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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. Z,', 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 OFC 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* LICNC 4 USE OF PERMIT fmdly dimlling' BL, !ON .FSB SSB SSB RSB OFC ,rr ZONE ORD LOT SZ 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