05-0353 (RER)79365 Mandarina
05-0353
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504
(760),777-7012
t95 CALLE TAMPICO FAX (760) 777-7011
6 UINTA, ,CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7.153
D BUILDING PERMIT
FC3 3 2005
Q IWTA
N Tnber 05=0-0'00.0353 Date 2/02/05
P y Address 79365 MANDARINA
APN: 772-350-013- - -
Application description REMODEL - RESIDENTIAL
Property Zoning . . . . LOW DENSITY RESIDENTIAL
Application valuation . . . 18000
Owner Contractor
JOHN 'SHAW OWNER
.79-365 MANDARINA
LA QUINTA CA'92253'
-- -- Structure Information REMODEL KITCHEN -----
'Construction Type TYPE V NON RATED
.Occupancy.Type DWELLG/LODGING/CONG <=10
Flood Zone NON -AO FLOOD ZONE
Other structs' info- 'CODE EDITION 2001 CBC
Permit. . . BUILDING PERMIT
Additional desc..
Permit Fee 189.0.0 Plan Check Fee'. 122.85
Issue Date Valuation 18000
Qty, Unit Charge Per Extension
BASE FEE 45.00
16.00 9.0000 THOU BLDG 2,001-25,000 144.00
Permit ELECT - ADD/ALT/REM
Additional desc
Permit Fee 26.25. Plan Check Fee 6.56
Issue Date Valuation . . 0
Qty Unit Charge Per Extension
BASE FEE 15.00
15.00 ..7500 PER' ELEC DEVICE/FIXTURE.IST 20 11.25
-------------------------------------------------------------------------------
Permit MECHANICAL
Additional desc
Permit Fee 24..00 Plan Check Fee 6.00
Issue Date . . . . Valuation, 0
Qty Unit Charge Per Extension
BASE FEE .15.00
1..00 9.0000 EA MECH APPL REP/ALT/ADD 9:00
------------
Permit PLUMBING
Additional desc
-1a
P.O. BOX 1504 •
VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 35 3 Date:
Applicant: I Architect or Engineer:
Applicant's Mailing Address:
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Code, and my License is in full force and effect.
License Class License No.
Date Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to constrict, alter, improve, demolish, or repair any stricture, prior to Its issuance, also requires the applicant for the permit to file a signed
statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or.that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects
t yapplicant to a civil penalty of not more than five hundred dollars ($500).):
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 Contractors' State License. Law does not apply to an owner of property who builds or improves thereon, and who does the work
himself or herself or through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is
sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve -for the purpose of sale.).
U I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owneldT property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law..
U I am exempt under Sec. B.& P.7.. f r this rep.
Datewner
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury a of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance
of the work for which this permit is issued.
_ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued. My workers' compensation insurance carrier and policy number are:
Carrier Policy Nu er
certify that, in the performanceof1he work r hich thi pe is issued, I shall not employ any person In any manner so as to become subject to the workers'
compensation laws of Califomia, a d a hat, i s 1' ecome subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provi ons
ate pplicant
WARNING: FAILURE TO SECURE WOR RS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED TH SAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, I EREST, AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury 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
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit
issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnify and hold harmless the City of La Quinta, its
officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes and v ' if work is not commenced within 180 days from date of issuance of such permit, or
cessation of work for 180 days will subject permit to c.a cella on.
I certify that I have read this application and state that the ab d info do is corre I to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representa ' es of this c unty toe er po he a ention property for inspection purposes.
to ignature (Applicant or Agent):
arSL
,
J'
' s
Page
. 2.
Application Number . . . . .
05-00000353
Date
2/02/05
Permit Fee 18.00
Plan Check
Fee-.
4.50
Issue Date . .
t Valuation
. . . .
0
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 3.0000 EA PLB
WATER INST/ALT/REP
3.00
----------------------------------------------------------------------------
Special Notes and Comments
REMODEL KITCHEN AREA AND RELOCATE
DOOR.2
/2/05 1:34:42 PM jjohnson
-------------------------------7--------------------------------------------
Other Fees . . . . . . . . .
ENERGY REVIEW FEE
12.29
STRONG MOTION (SMI)
- RES
1.80
Fee summary Charged
-----------------
Paid Credited
Due
--- ------
Permit Fee Total 257.25
---------- ----------
.00.
----------
.00
257.25
Plan Check Total 139.91
.00
.00
139.91
Other Fee Total 14.09
.00
.00
-14.09
Grand Total 411.25'
.00
.00
411.25
di ty of La Quinta
Building 8T Safety Division .
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: " "j C VA i
Owner's Name: X
A. P. Number:
Address: X –
Legal Description:
City. ST. Zip: y,
Contractor: x
Telephone:
Address: Q —
Project Description: X
City. ST, Zip: Y
Telephone: hon
e. x
State Lic. # : x°
Citv Lic. #:
Arch.. Engr.. Designer:
Address:
City, ST, Zip:
Telephone:
one:
to XX
S toLic ' . # X.
Construction
s ructi on cc
Y Occupancy:
u ancy
Te•XX P
Project type (circle e on e1. New Add' n Alt er Repair Demo
Name of Contact Person: X
Sq, Ft.:
# Stories:
# Units:
Telephone # of Contact Person:Estimated
Value of Project: X
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Ree'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
US
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"' Review, ready for corrections/issu
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SAM.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'".Review, readv for corrections/issue
Developer- Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
a
p
School Fees
°
Total Permit Fees
a
RESIDENTIAL RENOVATION
PROJECT: G I TRUS
BUILDER:
RJT HOMES
ORIGINAL
DOWNING
"AN ADEQUATELY SIZED DEBRIS CONTAINER
IS REQUIRED ON THE 10B SITE DURING ALL
PHASES OF CONSTRUCTION AND MUST BE
EMPTIED AS NECESSARY. FAILURE TO DO SO
MAY CAUSE THE CITY TO HAVE THE CONTAINER
DUMPED 9THE EXPENSE OF THE OWNER/
CON—trukfOR:" Y
COURSE — PLAN i
CONSTRUCTION HOURS
October ist - April 30
Monday - Friday: 7:00 a.m. to 5:30 pm.
Saturday: 8:00 a.m. to 5:00 pm.
Sunday: None
Government Code Holidays: None
May 1 st - September 30th
ARCHITECT:. Monday - Friday: 6:00 a.m. to 7:00 p.m.
Saturday: 8:00 a.m. to 5:00 p.m.
THORPE JAMES Sunda: None
Government Code Holidays: None
ADDRESS: Construction is NOT PERMITTED
on the following Code Holidays;
7Q-365 MANDARINA
LA QUI NTA. GA C12:2 w Year's Day
Martin Luther IGngir. Day
President's Day
Memorial Day -
OWNER: Independence Day
JOHN. SHAW Labor Day
Veteran's Day
Thanksgiving Day
DES I ONER FOR REN ri A8Tq tN5:
&OECKE DE51 CGNS
MOLLY GOECKE
760 777 1205
CITY -OF LA QUINTA
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRU TION .
DAT 2 BY
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