SFD (000976)76903 Calle Mazatlan
000976
APPLICANT NAME (Li F, MI) .
Andw/
ADDRESS - - •" -
P.O. Box 780
PERMIT
APPLICATION
JOB SITE ADDRESS/SPACE -
City of La Ouinta
• Department of Building and Safety
CITY/COMMUNITY/STATE/ZIP .. ,
• La Qui,nta CA 92253
BOK.
PAG •
,r-• - ;' -.'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 neednot be completed if
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.LICENSED CONTRACTORS DECLARATION: I hereby affirm, that I am licensed under provisions of Chapter 9
the'permit is-forone hundred ($100) o, less: I certify that in the performance of the.work,for which this permit is
t.,
(commencing with Section 7000) of Division Sof the Business and Professions Code: and my license is in lull force
issued; I shall not employ any person in any manner so as to become subject to the Workers' CompensatioRLaws of
and effect. "
California.
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License Class Li-c_!N!BX r ` _•
Date ` Applicant
1
2 '
.*"Date -1 ' Contractor 1 = ' -•
NOTICE,TO APP.LICANT;.If, after, making, this.Certificate of Exemption; you should become subject to.lhe Workers
'-
_
V
OWNER -BUILDER DECLARATION: 1 hereby affirm that I am exempt from fhe Contractor's License Law for the
Compensation provisions of the Labor Code, you must forthwith. comply with such provisions or.this permit shall
revoked.
OWNER NAME (L. F. MI) Andm• .-.
following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires. a permit to
be deemed
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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 asigned statement that he is licensed pursuant to the provisions of the Contractor's License Law
O'Iherebycertilythafnoexcavalionlive,(5)ormorefeetin,deplhintowhichapersdnisrequiredtodesiend,willbe
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(Chapter 9(commencing with 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.
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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 thanfive hundred dollars ($500.):
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0 I,.as owner.of the property, or my employees with wages as their sole compensation, will do the work, and the
0 As' 'owner -builder; I will 'not employ anyone to-do work which would require a permit from'the Division of
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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 persomhas a.permit to do such work from that -division.
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Law does not apply to an owner of property who builds, or improves thereon, avid who does such work himself or
O Division Industrial Safety. Permit No.
through his own employees. provided that such improvements are not intended or offered for sale. If, however, the
of
building orimprovemnt is sol it within one year of completion; the owner-, builder will.have the burden of proving that , I
Date Applicant
^ he did not-hbuild or improve for the, purpose of sale.).. ; , . :.
CONSTRUCTIONIENDING.AGENCY: I hereby affirm that there is a construction lending agency for the performance
q 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
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Name .
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builds 'or improves thereon: and who contracts for such projects with a contractor(s) licensed pursuant to.the•
.Lender's
. , .
Contractor's License Law.). _
Lenders Address
,
,. 0.1 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 Owder
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. •
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• WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a:certificate of consent to self, insure, or.a'
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' certificate of Workers' Compensation Insurance .'ora certified copy thereof (Sec:,3800. Lab. C:):.
Signature of Applicant or Agent Date
Policy.No. Company.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify Ihave read this application and state that
O. Certified copy is hereby furnished:
11 he information given i correcL•I agree to comply with all state laws and county ordinances relating to buidling
D. Certified co is filed with the Cit Building Ins ectiori Department Cit De artment.
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- c Onstruction; and authorize; a'representative of the City of La Ouinta Department of Building and Safety to enter
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upon the p?Joperty to which haave.applied for this permit for the purpose of making inspections.
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,
Date Applicant .
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Signature of Applicant or Agent Date
Print Applicant/Agent Name
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APPLICANT NAME (Li F, MI) .
Andw/
ADDRESS - - •" -
P.O. Box 780
CITY/COMMUNITY/STATE/ZIP
La Qwnta, M 92253
JOB SITE ADDRESS/SPACE -
.% 76-903 Calle Mazatlan
CITY/COMMUNITY/STATE/ZIP .. ,
• La Qui,nta CA 92253
BOK.
PAG •
PRC
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FIND
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TRACTLOT
MOD
SB
14496-31.
.34'
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- •' S + v. iy •• f: ' ;
,FEE .
TRACT NAME
Santa Fbsa C vrb
OWNER NAME (L. F. MI) Andm• .-.
CONTRACTOR -FIRM NAME ..
Aoplil ant -
ADDRESS ' ..
above
CITY/COMMUNITY/STATE/ZIP
PHONE 0 .•
LICNC
56A-3315 a
333762
ARC/ENG FIRM NAME. Q'' Berlds
Ba `.Z
ADDRESS
1531. Okipala Street
CITY/COMMUNITY/STATE/ZIP • "'
Santa Barbara, CA 93101
HONE -9 -8901
LICNC . ,
USE OF PERMIT
1 - Sinvle family &vell&n '
BL
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FSB
I SSB
'SSB
RSB
OFC
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44
ZONE ORO. LOT SZ • END • SIDE b: q • , 4
y t * 1J fy,• d4 .A-,i( a.Ri
4%, 1, 1
.".{ y }. .r ♦ w • u:
•! u-. ;+r'F,j '=+`.^S' S'r.y,`+r t .a•s/ 3.+ ` IT.i. v .. w,. 4r. .. ] VALUATION
:fir*_ c t ? ' w= . s.%?PE,SR:RO
'""fir[!_ G• [, , .. "i < ... , ,BLDG. DEPT, n' .?"t tit` vt •, «
APPL/PRMT . DATE
l0- 9-84 S.F.D.. _... _
A mi t to o mstculat 2,758 sa. ft. of •
c; ru'r P family Lalling with attached
vkao—' •, i al Fio2a 26-00
u ar, le kY ' 3.76-95
C onstn=it a. 11 Fee- 503.00 '
M-trical Fee 42.16
SMI Fee 8.93
P iaTiT ]] tl1Q ' Fif P 3.00
Pranert Dev. Fee 450.00
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CIT f OFP RTMFNT
1LC)ING
TOTAL
- •' S + v. iy •• f: ' ;
,FEE .
-
1„430.011 .
44
ZONE ORO. LOT SZ • END • SIDE b: q • , 4
y t * 1J fy,• d4 .A-,i( a.Ri
4%, 1, 1
.".{ y }. .r ♦ w • u:
•! u-. ;+r'F,j '=+`.^S' S'r.y,`+r t .a•s/ 3.+ ` IT.i. v .. w,. 4r. .. ] VALUATION
:fir*_ c t ? ' w= . s.%?PE,SR:RO
'""fir[!_ G• [, , .. "i < ... , ,BLDG. DEPT, n' .?"t tit` vt •, «
APPL/PRMT . DATE
l0- 9-84 S.F.D.. _... _
A mi t to o mstculat 2,758 sa. ft. of •
c; ru'r P family Lalling with attached
vkao—' •, i al Fio2a 26-00
u ar, le kY ' 3.76-95
C onstn=it a. 11 Fee- 503.00 '
M-trical Fee 42.16
SMI Fee 8.93
P iaTiT ]] tl1Q ' Fif P 3.00
Pranert Dev. Fee 450.00
Jx
CIT f OFP RTMFNT
1LC)ING
TOTAL
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Ak
NO.
OPERATION TATE
INSPECTOR
NO.
OP ,ATION 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
a
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
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
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
p/L PiI
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire "A
29B Bonding
30 Fixtures
31 Service
32 Final 1