�
Contractor's License Law.). _
Lender's Address ��
0 1 am exempt. under Sec. B. & P.C. (Attached Certificate).' '
I certify that I have read this application and state that the above information is correct. I agree to comply with all
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
0 Certified copy is hereby furnished:
0 Certified copy is filed with the City Building inspection, 'Depart ment or City` --"It" Department.
Date Appli� ✓M X11
APPLICANT NAME (L, F. MI)
M.D. Janes
ADDRESS
2950 Airway Avenue
CITY/COMMUNITY/STATE/ZIP
Costa Mesa, CA 92626
JOB SITE ADDRESS/SPACE
widx1ft aaralae as
CITY/COMMUNITY/STATEIZIP
La Quinta, CA 92253
BOK
PAG -
'.PRC
C
'
TWN
FIND.
SE.
S,
'TRACT '
18915
LOT
-
30
SNI Fee
MOD
1
SB
Bldq. 3
TRACT NAME
Reflections
OWNER NAME (L, F. MI( '
Applicant
CONTRACTOR -FIRM NAME .
Applicant
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
above
PHONE •LICNC
,
34581436
1;066.14FEE
ARC/ENG FIRM NAME
Carlson, Shleppev & Hemalhalch
ADDRESS
18G02 SkyPark Circle
CITY/COMMUNITY/STATE/ZIP
Irtine, CA' 92714
PHONE II
LICNC•
714-250-0607
USE OF PERMIT -
Condo
BL
ZON
FSB SSB
SSB
RSB
OFC
ZONE ORD*.
. LOT S2
END
SIDE
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 statethat
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° city for which I h ve applied for this -permit for the purpose of making inspections-
Signature ZApt%cani of Ag n{' Date
Print Applicant/Agent Name/
APPL/PRMT
nni M1
OAT
22E IJ p•I J►.F.,D.
Permit to construct 926 scr. fit. of
condo Plus 235 so. ft. of mmxm#
widx1ft aaralae as
Per amroved n1ans
Mech. Fee
24„A0
Plan Check Fee
246.00
Const. Fee
289.00
Elect. Fee
�� 23.50
SNI Fee
3.64
Plumbina Fees
30.00
Peron. Deve1 _ FAP_
450.00
Q
TOTAL •"
'•
1;066.14FEE
BLDG. DEPT.
VALUATION 51, 669.00
a
NO.
OPERATION ATE
INSPECTOR
NO.
OP ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
iS
34
Plenums & Ducts •
2A
Slab GradeS
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
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 •�.�^FS 9,C��
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
P/I
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring •
29A Grounding Wire V49P/L
29B Bonding
30 Fixtures
31 Service
32 Final