SFD (000977)76893 Calle Mazatlan
000977
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. .-
LICENSED CONTRACTORS DECLARATION: I hereby raffirm that I am licensed, under provisions of Chapter 9'
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
and effect.
.License Class chic Num Jb----%
Date , f Contractor .'✓ { .
OWNER -BUILDER DECLARATION: I herebyaffirm that I am exempt from theContractor's License Law for the
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to
construct, alter, improve. demolish, or repair any structure. prior to its issuance, also requires the applicant for
such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
(Chapter 9 (commencing with section 7000), of Division 3 of the Business and.Protessions Code) or that he is exempt
therefrom.and the basis for -the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
0 I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License
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 aremot intended or offereofor sale. If, however, the
building or i mprovemnt is sold within one year of completion, the owner -builder will have the burden of proving that
he did not build or improve for the purpose of sale.).
0 I, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec.
7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
'builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
0 1 am exempt under Sec.. B. & P.C. (Attached. Certificate)..
Date Owner t1
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
certificate of Workeis' Compensation -insurance , or a certified copy thereof (Sec. 3800. Lab. C.).
Policy No. Company -
:0 Certified copy is hereby furnished.'
0 Certified copy is filed with the City Building Inspection Department or City Department.
Date Applicant
APPLICANT NAME (L. F. MI)
ArwrUm 0yrryw-ation
ADDRESS'
790
CITY/COMMUNITY/STATE/ZIP
LR OWt CAArtta. CA 92253
JOB SITE ADDRESS/SPACE
-R43
CITY/COMMUNITY/STATE/ZIP
BOK
PAG
PRC
C
TWN
RNG
- SE
S
TRACTLOT
A406-1
35
36.90
SMI Fee
MOD
Gr -3
so
73.00
TRACT NAME '
C:="4 -
- - -
OWNER NAME (L. F. MI) [t .
tSb l
CONTRACTOR -FIRM NAME '
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
above
PHONE N
564-1315
LICNC N
333762
LAUIN,
CIVOFD P RTMENT
ARC/ENG FIRM NAMEBar iI Berkus
ADDRESS
1531 Chapala Street
CITY/COMMUNITY/STATE/ZI,;Mta 11O:baM, CA 93101 1
PHONE N
805 963-8901
TOTAL
FEE
I LICNC N
USE OF PERMIT '
Single Mnily Dwell nl R
BL
ZON
FS8
SSB
SSB:
RSQ
OFC
- ZONE ORD »
LOT SZ
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCES This section need not be completed if.
the permit is for one hundred ($100) o,. less. I certify that in the performance of the work for which this permit is
issued,) shall not employ any person in any manner so as to become subj ect to the Workers' Compensation Laws of
California.
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of.Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
0 1 hereby certify that no excavation five (5) or more feet in depth into which a peison is required to descend, w ill be
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3:2; Grp 2. An 2, Sec 341, Title 8.
C.A.C.) r -...
0 As owner -builder, I will not employ anyone to do work which would require a permit from the Division of
Industrial Safety, as noted above, unless -such person has a permit to do such work from that division.
a. .
0 Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
of the work for which this.permit is issued (Sec: 3097; Civ. C.).
Lender's Name
Lender's Address
certify that I have read this'appfication and state that the above information is correct.) agree to comply with all
city and county ordinances and stateilaws relating to building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for inspection purposes.
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I •certify (have read this application and state that
the information gjven=is correct. I agree to comply with all state'laws and county ordinances relating to buidling
construction„ and.authorize a' representative of the City of La Ouinta Department of Building and Safety to enter
upon -the r$prrty for hich I have applied for this permit for the purpose of making inspections.
Signature f Applicant or Agent Date
Print Applicant/Agent Name
APPL/PRMT ) Ary DATE -
i0 -19-a4 s.F,D.
Permit to aDnstruct
2,326 sq. ft. of
sincrIryeep family dwelling with attached
garage,
;t A _
Mechafiica]. ibe
26.00
Plan Check Fee
291.20
Const. Fee
448.00
Elect. Fe a
36.90
SMI Fee
7.39
Plumbing Fee
73.00
Pte. Devel. Fee
450.00
D
1U)
LAUIN,
CIVOFD P RTMENT
TOTAL
FEE
1.332.49
BLDG.DEPT.
VALUATION 105,867.60
a
Ah
NO.
OPERATION I DATE
INSPECTOR
NO.
OP ATION I DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
O
p s
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.
❑
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 f
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/L P/I
STREET NAME
26 Power Pole
27 Conduit
'28 Service Entrance
29 Wiring ;A
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final /