SFD (000978)76883 Calle Mazatlan
000978
APPLICANT NAME (L. F, MII,_ _ n :q___ _._mi on
.iAl1-1
ADDRESS . ..]7^'TLY.)
- r . .
P'0. Bmc 780•
` PERMIT APPLICATION
2 758 s_ ft_ of,
City of
Department of Building
La Ouinta' •+
and Safety, ••
CITY/COMMUNITY/STATE/ZIP
7
- 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:'- `
,•-' .Yt+ '.
CERTIFICATEOEEXEMPTIONFROMWORKERS'COMPENSATION'INSURANCE: This section need not be -completed if.
LICENSED CONTRACTORS DECLARATION: 1 hereby affirm that=l amAicensed under provisions of Chapter 9 " ..,
the permit is for one hundred ($100) o, less.) certify that in the performance of the work for, which this permit is , M
(commencing with Section 7000) of Division Sof the Business and.Professions Code; and my license is in full force-..
issued, I shall not employ any person in any mannersoas to become subjectto the Workers'Compensation Laws of
and effect.
California.
`
License Class ' Lit. N mbe
_ 'Date Applicant.
Date ' IU LI - Contractor- • r' -
NOTICE TO'APPLICANT: If,.after:makmg 116 Certificate of Exemption„you should become subject lo -the -Workers
I'
ARhereby affirm that I am exempt fram the Contractor's License Law for the
OWNER-BUILDER DECLATION I
Compensation;provisions.of the Labor Code; you must forthwith comply with such provisions or this permiLshall
"_
following reason (Sec. 7031.5. Business and Professions Code; Any city or county which requires a,permit to.
be deemed revoked.., ti?u •
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 pursuant to the provisions of.the Contractor's License Law
'.tO I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be
(Chapter 9 (commencing with section 7000).of Division 3 of the Bus.iniss and Professiiins Code) or that he is exempt -
made inconnection.with'viork'authorizedby.thispermit;andthatnobuilding structure, scaffolding, falsework,or -
therefrom and the.baAjor the.alleged exemption. Any violation of Section 7031.5 by any.applicani for a permit
demolition or dismantling thereof; will be more than thirty-six (36) feet high:(Chap 3.2, Grp 2, Art 2. Sec341, Title8.
subjects theapplicantlo-a civil penalty of not more than five hundred dollars ($500.):
C.A'.C.) '' " i' e;
0.I.,as owner of the property, or my employees with wages,as their sole compensation; will,do the work, and the .
_ .-O Asiowner-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,vnless"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,notintended or offered for sale. If, however, the 1
O.Divisio iof Industrial. Safety. Permit No.
building orimproyemntissold within one year ofcompletion. the owner -builder will havetheburdenofproving that. ; -,•
Date ' - Applicant
he did not build or improve for,the purpose of sale:).. -
CONSTRUCTION LENDING AGENCY: Lhereby affirmihat there!is a construction lending agency for the performance
O I, 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 withla contractor(s) licensed pursuant to. the -
RSB
.Contractor's License Law.). _ .
Lender's Address
,❑ i am exempt under. Sec:. 8. 8. P.C.;(Attached Certificate).
- I certify tha(A ave read this_3pplicalidri;aitdsfate that the above information is correct I agree to comply with all .
•
'Date'
city and countyordinances and slate laws relating to building construction, and hereby authorize representatives .
Owner
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
SIDE.'',
certificate of Workers' Compensation Insurance, or a certified•copy thereof (Sec. 3800. Lab. C.).
Signature of Applicant or Agent Date
Policy No. Company.
jm
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify l have read this a pplication and state that
❑ Certified copyis hereby furnished..
-.-
the information given incorrect. I agree to comply with allstate laws and county, ordinances relating to buidling •,
O Certified co is. filed with the Cu Buddln Inspection De artment or, Cit Department. ' • ..
PY- Y 9 P P. D
construction, ani authorize a;representalive. of the City of La Ouinta Department of Building and Safety to enter t
Y ,
Date Applicant
/! paa the'prope yfor which 1 16ve.'applied for this permit for -the purpose of making inspections.
l`__
/i% JS" A
Signature of Applicant or Agent Date
1
Print Applicant/Agent Name . r*
APPLICANT NAME (L. F, MII,_ _ n :q___ _._mi on
.iAl1-1
ADDRESS . ..]7^'TLY.)
- r . .
P'0. Bmc 780•
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA. 92253
2 758 s_ ft_ of,
JOB SITE ADDRESS/SPACE- ,..
6-883 Calle I4a'aatlan
CITY/COMMUNITY/STATE/ZIP
La Qu nta. ComM' '92253
BON
PAG
PRC
:C , ,
TNM _
'RNGSE
503.00
.S
TRACT
14406-31 •
LOT
6
Pl to bincr rea
ol.
so
450.00
TRACT NAME ^ .CIQo m
Santa i
OWNER NAME (L. F. MI) - .. -,•..
L!nAAGII J
CONTRACTOR -FIRM NAME 7., • - ' . ,
ADDRESS ..,,,,bow
CITY/COMMUNITY/STATE/ZIP
jj,,^^ MM
v>ti
PHONE •, ' '
564--1335'
.• y 'A
LICNC .
333'762'
ARC/ENG FIRM'NAME .Barri•B^
kw'
ADDRESS - -
1531 Chapala Scree
CITY/COMMUNITY/STATE/ZIP
Santa Barbara, CA 93101 `
PHONE.
LICNC
805 963-8901
USE OF PERMIT ”
• Single fairiily dwelling
Bl
ZON
FSB
SSB SSB-
RSB
OFC'.
-
'. ZONE ORD 41.1
• LOT -SZ
•" END
SIDE.'',
tM • ^
. APPVPRMT lk -nn .qyf
DATE
10-19-84 S.F.D.
Povynit 1-n st-_rtx+_
2 758 s_ ft_ of,
sih4le f&dlV dwelling with attached
craracxe.
6 .,! i` • : • :,VALUATION
"'
`^iYrAn:l"[ :>
N 1►:
Medbanidal- Fee
26.00
n Cock Flee
326.95
clox st. Flee
503.00
Mpetrical. Flee
42.16
5M Fee
8.93
Pl to bincr rea
73.00
Prm. navel. Fee
450.00
ii i ni,-
;01Y.{ + . RTMENT
gUll'DIIiG.DEF1 ,
.• y 'A
TOTAL
FEEn -
. ` '
•,.. [,, {. • r . } i t y .•;'. .yf•,w t
{ .{ !
r' .L Z ii .. yr . ; „' l •-•..., ti _ f
s
. s'.:1• '
='
6 .,! i` • : • :,VALUATION
"'
`^iYrAn:l"[ :>
N 1►:
-
BLDG. DEPT: "Y :Ly'
' • 'ti. /- ,?f. ,',•
ti -: i-
1, L•.A .. „" w. __ ' .. ._v _.
r. .QUI - - --•
A's
Alk
AdL
NO.
OPERATION ATE
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
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 o; klf
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer 7,6 O
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 PiI
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring P
29A Grounding Wire
29B Bonding ,; ,
30 Fixtures
31 Service
32 Final