001082 (SATT)50l `
PERMIT RPPUCRTION .. 9 $" •
a City of La Ouinta
Department of Building and Safety
This permit becomes void if work not cimmenced within 180 days from date of issuance, OR, if work has been suspended of abandoned for a period of 180 days. ;
• LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter'9
4commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force.
no effect.
tQcense Class Lic. Number
..Date Contractor
r'OWNER-BUILDER DECLARATION: I hereby affirm tha 'I of m exempt from the c'ontractor's Licensolk1w 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 (commencing 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.):.
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.
Date ' Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption. you should become subject tothe 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 1 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
demolilion or dismantling thereof, will be more than thirty-six.(36) feet high. (Chap 3.2, Grp 2, An 2, Sec 341, Title 8,
C.A.C.) 1•,
0 I, as owner o1 the properly, or my employees with wages as their sole compensation, will do the work, and4he
0 As owner -builder, I will 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, and who does such work himself or s
CITY/COMMUNITY/STATE/ZIP
Tia Quinta, CA 92253
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 improvemntissold within one year ofcompletion, theowner-builder will have the burden of proving that
Date Applicant
he did not build or improve for the purpose of sale.). ;!; I
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 ermit 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
\ , y h� �� 94
Lender's Name � �•
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed -pursuant to the
4! _ -
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
Date Owner 's
K
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 or City Department.
Date Applicant
V
79,;2/7
APPLICANT. NAME (L. F. MI)
M. D. Janes
ADDRESS -
•2950 Airvay Rvenue
CITY/COMMUNITY/STATE/ZIP
Costa Mesa, CA 92626
JOB SITE ADDRESS/SPACE '
TiY
7
CITY/COMMUNITY/STATE/ZIP
Tia Quinta, CA 92253
BOK
PAG
PRC
C
24.00
TWN
RNG
SE
S
TRACTLOT
18915
23.50
21
3.64
MOD
1
S8
Sldc: 3
TRACT NAME '
Reflections
OWNER NAME (L. F. MI)
Applicant
CONTRACTOR -FIRM NAME '
Applicant
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
above
PHONE .-
UCNC •
345--143'
TOTAL ' -
FEE
ARC/ENG FIRM NAME
Carlson, Shlennev & Hemalhalch-
ADDRESS
18002 Skvrlark Circle
CITY/COMMUNITY/STATE/ZIP
zrvine„ CA 92714
PHONE 0
-
LICNC '
714--250-0607
USE OF PERMIT
Condo
BL
ZON
FSB SSB
SSB
RSB<<
ay
OFC
ZONE ORO 0
LOT SZ
t•
�•' END.
SIDE..
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: 1 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 ee air pp a for this permit for the purpose of making inspections.
P'Slgnaturre ofA poicant or Agent f Date
Print Applicant/Agent Name V
APPUPRMT 7.DATE -
12/10/84
S.F.D.
Permit to construct 926 sq. ft. of
condo plus 235 sq. ft. of
crarage
as per app 6ved plans,
Mech. Fee i
24.00
Plan Check Fee
246.00
Const. Fee
289.00 •'
Elect. Fee
23.50
SKITee
3.64
Plumbinc Fee
30.00
Prop. Devel. Feb
450.00
PA 10 DEC 2 >
Jul,
TOTAL ' -
FEE
1,066.14
s �
' r.►VIM BLDG"DEPT
VALUATION
51.6E9 00
NO.
OPERATION TE INSPECTOR
NO.
OPWATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
J�
33
34
Ventilation System
Plenums & Ducts
2 Ftgs & FrmsS�
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
AW
42
Commercial Hood
10
Fireplace P.L.
❑
43
Final
10A
Fireplace T.O.
X
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 rZt;
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb •
18 Vents VA
19 Sewage Disposal •
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
PSL PiI
STREET NAME
26 Power Pole
27 Conduit IN
28 Service Entrance
29 Wiring •
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final i