001105 (SATT)PERMIT APPLICATION
City of La Duinta
Department of Building and Safety
This permit becomes void i1 work not commenced within 180 days from date of issuance, OR, if work has been suspended or abandoned for a period of 180 days.
LICENSED CONTRACTORS DECLARATION: I herebyaffiim that .1 am.licensed under provisions 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 � Lic. Number.
Date Contractor .r'1 /1
OWNER -BUILDER DECLARATION: I hereby affirm tha I am exempt from the Contractor's License:Law fore''
following reason (Sec. 7031.5. Business and Professions` Code: Any city or eou iS which requires a perq 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 previsions of the Contractor's License Law
.(Chapter9 (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):,� ve •
C 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, avid 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 improvernnt is sold within one year of completion. the owner-buider will have the burden of proving that -
he.did no] build or improve for the purpose of safe.).
❑ I, as owner of the property, am exculsively.contracting with licensed contractors to construct the project (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 contracts for such projects with a :ontractor(s) licensed pursuant to the
Contractor's License Law.).
a 1 am exempt under Sec. B. 8 P.C. (Attached Certificate).
Date ''I a Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a•
certificate'ot Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.).
Policy No. Company
0 Certified copy is hereby furnished.
❑ Certified copy is filed with the City Building Inspection Department or City I/ Department.
Date Applicant('
pplicant 1 e
APPLICANT NAME (L. F. MI)
M. D. Janes
ADDRESS -
2Q';O A i rtxaRs avxxint A
CITY/COMMUNITY/STATE/ZIP
Costa Mesa, CA 92626
JOB SITE ADDRESWSPACE -
,.
a
ITY/COMMUNITY/STATE/ZIP
La ftinta CA 92253
BOK
PAG
PRC
C
.. TWN•
RNG
SE ..
S
TRACT -
LOT
Elect. Fee
23.76
MOD
SB
'
15915
44
450,00
3
iA�D
Bldg_. 5
TRACT NAME
Reflections
OWNER NAME (L. F. MI) -.
Applicant
CONTRACTOR -FIRM NAME
Applicant
ADDRESS -
above
CITY/COMMUNITY/STATE/ZIP
above
PHONE 3•45-1436 •
LICNC IA,R
'
a= Fson, Shleppey & Hezalmalhalch
ADDRESS -
18002 Skypark Circle
CITY/COMMUNITY/STATE/ZIP .. '
Irvine, CA 92714
PHONE '•
714-250-0607
LICNC e
USE OF PERMIT
Condo
BL
ZON
FSB
I SSB
SSB
RSB
OFC
ZONE ORO •
LOT SZ.
END
.SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if v'
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:. It, after making this Certificate of Exemption, you should become subject to the Workers'
Compensation provisions of .,the Labor Code, you must forthwith complywith such provisions or this permit shall
be deemed revoked., ,
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 hereby.ce!tify that no excavation fiie (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,
C.A.C.)
OAs owner -builder, I will not employ anyone to do work which would aequire a permit from the Division of .
Industrial Safety, as noted above, unless such person has a permit to do such work from that divisior.
t ,
O Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY"I hereby affirm that there is a construction lending agency for the performance w
of the work for which this permit i issued (Sec. 3097, Civ. C.).
Lender's Name �3
Lender's Address _
`,
I certify that I have read this application and state that the'above inform ati n m Iscorrect. 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 purposes. •
Signature of Applicant or'Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
f the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
r; construction, and authorize a representative of the City of La Duinta Department of Building and Safety to enter
upon the property for which I have akpl for this permit for the purpose of making inspections.
/ignaiuT'�df gppllca'hf�'�r`'A'gi nt'lj Date
Print Applicant/Agent Name G • /
APPL/PRMT Bull 1 ns s 1 20�T� � / � 4 S ..0 . D •
Permit to construct
763 sq. ft. of
condo plus 160 sq.
ft. of porch
plus 235 sq. ft of
garage as per
approved plans.
Mech. Fee
21..00
Plan Check Fee
240.27
Const. Fee '
260.50
Elect. Fee
23.76
SMI Fee
3.15
Plumbina Fee
22.00
Prop. Devel. Fee
450,00
iA�D
ASS
TOTAL
FEE
1,Q20.68
BLDG. DEPT.
VALUATION 44,375.00
Ah
NO.
OPERATION I DAT INSPECTOR
NO.
OPERA N DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System C
2
Ftgs & Frms
�s� T
34
Plenums & Ducts 96.
2A
Slab Grade
C
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.
❑
OP'NO.
ADDITIONAL INFORMATION
^
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick Value •
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb CNe�
18 Vents' 44
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
P/L Pyl
STREET NAME
26 Power Pole
27 Conduit Cob
28 Service Entrance
29 Wiring
29A Grounding Wire •
29B Bonding
30 Fixtures
31 Service
32 Final