SFD (000902)76891 Calle Mazatlan
000902
PERMIT APPLICATION
City of La Ouinta
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
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CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if .
' LICENSED CONTRACTORS DECLARATION:, I hereby affirm that .l am licensed under provisions of Chapter 9
the permit is for one hundred ($100) It, less. I certify that in the.performance of the work for which.this permit is
(commencing with Section 7000) of Division 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 effect.
California.
License Class - Lic. Number
Date Applicant
Date Contractor
NOTICE TO APPLICANT: If, after making this Certificate of Exemption; .you should become subject to the Workers'
i -Compensation
OWNER -BUILDER DECLARATION: I hereby affirm that'l am exempt from the Contractor's License Law for.the
provisions of the Labor Code, you must forthwith comply with such 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: ..
suchpermittofileasignedstatementthatheislicensedpursuanttotheprovisionsoftheContractor'sLicenseLaw ..
01 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 Business and Professions 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
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp Z Art 2.Sec 341, Title 8.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
' C.A.C.) -
O I. as owner o1 the property, or my employees.with wages as their sole compensation, will do the work, and the . ..
p As owner -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 ibove,'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 - ..
ADDRESS•
through his own employees, provided that such improvements -are not intended or offered for sale. IL however, the
- O Division of Industrial Safety Permit No.
building orimprovemniissoldwithinoneyearofcompfetion.theowner-builder will havethe burden of provingthat
Date Applicant '
he did not build or improve for the purpose of sale.).
CONSTRUCTION,LENOING AGENCY: I hereby affirm that 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.wilh a contractor(s) licensed pursuant to the
SSe SSB
Contraclor's.License Law.).
Lender's Address
❑ 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 hereby authorize representatives
LOT SZ
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, or a
END
certificate of Workers' Compensation Insurance', or a certified. copy thereof (Sec. 3600. Lab. C.):
Signature of Applicant or Agent Date
Policy No. Company
1
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certif .l have read thisapplication and state that
Y'
O Certified copy is hereby furnished. J .
the information given is correct. I agree to comply with all state laws and county ordinances relating -to buidling
O Certified copy_is filed with the City Building Ihspec ion epa me_ or City Department.
construction, and authorize a'representative of the City of La Ouinta Department of Building and Safety to enter
T`e • '
upon the property for which I have applied for this permit for the purpose of making inspections.
Date Applicant
Signature of Applicant or Agent Date
AP_LICANT NAM . F, MI) a
(AY YL"Yr''''
ADDRESS '
P.O. B= 780
CITY/COMMUNITY/STATE/ZIP ,
La Quinta, CA 92253
JOB_ 6-0;SITE ADDRESS/$PAC M azaL. i n
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CITY '. /COMMUNIJY/t4,, 7L. a
Ia CA 92253
BOK
.
FAG
0-!59
PRC
C
Garage
TWN
PING
SE ,
S
TRACT
x.4491-3
I LOT
39
1
MOD
F-3
$B
.. .
TRACTNAME
Santa pbsa /&4e
OWNER NAME (L, F. MI) ,
CONTRACTOR -FIRM NAME
above
ADDRESS•
CITY/COMMUNITY/STATE/ZIP _
PHONE.
564-1315
PUrbing Fee a "
LICNC .
333762
Prop. Derv. Fee
ARC/ENG FIRM NAME
ADDRESS•
CITY/COMMUNITY/STATE/ZIP
PHONE .
AUGn
LICNC .
.
USE OF PERMIT
Single family awelliIag
BL
1,311.34-
ZON
FSB
SSe SSB
RSB
OFC
ZONE ORD N
LOT SZ
END
SIDE,
Print Applicant/Agent Name
APPL/PRMT DATE
8-Y6-84
S.F.D.
Permit to constrict Model P-3 B
Dwelling, (1st, floor)
1,616 sq. £t.
(2nd floor)
277 sq. ft.
Porch =
112 sq ft.
Garage
433 &q. • ft.
Mechanical Fee
3100
Plan Ck. Fee
291.20
Con t. £"ee
448,00
Elect. Fee
31.25 .
all Fee
7.39 ;
PUrbing Fee a "
52,50
Prop. Derv. Fee
450.00
R CV
AUGn
nn
L
.1--ril 9.04 Qlrcu.- V
TFee
1,311.34-
VALUATION
.' } BLDG. DEPT.
r-1
F— 1
NO.
OPERATION TE INSPECTOR
NO.
OP TION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
D
34
Plenums & Ducts
2A
Slab Grade
Q
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
10%1
fireplace T.O.
❑
OPINO.
ADDITIONAL INFORMATION
D C
-
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 APP OVALS
15 Ground. Plumb Q
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
PSL P/1
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service ,
32 Final