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001088 (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 issu 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 �i'cf Number. Date ContractoN � 'O OWNER -BUILDER DECLARATION:' I hereby affirm that am exempt Irom the'yontracior's License La 'Ao�e following reason (Sec. 7031.5. Business and Professions Code: Any city or county which. requires.arermit to construct• alter, improve, demolish, or repair any structure, prior to its issuance, 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(commencingwith section 7000)ofDivision 3ofthe Business and Professions Code) orthat heisexempt therefrom and the basis.for the 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.): • 0 I. 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, 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 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.). , ❑ I, as owner o1 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 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 I. am. exempt under Sec. •,. B. & 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. Q. c Policy No. Company ❑ Certified copy is hereby furnished ❑ Certified copy is filed with the City Building Inspection Department or City �- �De artment.. Date Applicant v r APPLICANT NAME (L. F. MI) M • D. Janes ' ADDRESS �, 2950 Aieway Avenue CITY/COMMUNITY/STATE/ZIP Costa Mesa, CA 92253 JOB SITE ADDRESS/SPACE .� •• 3 CITY/COMMUNITY/STATE/ZI La Qu.inta, �CA 92253 BOK PAG PRC C- TWN RNG- SE S' T18915 LOT 1 27 260.50 Elect. Fee 3 SB Bldg. 3' TRACT NAME • Reflections OWNER NAME (L. F. MI) , Applicant CONTRACTOR -FIRM NAME Applicant• ADDRESS above CITY/COMMUNITY/STATE/ZIP above PHONE a 345-1435 LICNC Y ARC/ENG FIRM NAME Carlson, Shleppey & Hezmalhalch A18002 Skypark Circle CITY/COMMUNITY/STATE/ZIP , Irvine, CA 92714 PHONE 714-250-0607 LICNC Ir USE OF PERMIT condo BL ZON FSB SSB SSB' RSB ZONE ORD M LOT SZ END SIDE once, OR, if work has been suspended or abandoned for a period of 180 days. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This'section need not be completed ib -- • 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 beco me.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: . 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 thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec341, Title 8. C.A.C.) 0 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. 0 Division of Industrial Safety Permit 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 is" sued (Sec. 3097, Civ. C.). Lender's Name ' `/� f—, Lender's Address / �/ /� 4 s�—2 I.certify that I have read this application and state that the above information is correct.) 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�p op rty for which I have pplied„Lal this•permit for the purpose of making inspections. .I► —Signat of Applicant or gent Date Print Applicant/Agent Name APPVPRMT{ tol ■ BRV 12/11/5 -TIE SFD Permit to construct 763 sq. ft. of condo plus -160 sq. ft. of porch and 235 sq. ft, of garage as per approved plans. Mech. Fee 21.00 Plan Check Fee 240.27 Const. Fee 260.50 Elect. Fee 23.76 SMI Fee 3.15 Plumbing Fee 22.00 Prop, Devel. Fee 450.00 TOTAL •- 3.,020.68 VALUATION44,375.08' BLDG. DEPT. z n Ah NO. OPERATION ATE INSPECTOR NO. OP ATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS 1 Set Back ! 33 Ventilation System 2 Ftgs & Frms S 34 Plenums & Ducts 2A Slab Grade r 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 41i Smoke Detection Device 9 Garage Fire Wall a& 42 Commercial Hood 10 Fireplace P. L. ❑ 43 Final /sS 9, c., 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) d 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 9� Tank Pit L. Line ELECTRIC APPROVALS REAR OF PROPERTY LINE PSL P/I STREET NAME 26 Power Pole Also 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service 32 Final .