001084 (SATT)PERMIT APPLICATION 1�
City of La Dg a UU
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. -
CITY/COMMUNITY/STATE/ZIP '
La Quinta, CA 92253.
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
' LICENSED CONTRACTORSDECLARATION: 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
;. (commencing, with Section 7000) of Division 3 of the Business and Professions (:Ode; and my license is in fulfforce
issued, I shall not employ any person in any manner so as to become subject tothe Workers'Compensation Laws of
and effect._
California.
License Class. I ic. Number
Date Applicant.
`
Date Contractor oma+ f y
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' ,
OWNER -BUILDER DECLARATION: I hereby affirm that`.1 am exempt Irom'the Contractor' License Law for the
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a�ermit to
be deemed revoked.
construct, alter, improve. demolish, or repair any stlucture, prior to its issuance, also requires the applicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
such.permit to file a signed statement that he is licensed pursuantto the provisions of the Contractor's License Law :
01 hereby certify that no excavationfive(5)ormorefeetind"epthintowhichapersonisrequiredtodescend,willbe
(Chapter 9(commencing with section 7000) of Division 3.of the.8usiness and Professions Code) or that he is exempt
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or .
therefrom.and the basis for the alleged exemption. Any violation of Section 7Ca1.5 by anyapplicant 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,.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500:): ;en
C.A.C.)
0 I. as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
0 As owner -builder, Twill not 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, avid who does such work himself or
. . -r
through his own employees, provided that such improvements are not intended or offered for sale. If, however, the
0 Division of Industrial Safety. Permit No
building or improvenunt is sold within oneyear of completion. the owner -builder will have the burden of proving that
Date Applicant
he,did not build or improve for the purpose of sale.).
CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance , a
O I, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec.
of the work for which this -permit is issued (Sec. 3097, Civ. C.).
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;
Contractor's License Law.).
Lender's Address
0 1 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. I agree to comply with all.
Datee Owner
'
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. -
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.
Policy No. Company 711,
O Certified copy is hereby furnished. n _
0 Certified copy is filed with the City Building Inspection Department or City. Department, i
Date + Applicant�S� -
7
APPLICANT NAME (L. F. MI) M.D.Janes
1'1
ADDRESS -
2950 Airway Avenue
CITY/COMMUNITY/STATE/ZIP
Costa Mesa, CA 92626
JOB SITE ADDRESS/SPACE +A •. T„� O ANS T17^
CITY/COMMUNITY/STATE/ZIP '
La Quinta, CA 92253.
BOK
PAG
PRC
C
TWIN
FIND
i SE
S
TRACT - •
18915 �
LOT 2
3
289,00
MOD
26.76•
Bld . 3
i+ g
TRACT NAME '
Reflections
OWNER NAME (L. F. MI) Applicant '
CONTRACTOR -FIRM NAME;
Applicant
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP -
abovq
PHONE N
345-1436
LICNC N
-
ARC/ENG FIRM NAME
Carlson, Shleppey & Hezmalhal-ch
ADDRESS
18002 Skypark Circle
CITY/COMMUNITY/STATE/ZIP -
Irvine CA 92714
PHONE NLICNC
QltA�i An
N
714-250-0607
USE OF PERMIT - -
Condo
BL
.ZON
FSB
SSB
SSB-
RSB
OFC .
ZONE ORD N
LOT SZ
END -
SIDE ,
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 property for which I have applied for his permit for the purpose of making. inspections. -
Signature of,Applicant or Agenf Date
Print Applicant/Agent Name Y
APPL/PRMT not on
1z./'E10'84 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'
Const. Fee
289,00
Elect. Fee
26.76•
SMI Fee
3.64
Plumbing Fee
27.00
Prop. Devel. Fee
450.00
PA I D DEC 27 1984
TOTAL .
FEE
QltA�i An
' VALUATION 51.140 . oC
BLDG. DEPT.
Ak
NO.
OPERATION TE
INSPECTOR
NO.
OP TION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
S
34
Plenums & Ducts 4b
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.
❑
43
Final
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 ��,(„�4T14, C,
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 �a•
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY.LINE
P/L P/1
STREET NAME
26 Power Pole
27 Conduit •
28 Service Entrance
29. Wiring •
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final