AR (001249)76890 Calle Mazatlan
001249
APPLICANT NAME (L. F. MI) Ix-andmark'Imd
T.
PERMIT APPLICATION
City of 6 Quinta
Department of Building and Safety
CITY/COMMUNITY/STATE/ZIP • Ja Quinta,'CA"92253,
BOX
This permit becomes void it work not commenced within 180 days from date
of issuance.,OR, if work has been,suspended'or abandoned for a period of 180 days.
C -!•
CERTIFICATE -OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE: This section need not be completed it
LICENSED CONTRACTORS DECLARATION: I 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, I shall not employ any, person in any manner so as to become subject to the Workers'Compensation Laws of
and elfect.
California.
License Class Lic ?&m 49
Date Applicant'
• Date Contractor A,eer 7
4r _ .
NOTICE.TO APPLICANT: If, after making this,Certiticati.of,Exemption; you should become subject to the Workers'
OWNER -BUILDER DECLARATION: I hereby affirin'that-l"am exempt from the Contra'ctor's,LiIiih'se Caw'f6r, the
Compensation provisions of the Labor Code.,you must forthwith comply with.su h provisions or this permit shall
following reason (Sec. 7031.5. Business and Professions Code: Any city'or county which requires a permit to
be deemed revoked
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 §ta.temen.t.th.at he is.licensed pursuant to the provisions of the Contractor's License Law*
01 hereby certify that no excavation 66 (5) ornfore feel in depth into whicha'person is iequired to descend, will be
(Chapter 9 (commencing with section 700O)of Diviiion 3 of the Business and Professio, ns Code) or that 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 for a permit
deffioliiion or dismantling thereof, will be more fharfThirty-six (36)'feet high.!(Chap 3.2. Grp 2:Art 2; Sec341,-Titleff.
subjects the applicant to a civil penalty of not more than five hundred dollars (SWO.):
PHONE
0 1. as -owner of the property, or my employees with wages as their.sole compensation, will do the work..and.the•
0,A . s owher-builder, I will -hot employ anyone to do work which woud'require,`a--permit frorn'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 sbch 'work.irom that division.
Law does not apply to an?owner of property who builds. or improves thereon, and who does such -work himself or,
- . I . . . . • — I .. . %.r I
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 improvemnt is sold within oneyear of completion, the owner -builder will have the burden of proving that
.Date c Applicant
he did not build or.improye. for, the, purppse, of sale),
--CONSTRUCTION LEN DING AGENCY: I hereby affirm that there is a construction lending agency for the performance
• 0A 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 Contractors 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 totw.:..
LOT,sz
Contractor's License Law.),
Lender's Address
0A 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 Vagree to comply with all
. . . - r , . . . . I
Dale Owner
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.
WORKERS' COMPENSATION DECLARATION: I hereby'affirm that I have a cerlificat - e of'consent to self -insure; ora
certificate of Workers' Compensation Insurance', or'a certified copy thereof (.Sec. 3800: Lab.*Ci.), 1'., 1,'-1
Signature 'of Appkant'br Agent Date
—.PolicyNo. Company . - . I - . . . . !.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY. I ceffifil hive read this application and state that
0 Certified copy is hereby furnished., . _. . - , -. . . ... ;:. , I .-,. .
tfie information given is correct. I agree to comply with all state lawsand county 6rdinances relating to buidling
0 Certified copy is filed with the City Buildi"ng*16specti6n Departm ent or City Department.
construct* Z6 auth-i 'representative of the City of La Ouinta'Department of Building and Safety to -enter
T91 e, authorize a
upon _ eFty IRwh ,Jch f ave applied for this permit for the purp6se of making inspections.
Date Applicant
Signature of Applicant or Agent Date
APPLICANT NAME (L. F. MI) Ix-andmark'Imd
ADDRESS P. 00Bbk3,8q*
CITY/COMMUNITY/STATE/ZIP la Quinta,, CA -9 . 2253
JOB SITE ADDRESS/SPACE 76-890'C:§,l1d Mwatlaw
CITY/COMMUNITY/STATE/ZIP • Ja Quinta,'CA"92253,
BOX
PAG
PRC.
C -!•
Elect. Fee. 72.66
TNM
FING
SE
S
TW! 65-21
I LOT 25I
dul
.1
so..
'TRACT NAME Tlemii—s'ViUas
OWNER NAME (L. F. MI) 'Vp liz6nt
CONTRACTOR -FIRM NAME
ADDRESS
d
CITY/COMMUNITY/STATE/ZIP
PHONE* 34
345-2888
"°"°
-ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE
LICNC 8
USE OF PERMIT 00roo.
BL
ZON
FS8
SSB
SSB
RSB
OFC
ZONE ORD 0
LOT,sz
END
41RE
Print Applicant/Agent Name
APPUPRMT
nni 24 q
Pmt ..to c6ingtrilct RM 1736 sq'- ft. of
tuo-story condo 611—is 288,sq. ft. of -porch
and 451 sq. ft.'bf garage as per approved
Mwh.- Fee 42.'00
Plan Check Fee 379.85
Const. Fee 455.50
Elect. Fee. 72.66
SMI Fed' 7.60
Plumbing Fee* '102.'00
000.00
TOTAL
FEE
3 r059..61
A,O 4 0 2
BLDG. DEPT.
A 2 0 .3 _ 1._
VALUATION iq8,275.00-1
Ah
Ah
NO.
OPERATION I ME
INSPECTOR
NO.
OPE ION 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
xa
36
1 Inlets & Outlets
4
Grout Blocks
37
1 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.
❑
NON
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts) Z4 19
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APP OVALS
15 Ground Plumb
16 Water Piping
418 17 Rough Plumb 7 7/4—
isVents
19 Sewage Disposal
20 Sewer f
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test OS
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
P/L 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