SFD (000979)76873 Calle Mazatlan
000979
APPLICANT NAME (L. F; M)p7 ,, //-
J'lLiLLlriJt rte• oro.
ADDRESS - -
P.. o. Box 780
'PERMIT APPCCAT16N
1+
City of La Duinta
® 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.:
x:• -'
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: -This section need not be.completedif
' LICENSED. CONTRACTORS. DECLARATION: I hereby affirm that I am.licensed under provisions of Chapter' 97
the permit is for one hundred.($100) o; less. I certify that in the.performance of the work for which this permit is
' •(commencing'wilh Section 7000) of,Division 3of the Business and Professions Code, and my license is in full force'.
issued, I shall not employ any. person in any manner so as to become subject to the Workers'Compensation Laws of..-
f.-and
andeflect.I /
California.
License Class c. 1'{um b g _ 1 -•
..Date " Applicant 4
-L
• Date ' •'/ -;,ZJ I34-' • Contr
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' "
Co
' OWNER -BUILDER DECLARATION: Nereby affirm that l am exempt from the'Contractor's License Law for the :.'
-Any
Compensation,provisions of'the Labor Code, you must forthwilh•comply with such provisions or this permit shall
Ce deemed revoked.
following reason (Sec. .7031.5. Business and Professions Code city or county wfiich.requires a permit to
construct, alter, improve, demolish, or repair any structure, 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 pursuanttothe provisionsofthe Contra ctor'sLicense Law ;.
0 1 hereby certify that no excavation five (5) or more feet in depih into which a peison is required to descend. will be
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) orthat 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 7031:5 by any applicant fora permit
'demolition or'dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2• Art 2, Sec341, TitleIL-.
subjects the applicant to a civil penalty of not more than five hundred.dollars ($500.):
C.A.C.)
❑ Las owner -of the property, or my employees with, wages as their sole compensation, will do the work, and the.O'As,owner-builder,
I willrnot employ.,anyone to Wwork 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 atiove,.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.
' r 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 improvernnt is sold within one year.of completion, the owner -builder will.have the burden of proving that
DateApplicant
he did not build or r improve for the purpose of sale.).
-•
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 90 construct the project (Sec: '
.. of the work -tor 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
'
Coniractor's License Law.). ..• _ -' -
Lender's Address
0.1 am exempt under Sec. • '. B. 8'P.C. (Attached. Certificate).
' I certify thatd:have read.this application and state that the above information is correct. I agree to comply.with all.
Date ' Owner R.
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this countyto enter upon the above-mentioned property fof 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. C.).
-
Signature of ApplicanYor Agent - Date
•Policy No. Company
'
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify l have read this application and state that
0 Certified copy is hereby furnished. t, ^
the'information given s.correct I agree to comply with all state laws and countyordinances relating to buidling
0 Certified copy is filed with the City Building Inspection Department or City Department.
yr
construct`n, af d•authorize a)representative of the City of La Duinta Department of Building and Safety to enter'
•_ Date Applicant
[/upon the p?o ert for w hsich 1 -have applied for this permit for the purpose of making inspections. '
ficL .....'.. 3" i 4
Signaturelof Applicant or Agent Date
Print Applicant/Agent Name
APPLICANT NAME (L. F; M)p7 ,, //-
J'lLiLLlriJt rte• oro.
ADDRESS - -
P.. o. Box 780
CITY/COMMUNITY/STATE/ZIP ' ' -
La Qtunta, CA 92253
JOB SITE ADORESS/SPACE
Rx 76-873 Calf Mazatlan;
CITY/COMMUNITY/STATE/ZIP • '
La Quinta CA 92253
BOK
'PAG
PRC C
TWN
RNG
SE.,
S'
TRACT -
14496
14496-3
291.20 .
LOTMOD-
37
448.00
OD
G-3
SB
- ,
TRACT NAME
Santa Rmm Chv
OWNER NAME (L. F. MI Aft Iftm
CONTRACTOR -FIRM NAME _
bn
ADDRESS •, - _ .
abbe .
CITY/COMMUNITY/STATE/ZIP , ,,
above
+
PHONE 0'
564-1315
LICNC -
333762
ARC/ENG FIRM NAME^ mow. . .
- Z.7rr •DCl.kus " ..
Da
ADDRESS
1531 Chapala Street
CITY/COMMUNITY/STATE/ZIP - - -
Santa Barbara. CA 93101
PHONE.. ' -
.805 963-8901
-
-LICNC •
-+
USE OF PERMIT ,
Single family &4ellim
BL
ZON
-FSB ,SSB•
SSB RSB
OFC-:
' . - ZONE ORD N •
-
.^ LOT SZ
..END
• SIDE'
....,' - .`a 'jam• a ♦ .
a BLDG. DEPT.
APPL/PRMT
flnn q
DATE
10-19-84 S.F.D.
Permit to constnzct 2,326 sa. ft.' Of
'sincile 'fiimilw' ftellincr with attached
aaracre. .
Mechanical Flee
26.00
Plan check Fee
291.20 .
Const. Fee
448.00
Electrical 'Fee
39.90
SMI Flee
7.39
Plumbing Fee
73.00
prm. Dever'l. Fee
450.00
;3qq
e
TOTAL . •r ,:.. .
:-*TOTAL
FEE
VALUATION
W., 867.66
r -7
Ah
NO.
OPERATION MATE
INSPECTOR
NO.
OP ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
f-
35
Furnace Compart.
3
Steel
14
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
39
Appl. Clearance
7
Framing
a
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.
❑
NPON
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
PLUMBING APPROVALS
15 Ground Plumb i
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
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
P P/I
STREET.NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring C s
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final _ j
e
°