001090 (SATT)1 PERMIT APPLICATION
City of La Ouinta i l�
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 hereby.affirm that I am licensed' under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Ccde• and my license is in full force
and effect.
License Class Litc. Number A ----
Date Contractor\,x�7
OWNER -BUILDER DECLARATION: I hereby affirm that/m exempt from the Contractor's License Law for the
following reason (Sec. 7031.5. Business and Professions Code: Any city or pounty which requ'%s a permit to
construct, alter, improve• demolish,.or repair any structure, prior to its issuan,e, also requires1he applicant for
such permit to file a signed statement that he is licensed pursuantto the provisicns of the Contractor's License Law.
(Chapter 9(commencing with section 7000) of Division 3 of the Bus inessand Pro'essions Code) or that he is exempt ,
therefrom and the basis forthe 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 dollars ($500.): '
O 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, acid who does such work himself or
through his own employees, provided that such improvements are -not intended Dr offered for sale. If, however, the
building or improvemnt 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.).
O 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 contactor(s) licensed pursuant to the
Contractor's License Law.).
O 1 am exempt under Sec. B. & P.C. (Attached Certificate)..
Date' Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certifcate of consent to self -insure, or a'
-. certificate of Workers" Compensation Insurance , or a certified copy thereof Gec. 3800. Lab. C.). • , -
Policy No. Company
r,0 Certified copy is hereby furnished.
•
'0 Certified copy is filed with the City Building Inspection Department or City, /= — Department.
Date Applicant
APPLICANT NAME (L. F, MI)
m. D. Janes
ADDRESS
2950 Airway Avenue
CITY/COMMUNITY/STATE/ZIP
Costa Mesa, CA 92626
JOB SITE ADDRESS/SPACE
CITY/COMMUNITY/STATE/ZIP
La Quinta, Chi 92253
BOK
PAG
PRC
C
TWN •'
RNG
SE
S.
TRACT
18915
LOT'
29
Elect. Fee
26.76
MOD
2.
SB
Bldg. 3
TRACT NAME '
Reflections
OWNER NAME (L. F. MI)
Applicant
CONTRACTOR -FIRM NAME
Applicant
ADDRESS --
above
CITY/COMMUNITY/STATE/ZIP
above
PHONE 0LICNC
- o&
II
'
345--1436 1
TOTAL
1
ARC/ENG FIRM NAME
Carlson. Shlenvev & Hezmalhalch'
ADDRESS
19n02 skvos,rk Circle
CITY/COMMUNITY/STATE/ZIP
Irvine CA 927$4
PHONE 11
LICNC 0
714-250-0607
USE OF PERMIT
Condo
BL
ZON
FSB
SSB
SSB
RSB
OFC
ZONE ORO •
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:
O 1 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 thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8.
C.A.C.)''
O As owner -builder, I will not employ anyone to do work 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 Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name �.. 42 -
Lender's Address— iylAJ �//�
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 Js correct: I agree to comply with all state laws and county ordinances relating to buid ling
construction, and authorize a'representative of the City of La Ouinta Department of Building and Safety to enter j
upon the,property for which Iave a hIied.for this permit for the purpose of making inspections.
Signature of Apphcan d*r'Age 1 Date
Print Applicant/Agent Name y
APPLNRMTifl 0
I1.�11,84 S.F.D.
Permit to construct 912 sq, ft. of
condo plus 26 sq.'ft.
of porch
and 235 sq. ft. of garage as per
approved plans.
Mech. Fee
24.00
Plan Check Fee
246.00
Ronst. Fee "
289.00
Elect. Fee
26.76
SMI Fee
3.64
Plumbing Fee
27.00
Prop. Devel, Fee
450.00
- o&
TOTAL
1
BLDG:DEPT.
FEE ,066.40 �
VALUATIONrjl,l4n_AA
NO.
OPERATION ATE
INSPECTOR
NO.
OP ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
�`
33
Ventilation System
2
Ftgs & Frms
��
/�
34
Plenums & Ducts al -
2A
2A
Slab Grade
S
35
1 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
V
41
Smoke Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P.L.
❑
43
Final r.
10A
Fireplace T.O.
❑
NP'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 IL 4L It
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final :9, ge
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
P I L 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