001086 (SATT)PERMIT APPLICATION
Policy, No.
City of La Ouinta
Department of Building and Safety •
0 Certified,copy is hereby furnished.
`
0 Certified copy is filed with the City Building Insprectiun Departme ou Ct Depa Iment:
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• 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.
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CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
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LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9'
the permit is for one hundred ($100) o, less.I certify that in the performance of, the work for which this.permit is
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I (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in lull force
issued, I shall not employ any person in any manner so.asto become subject to the Workers',Compensation Laws of
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and effect.
California.
SB
License Class Li,. Numb/8r
< F
Date Applicant
q
- Date Contractor
NOTICE.TO APPLICANT: If. after making this Certificate ot.ExempOon,.youshould become subject to the Workers'
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/r
rI am' to the
OWNER -BUILDER DECLARATION: I hereby affirm that exempt from the Cony ctor's License Law
Compensation provisions of the Labor Code,.you must forthwith comply with such provisions or this permit shall
y
to
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a pe mit to
be deemed revoked.
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construct, alter, improve. demolish, or repair any structure, prior to its issuance, also requires the applicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
1.020.68
such permit to file a signed statemenIffiat he is licensed pursuant to the provisions of the Contractor's LicenseLaw
0 1 hereby certifj that no excavation five (5) or more feet in depth into which a person is required to descend, w if I be
USE OF PERMIT
Condo
(Chapter 9(commencing with section 7000) of Division 3 of the Business and Professions Code) orthat he is exempt
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
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therefrom.and the basis for -the alleged exemption: Any violation of Section 71X11.5 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. Sec 341. Title 8,
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subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):,
C.A.C.)
O I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the ,
❑ As owner. -builder; I will not employ anyone to do work which would require a permit from the Division of
ZONE ORD N..,
structure.is not intended or offered for sale (Sec. 7044. Business and Professions Cade: 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 properly who, builds, or improves thereon, and who does such work himself or
'END..
SIDE.
through his own employees, provided that such improvements are not intended or offered for sale. It, however, the
0 Division of Industrial Safety Permit No.
building orimprovemntissoldwithinoneyearofcompletion,theowner•builderwillhavetheburden.ofprovingthat
Date Applicant
he did not build or. improve for the purpose of sale:).- a
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
. 0-1, as owner of the property, am exculsively contracting;with licensed contractors to construct the. project (Sec:
of the work for which this permjt is 'sued (Sec. 3097, Civ. C.).
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7044. Business and Professions Code: The Contraclor:s License Law does not apply to an owner of property who
Lender's Name l�
builds or improves thereon, and who contracts lor'such projects with a comractor(s) licensed pursuant to the
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Contractor's License Law.).
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Lender's Address
0 l am.exempt under Sec. •' B: 8 P.C. (Attached Certificate). . ,
I certify that I have read this application and state that the above information is correct. l agree to comply with all
Owner a ,:
city and.county ordinances and state laws relating to building construction, and hereby authorize representatives
,Date
of this county to enter upon the above-mentioned property for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certif Cate of consent to self -insure, ora
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A,
certificate of Workers Compensation Insurance': or a certified copy thereof ISec.3800. Lab. C.).
Policy, No.
Company.
0 Certified,copy is hereby furnished.
;
0 Certified copy is filed with the City Building Insprectiun Departme ou Ct Depa Iment:
Date
Applicant
PRC
C
rd
TWN
APPLICANT NAME (L• F. MI) M.D.
11 • D • Janes
ADDRESS •Y'
2950 Airway Avenue
CITY/COMMUNITY/STATE/ZIP ,
Costa Mesa, CA 92626
JOB SITE ADDRESSISPACE T
I as
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
BOK
PAG
PRC
C
TWN
RNG
SE
S
TRACT
18915
LOT
25
., +
MOD
3
SB
-Bldg, .3
T,AACT NAME
Reflections
OWNER NAME (l. F, MI) Applicant
CONTRACTOR -FIRM NAME -
Applicant
ADDRESS
Above
CITY/COMMUNITY/STATE/ZIP
Above
PHONE.
345-1435
DEC27 1984
LICNC •
ARC/ENG FIRM NAME
Carlson, Shleppey & Rezmalhalch
18002 Skypark Circle
CITY/COMMUNITY/STATE/ZIP
Irvine, CA 92714
PHONE •
714--250-0607
1.020.68
LICNC N
USE OF PERMIT
Condo
Bl
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FSB
SSB
SSB
•,aSB
OFC ,
ZONE ORD N..,
LOT SZ
'END..
SIDE.
Signature of Applicant or Agerit 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'repysentative of the City of La Ouinta Department of,Building and Safety to enter
upon -the property for which I ave.appfied4orthis permit for the purpose of makind inspections..
M a
/i Signa ure of Ap can, or gen_ Date
Print Applicant/Agent Name
APPUPRMT nRE
1DATE
2( v 11/8 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
approved plans.
Mech. Fee
21.00
Plan Check Fee
240.27
Const. Fee
260.50
Effect. Fee,
23.76
'SMI Fee
3.15
Plumbing Fee
22.100
Prop. Devel. Fee
450.00
PAID
DEC27 1984
TOTAL
FEE
1.020.68
BLDG. DEPT: s
VALUATION 44,375 .10d
Ah
Ah
NO.
OPERATION InTE
INSPECTOR
NO.
OP ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
(
33
34
Ventilation System
Plenums & Ducts dr .
2 Ftgs & Frms >
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
41
Fire Damper
Smoke Detection Device
8 Vents
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P. L.
❑
43
Final — 24-7-0-1 -9L-C.,
10A
'fireplace T.O.
❑
NON
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 ��,(� G,
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal NA
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final �Z(s•'CS Q.
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
P/L P/I
STREET NAME
26 Power Pole
•
27 ConduitOno
28 Service Entrance
29 Wiring •
29A Grounding WireVIA
29B Bonding
30 Fixtures
31 Service
32 Final