001083 (SATT)PERMIT APPLICATION
® City of La Og a
Department of Building and Safety
This permit becomes void if work not commenced within 180 days from date of issuance, OR, it work has been suspended or -abandoned for a period of 180 days. '
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensec'underprovisions 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 -14. Number r+►
Date •'.Contractor,. eJ _.lrf
~ OWNER -BUILDER DECLARATION: I hereby affir`dl tha�l�am exempt from the Co�ractor's LicensrQ Law for the
following reason (Sec. 7031.5. Business and Professions 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 provisions of the Contractor's License Law _
• (Chapter 9 (com.mencing with section 7000) of Division 3 of the Business and. Professions Code) or that he is exempt .
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 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, 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 i mprovemnt 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.).
.0 I: as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec. t
7044• Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
bUilos 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. 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 thereof (Sec. 3800. Lab. C.).
Policy No. Company, +
0. Certified copy is hereby furnished.
0 Certified copy is filed with the City Building Inspection Department o Cit - - DeartmenI
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 '
it
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
BOK
PAG
PRC
C
-
TWN
RNG
'SE
S
18915
LOT
22
plact. Fee
2D ,Is'
SMI Fee
Bldg.3
TRACT NAME
Refilections
OWNER NAME (L. F, MI) Applicant
CONTRACTOR -FIRM NAME
Applicant
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
above
PHONE N
345-1436
P A
'LICNC N
-
ARC/ENG IRM NAME -
Carlson, Shleppdy & Hezmalhalch
ADDRESS
18002 Skypark Circle
CITY/COMMUNITY/STATE/ZIP
Irvine, CA 92714
PHONE N • -
714-250-0607
TdTAL
FEE
- LICNC N
-
USE OF PERMIT
Condo.
BL
ZON
FSB
I SSB I
SSB
RSB
OFC
ZONE ORD N
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. {t
.Date Applicant \
NOTICE TO APPLICANT: It, after making this Certificate of.Ezemption, 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 Thereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, w ill 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. .:Ya
C.A.C.) r,
0 As owner -builder, Fwill 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 divisions .
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. Q.
Lender's Name '1/ "
Lender's Address- .5
1 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 putposes.
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify l have read this application and state that
iL�'E10/84
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
condo plus 26 sar.
construction, and authorize a'representative of the City of La Ouinta Department of Building and Safety to enter
235 sar. ft. of aaraaa as ner annfrove
upon the property for which I have applied for this permi for the purpose of making inspections.
+ Signature of Applicant or Agent Date
i
v
24.04
Print Applicant/Agent Name
`
APPVPRMT UM ■ 83
iL�'E10/84
Permit to construct 912 so. ft. of
condo plus 26 sar.
ft. of 'Dorch and
235 sar. ft. of aaraaa as ner annfrove
plans.
Mech. Fee
24.04
Plans Check Fee
246.00
Const_ Flap
2fi .00
plact. Fee
26-76,
SMI Fee
3_64
Plumbing Fee
27.00•
Prop. Devel. Fee
450.00
P A
VQ DEC
TdTAL
FEE
1.066.4n
•BLDG. DEPT. . VALUATION 151,140-00
•
Ah
NO.
OPERATION I
INSPECTOR
NO.
OPPKTION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
35
36
Furnace Compart.
Inlets & Outlets
3 Steel
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
39
Appl. Clearance
7
Framing
40
Fire Damper
8
Vents
cow
41
Smoke:Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P. L.
❑
43
Final
10A
fireplace T.O.
❑
UPON
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value •
7A Walls (Batts)
128 Ceiling (Batts)
12C Ceiling (Blown)
14 Final �i•(a�$Q-' �i G,
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents a
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final C .
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
P/L P/I
STREET NAME
26 Power Pole
27 Conduit 1% Wit
28 Service Entrance
29 Wiring _- •
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final �� (�.�— 9•