001087 (SATT)L
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 issua
LICENSED-CONTRACTORS'DECLARATION: I hereby -affirm that I' am under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
and effect.
License Class 2rLic: Number R
Date - Contractor +l
.c OWNER -BUILDER DECLARATION: I hereby affirm that Lam exempt fromthe�Contractor's Lice�nse Law forthe
following reason (Sec. 7031.5. Business and Profess%os Code: Any city or County which reQuires a permit 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 provis ir•ns of the Contractor's License Law
(Chapter 9 (commencing with section 7000) of Division 3 of the.Business and Prdfessions Code) or that he is exempt
therefrom and the basis for Ihe.alleged exemption. Any violation of Section 7[31.5 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 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 Professicns Cade: 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 intendeftr offered for sale. If, however, the
building or improvemnt is sold within one year of completion, the owner -builder vil I have the burden of proving that
he did not build or improve for the purpose of sale.). �^
0 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 owner of property who
builps or improves thereon, and Who contracts for such projects with -a contractor(s) licensed pursuant to the
Contractor's License Law.).
0 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'thereot §ec. 3800. Lab. C.).
Policy No.. Company
0 Cerlified,copy is hereby furnished. :I;,
..
0 Certified'copy is filed with the City, Building In spectionY'Department r City-Departmen .
Date Applicant `
APPLICANT NAME (L. F. MI) '
J,anps
ADDRESS
2950 Airway Avenue
CITY/COMMUNITY/STATE/ZIP
Costa Mesa, CA' 92626
JOB SITE ADDRESS/SPACE
—� � • 1 T .3 T
CITY/COMMUNITY/STATE/ZIP '
La Quinta, CA 92253
BOK
PAG
PRC
C .
11WN
PING
SE '
S.
TRACT
LOT
Plumbinct Fee
22.00
MOD SB
450.00
18915
26
3
Bldg. 3
TRACT NAME
Reflections
OWNER NAME (L. F. MI)
Avolieant
CONTRACTOR -FIRM NAME - -
Aunlicant
ADDRESS .-
above
CITY/COMMUNITY/STATE/ZIP
above
PHONE 1
'
LICNC •
345-1435
ARC/ENG FIRM NAME
Carlson. Shlencev & Hegmalhalch
ADDRESS 2
5002 Skvnark Circle •
CITY/COMMUNITY/STATE/Z'IP -
A-
T e. C 2714
PHONE 0
714-250-0607
'LICNC •
-
USE OF PERMIT
�Q �Q
BL
ZON
FSB
sse
Sse
RSB
OFC '
ZONE ORD +
LOT SZ
END
SIDE
sic
nce, OR, ilkwork has been suspended or abandoned for a period of 180 days. `
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 soasto become subject to the Workers'Compensation Laws of i
California.
Date Applicant, $y
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' ,•�;gr�
Compensation provisions of the Labor Code, you.must forthwith comply with such provisions or this permit shall ^ 4
be deemed revoked.
.DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:'
0 l 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 4, Sec 341,.Title8,
C.A.C.) a .
0 As owner-156her, 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: 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
Lender's Address �. / uv v
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 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 Safely to enter
upon the property for which I ve a lied for this perm's for the purpose of making inspections.
Signature of Applicant or gent Date
Print Applicant/Agent Name
APPUPRMT11110-1 nRAT 12/11/86 S.F.D.
Permit to construct 763 sq. ft. of
condo plus 160 sq.
ft. of porch and
235 sq. ft. of garage as per approve
plans.
Mech. Fee
21.00
Plan Check -Fee
240.27
Const. Fee
260.50
Elect. Fee
23.76
SMI Fee
3.15
Plumbinct Fee
22.00
Prop. Devel. Fee
450.00
PAID
DEC 2 7 198t'
TOTAL
FEE
1', 020 .68
4, ./rt'.a .t,� l ?� �A'r3 VALUATIONS
a+t...,.:> ..H•i..i4��a.t►4�_ .,..� � :T.+Mirail�3L1��a�13LDG. DEPT:
r,
NO.
OPERATION ATE
INSPECTOR
NO.
OP rrATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation SystemVC OA
2
Ftgs & Frms
34
Plenums & Ducts
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.
❑
N,
43
Final
10A
Fireplace T.O.
❑
NO
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE.& LOCATION
11 Exterior Lath t A,
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 Ilk roft-
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` (.��3' G7j—i�,
..
Tank Pit L. Line
-ELECTRIC APPROVALS.
REAR OF PROPERTY LINE
PSL PiI
STREET NAME
26 Power Pole
27 Conduit IL
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31, Service
32• Final