SFD (001250)76900 Calle Mazatlan
001250
APPLICANT NAME (L. F. MI) . Liiwnl: T n
ADDRESS P.O. B6X `7fl
PERMIT APPLICATION
• ' City of La Owrita X:
•_ Department of Building and Safety
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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 of180 days.
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CERTIFICATE OF EXEMPTION FRO KWORKERS' COMPENSATION INSURANCE:.Thissection neednotbecompletedif:';',
' LICENSED CONTRACTORS DECLARATION: I hereby affirm that P am: licensed under provisions of Chapter:'.9 .'
. the,permit.is for:ane hundred ($100) or less. I'certify that in the performance of the work for which this,permit is
-.(commencing with 'Section'7000)of:Division3of.the Business and.ProfessionsCode;andmylicense isinfuliforce
issued, I shall not employ any person in any manner so as to become subject tothe Workers' Compensation Laws of.
and effect. -
'California.
License Class LiclNturpber
Date. Applicant ' r
Y
Date ' Contractor V 1 ' ''O~
NOTICE TO APPLICANTi, If, after, making this Certificate'of Exemption, you should become subject tonhe Workers' , =
' OWNER•BUILDER DECLARATION: Thereby affirm'that I'am exempt from the Contractor's License Law for the,
Compensation provisions of the Latior-Code, you must forthwith.comply with such provisions or this permit shall' `.
• - •
followingreason 7031.5. Business.and Professions Code:. An cit or count which requires a to
be deemed revoked:'. .:: ,•' ,
(Sec. permit
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'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 pursuantto the provisions of the Contractor's License Law .:.,,
0 1 hereby cer . tify that no exuv5lion five (5) or more feet indeoth into which a person is required to descend, -w ill be -
(Chapter 9(commencing,wjth section 7000) of Division 3 of the Business and. Professions Code) orthat 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 2• Art,2; Sec341, Title B;
' subjects the applicant to a civil penalty of not more.than live hundred dollars ($500:):
' C:A.C.)
❑ 1. as owner of the property, or my employees:wilh wages as their sole compensation„will do the work, and the `.
0, As owner -builder; l .will hot 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, unless such person has a permit to do such work from that division...; , • -
' Law does not apply to an owner of property who builds; orimproves thereon, and who does such work himself or
❑ Division Industrial Safety Permit No.
'through his own:employees: provided that such improvements are not intended or offered for sale. ll, however, the
of
building orimprovemntissoldwithinone year ofcompletion. the owner -builder will have the burden of proving that
Date 'Applicant
he did not build or improve for the purpose of sale.).
CONSTRUCTION LENDING AGENCY: 1 hereby; affirm that there is a construction lending agency for.the performance . • .
❑ 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. -CJ.
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 contractor(s) licensed pursuant to the
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Contractor'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
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 tonsent,to. sell•insure, or a
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.).^
Signature of Applicant or Agent ' Date
. Policy No. ,Company -.-
' 'CERTIFICATE &.-COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that .
• .17 Certified copy is hereby furnished. g<• ., .r.',
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
' ❑ Certified copy is filed with. the City. Building Inspection Department or City • Depaitmeht.
•
construct' pp, an out Ilrize a representative of the City of La Ouinta Department of Building and Safety to,enter
upon the fap ty td w iehd'ha. a appl ed•for this.permi(for the purpose of making inspections:
Date Applicant
/ .
'V Signature of Applicant or Agent Date
APPLICANT NAME (L. F. MI) . Liiwnl: T n
ADDRESS P.O. B6X `7fl
CITY/COMMUNITY/STATE/ZIP . ta Qu=ta>/' `CA' 92253
JOB SITE ADDRESS/SPACE ., 76=900 Calle -Mia' li t.1„ n .
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CITY/COMMUNITY/STATE/ZIP
•_ ta, 17Gt<92
BOK
-PAG
PRC•.
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TWhI
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TNh5-2
LOT,2
Elects Fee
72.66
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SB
Plumbing Fee.
TRACT NAME..
Ibnni.s Villas
OWNER NAME (L. F. MI) ♦ . • .
Applicant
CONTRACTOR -FIRM NAME t ..
]7C]
applicant
ADDRESS .. ,
ablme
CITY/COMMUNITY/STATE//ZIP
above
PHONE N • 345/2888
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ARC/ENG FIRM NAME :..
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ADDRESS
CITY/COMMUNITY/STATE/ZIP . ,.
PHONE N
LICNC N
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USE OF PERMIT Condo -
BL
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,SSB.'
• SSB'
'RSB
OFC.,.
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.' END'
:' SIDE',•
Print Applicant/Agent Name
APPL/PRMT q Ij
1111`85 CC=.
Permit to camkrdct 1736 sq. ft, of taro- -
story condo plus 288
sq. ft. of porch 'and
451'sq. ft:'of.gxrage as per ag '.plans••
YAX1. Fee
- 42.00
Plan Qli Fee
379.85
455.50
Elects Fee
72.66
SIVa ' Fee
7.60
Plumbing Fee.
102.00
Infrastructure Fee
2,000.00
TOTAL.'-`:
FEE
3,059.61
A Q, 4,,.1.3. 3 2,0 3 t, 5 9 4 1C
• ;:, VALUATION 108.275.00,
BLDG: DEPT. r '
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NO.
OPERATION I rKTE
INSPECTOR
NO.
OPE TION I 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
a1
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)
126 Ceiling (Batts)
12C Ceiling (Blown)
14 1 Final
PLUMBING APP O ALS
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 - A
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
P/L PA
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final