SFD (000892)76901 Calle Mazatlan
000892
APPLICANT NAME (L. F. MI)
PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
P.O. Box 780
CITY/COMMUNITY/STATE/ZIP
This permit becomes void if work not commenced within 180 days from date of issuance, ORJf,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 it
LICENSED CONTRACTORS' DECLARATION: 1. hereby affirm that, I am, licensed under provisions -of Chapter 9
the permit is for one huridred.($100) o. less.,,l 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, [shall not employ any person inany mannerso asto become subject to the Workers'CompensationLaws of
and effect.
California.
.License Class Lic..Number
Date Applicant.
Date Contractor -4 _NOTi10E
TO APPLICANT: If, after making this Certificate'of.Exemption., you should become subject to the Workers' -
OWNER -BUILDER DECLARATION:' I hereby affirm that I am exempt from the Contractor's License. Law. for the.) t ,, Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
be deemed
following reason (Sec. 7031.5, Business and Professions Code: Aqy.city or county.which requires. a. permit to
revoked.
construct, alter, improve, demolish, or repair any structure, prior 16 its issuance,.also requires the applicant for
DIVISION.OF.INDUSTRIAL SAFETY PERMIT CERTIFICATION: -
such permit to file.a.signeo statement that he is licensed pursuant to the proyisions,of the Contractor's License Law
0.lhereby certify that no excavation five (5) or more feet in depth into which 6 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 permil, 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 thiity-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 ($500.1:
C.A.C.)
0 1, as owner of the property, or m; employees with wages as their sole compensation, will dothe work, and the.,'
0 As`-Itwneir-builder, 1.*Ill'n\6t employ -anyone to do work.which would require a permit from tfie Division of
structure is not intended.or offered for sale (Sec. 7044, Business and. Professions.Code: The Contractor'slicense
lndu`shr_ial. - Safety, as -noted aibove, unles s 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, hirnieWor -
' . I . I , . .. .
through his own employees, provided that such improvements are not intended or offered for sale. If, however, the
0 Division of Industrial Sa'f.ety..Permit Noy
building or improverrint issoldwithin one year of completion.,the owner -builder will have the burden of proving that
Date Applicant.
he did not build or improve for the 'purpose of sale.).
r
CONSTRUCTION LENDING AGENCY: I hereby affirm that eis
the- a construction lending agency' for the performance
0`i7 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.).*t
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.
1
Contractor's License Law.).
..Lender's Address
0 1 am exempt -under Sec: B. & P.C. (Attached Certificate).
lCerlify that I have read this application and state that the above information is correct. I agree to comply with all
Date ;"bwn.er-- 4e
• city and county ordinances and state laws relating to building construction, and hereby authorize representatives e.,
LICNC 4
of this county to enter upon the above-mentioned property.for inspection purposes. -
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have icertificate of.consent to self-insure,.or a
BL,
certificate of Workers"Compensation, Insurance , or a -certified copy thereof (Sec. 3800. Lab. C.).
Signature of Applicant or Agent Date
Policy No. Company
CERTIFICAT60F COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
I
0 Certifiedcopyis hereby furnished.
Ahe information given is correct: I agree to complywith all state laws and cou nty.ordinances relating to buidling
Building Inspection Department or City. 0 Certified Copy is filed with the City C, Department.
C?nstruction, and authorize'a 'representative of the City of La Ouinta Department of.Building and Safety to enter
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upon the prop rty,for which I have applied for this permit for the purpbse of making inspections.
ic
Date Appl aril
LOT SZ
"Signature 61 Applicant it Agent Date
•
Print Applicant/Agent Name
APPLICANT NAME (L. F. MI)
Arx3en Mrmration
ADDRESS'
P.O. Box 780
CITY/COMMUNITY/STATE/ZIP
la,Quinta. CA 92253
JOB SITE ADDRESS/SPACE 1. .
76-901 Callia Mazatlan
CITY/COMMUNITY/STATE/ZIP
Ta rxximt4. M 92253
BOK
PAG
71:20
PRC.
10
C.
31:00
TAIN
RNG
1 SE 1,S
373.00
TRACT
LOT.
SM FEE'
5.57
,mo 0
SIB
Pte. nemi. k Pal-
14496
40
Lit •TOTAL
W
FEE 1:_ 031-z77
1 P-2
TRACT NAME
ctArli-A
OWNER NAME (L. F. MI)
CONTRACTOR -FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE a
'11ICNC
•7
AA
SAA -111 q
62
1
ARC/ENG FIRM NAME*
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE*
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USE OF PERMIT
fmdly dimlling'
BL,
!ON
.FSB
SSB
SSB
RSB
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,rr ZONE ORD
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END ,
SIDES
APPL/PRMT
nRq
DATE
8-16-13 S.F.D. •
Perm itto construct Model P-2 B
Nellihcr
1,390 sq. -ft..
Porch
112 sq- ft,
etre
4,22-sict'.., ft.
-Magbanical Fee
31:00
Plan C -back Fee
242.45.
Onast. Fee
373.00
Fjaiit. Fee
31.25
SM FEE'
5.57
p1mbing 'Noe
48.50
Pte. nemi. k Pal-
300.00:
C IV AAV -V )
1.7198 . 4 We,
Lit •TOTAL
W
FEE 1:_ 031-z77
#
A
4 as
dr 4
E J
A
DG. DEPT.
VALUATION
Alk
A&
NO.
OPERATION
I INSPECTOR
NO.
OP , TION I DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back.
• 33
Ventilation System
2
Ftgs & Frms
0
(
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.
❑
NON
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall e
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts) 116 4
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
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
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
PSL PAI
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final