SFD (000896)76881 Calle Mazatlan
000896
APPLICANT NAME (L. F. MI)
jinclen C=Tdrat4on'
ADDRESS
P.O. Box 780
PERMIT APPLICATION
City
of La Quinla
Department of
Building and Safety afety
This permit becomes void if work not commenced.within 180 days from date
of issuance.. ORJf work has been suspended or abandoned fora period of 180 days.
RNG
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if..
LICENSED CONTRACTORS DECLARATION. -l- hereby affirm. that I am licensed under provisions _of -Chapter 9
the permit is for one hundred ($100) o, less. I certify that in the performance of the work for which this permit is,
(commencing with Section 7000) of Division 3 of the Business and Professions Code!and my license is.in full force
issued; shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of "2•
and effect.
California. ly
License Class Lic. Number
Date —Applicant
-Date Contractor
NOTICE TO APPLICANT: If, after. making this Gertificati of Exemption.. you should be -come subject to the Workers'
OWNER -BUILDER 'DECLARATION: I hereby -affirm that I am exempt from'the Contractor's License Law'for'the
Compensation provisions of the Labor Code: you must forthwith comply.with.such.provisions or this permit shall
' 'be
following reason (Sec. 7031.5, Business and Professions Code: Any city.or county which requires a permil,to
deemed revoked.
constritct, alter, improve, demolish, or repair any structure, prior to its issuance; also.requires the applicant.for.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
such.permit tofileasigned statemenlAhat he is licensed pursuant to the provisions of the Contractor's License Law
0 1 hereby certify.that no excavation five (5) or more feet in depth into which a pers66 is required -to descend; will be
• (Chapter, 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) or that heis 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 7031.5by.any applicant for a;permit
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2. Gro 2, Art 2, Sec341. Title B,
subjects the applicant to a civil penalty of not more than five hundred dollars ($500:):
C.A.C:)
0 L as owner-ot.the property, or my employees with wages -as their sole compensation, will do the work, and the0
As owner -builder; twill not I e . mpioy anyone to do work'whiEh*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
#
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,
Date Applicapt
he did not build or improve for.the.purpose of,sal(k.) -.,t . - . - . .. .
CONSTRUCTION LENDING AGENCY: I hereby affirrn t6 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 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 contractors) licensed pursuant to the
SIDE
Contractor's License Law.).
Lender's Address
..O.1 am exempt under Sec.- B. & 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
city and county ordinances and state laws relating to building construction, and herebyauthorize representatives.
- tA
of this county to enter upon the above-mentioned property for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, ora
VALUATION?,
certificate of Workers' Compensation Insurance , or'a certified copy thereof (Sec. =Aab. C.).
A!.
Policy No.. Company — --- ---
Signature of Applicant or Agent Date'
CERTIFICATEOF COMPLIANCE AND AUTHORIZATION OF ENTRY:. I certify Ihave read this application and state that
0 Certified copy -is hereby furnished.
11et
the information given is correct. [.agree to comply with all state laws and county ordinances relating to buidling
construction, the City La Quinta Department Building
Ce ified or C',
rt, y is I with the City Building Inspection Oq fment or City 'Department:
and authorize a representative of of of and Safety to enter
'upon
J -
6iproperty for which I have applied for this permit for the purpose of making inspections.
Date Applicant—
Signature of Applicant or Agent Date
APPLICANT NAME (L. F. MI)
jinclen C=Tdrat4on'
ADDRESS
P.O. Box 780
CITY/COMMUNITY/STATE/ZIP
La Quirrta, CA 92250
JOB SITE ADDRESS/SPACE
76-881 Calle mazatiLan
CITY/COMMUNITY/STATE/ZIP
la LA=ta, CA 92253
3 1 PRC -
BOK PA.
b ItION70038
C
TWN
RNG
SE
I
S
TRACT'
496-3
LOT
38
Const. Fee
385.06
k-1
Se
SMI Fe6,
TRACT NAME
Santa RDsa Wlve.'
OWNER NAME (L. F. Mot
CONTRboveACTOR-FIRM NAME
A
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE It
'5644315
LICNC 11
.33762
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATEIZIP
PHONE 0
•
LICNC.0
USE OF PERMIT
single family dwellincr
So.
ZON
FSB-
SSB
SSB
Asa,
4"
ZONE ORD
-:.LOT. SZ
A ' f ►
.EN
SIDE
Print Applicant/Agent Name
AP"RMT S.7.D.
Permit tai- f3
i -Qni I- f+ e4
single -fardly &aell:irg with
attached garage.
viachanical Fee
31.00
Plan Fee
250.25
Const. Fee
385.06
-Elect. Fee
31.25-
SMI Fe6,
5185
pimbing Fee.
48.50
Prop. Wmt,,Fee
450.00-.'
7 F7 IN
TOTAL—w
•
t
20h 85
FEE
v
4"
A ' f ►
J
-
- tA
VALUATION?,
.3.0
BLDG. DEPT.
I-
Adk
NO.
OPERATION I IMTE
INSPECTOR
NO.
OP TION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
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
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 R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
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
PIL P/I
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final