SFD (001005)76913 Calle Mazatlan
001005
ADDRESS .. ... - •. ".
P.O. Box 780
CITY/COMMUNITY/STATE/ZIP -
PERMIT APPLICATION
1 City of La Ouinta v 14
s ` `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.. ' • . - t
- r:* ++ •
'CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
• LICENSED CONTRACTORS' DECLARATION: I hereby affirm that I'am licensed under provisions of Chapter 9 =
.. the permit is for one hundred ($100) o, less. I 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, I shall not,employ any person in any manner so asto,become subject to the Workers'CompensationLaws of '-
and effect. f -
California.
License Class- —L•ic. Num bl r• r
'"%
Date Applicant
Date -'f=J `,1 - Contractor - r' '! . -...,c __:._...NOTICE TO APPLICANT: If; after.making.this Certificate obExemption, you should become subject the Workers.-,
OWNER -BUILDER DECLARATION: I hereby affirm itiat I -am exempCfrom`'the Contractor's License taw for'the
K; Compensation provisions of the Labor -Code, you must forthwith comply with such -provisions or this permit shall
following"reason (Sec. 7031.5. Business and Professions Code: Any city or county which-requires•a permit to
be' deemed revoked.
"' .
construct, alter, improve, demolish., or repair any structure, prior to its issuance, also requires the applicant for
..DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION. 5 '
such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
0 ihiireby certify that n6lexcavation five (5) or more feet -in depth into which a person is req'uired to descend; will b'e
(Chapter 9(commencing.with section 7000) of Division 3 of the Business and Professions Code) or that he is exempt
made in connection withbiork allihorized by this permit; and that no building strbcture, scaffolding, falsework, or •. M
•'.
therefrom and the basis for the alleged exemption. Any violation of. Section 7031.5 by any applicant for a permit" y,
^. ' demolitioh or dismantling thereof; will be more than thirty-six (36) feet high: (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8, '
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.): fr
C.A.C.)
p 1. as owner'of the property, or my employees with wages as their sole compensation, will do the work, and the
p' As'owner-builder, Twill not employ anyone to do work which would require a permit from the Division of I
- structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License
builds, improves who
Industrial"Safety, as noted above, unless such person has a permit to do such work from that division. °^ i
Law does not apply to an owner of property who or thereon, and does such work himself or
through his own employees, provided that such improvements are not intended or offered for sale. If, however, the'
p Division of Industrial Safety Permii No.
building orimprovemntissold within one 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.). :, , i, r • .. ' .
CONSTRUCTION LENDING AGENCY:' I hereby affirm that there'is a construction lending agency for the performance
p 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. 3D97, 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 '
builps or improves thereon, and who contractsforsuch projects with a contractor(s) licensed pursuant to the
CITY/COMMUNITY/STATE/ZIP - .. •*
Contractor's License Law.). _,
Lender's.Address ...i
❑ I am exempt under Sec.' B. 8 P.C. (Attached Certificate).
I certify tdat Lhave read.this application and,state that the above information is'correct. I agree 4o comply with all
Date - "' - Owner X'"
city and county ordinances and state laws relating to building construction, and hereby authorize representatives . ;,..
siml.e fewnilv dial - (rxx
"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.consent to self -insure; or a
certificate of.Workers' Compensation, Insurance or a certified copy thereof (Sec. 3800. Lab. C.).
ZON
,
r..
Signature of Applicant or Agent Date 4
Policy No.—Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:Icertify Ihaveread this applicationand state that
p Certified copy is hereby furnished. c- ..
the information given-is.correct. I agree to comply with all state laws and county ordinances relating to buidling
❑ Certified co Is filed with the City' Building Inspection'De Department or Cit Department.
Dy Y 9p Y D
constructyo%authorise a'representative of.the City of la Ouinta Department of Building and Safety to enter
.o
upon 4h ty-forr-wh`Ich / iave apiplied for this permit forthe purpose of. eking inspections:'Date
Applicant
„
Signature of Applicant or Agent Date
i—
Print Applicant/Agent Name
APPLICANT NAME (L: F. MI)
I) -
[nden CDrP. -
ADDRESS .. ... - •. ".
P.O. Box 780
CITY/COMMUNITY/STATE/ZIP -
La Quinta, CA 92253
JOB SITE ADDRESS/SPACE ..
76913 Gal•le Mazatlan
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
BOK
PAG
PRC
C
TWIN
RNG
SE •.
S
TRACT
LOT
MOD
SB
-
14496-"
33
G-3
TRACT NAME
Santa, RDsa Ome
OWNER NAME (L, F. MI).
CONTRACTOR -FIRM NAME - .-
kiden
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP •. . -
above
PHONE .
LICNC 0
-
564-1315
333762
ARC/ENG FIRM NAME - -
Dom-
ADDRESS .- - ,. .
1531. O_ ala Stmt
CITY/COMMUNITY/STATE/ZIP - .. •*
.Santa Barbara, CA93101
PHONE. -
LICNC 0
USE OF PERMIT .. -
siml.e fewnilv dial - (rxx
BL
ZON
,FSB
SSB SSB , Rse
OFC
h" ZONE ORD.
LOT'SZ
END
SIDE
T, ...
=
y,na i .p 1 ... .. a 1• t- _ u ",,, 4f.,.i-a t a" • w.r , t. i w. •y s • .
qty l 1 1 a.. t'S 'moi iV. x RT t• i, E .VALUATION 1d5,86s
VT w ,,BLDG:DEPT s ;„ . , • .. 4 _ .
'APPL/PRMT DA
u [ i 0..11{ , TEs S.F.D.
PenUt bo aonstb t 2,326 Sq. ft. of.
suigle, fame iy dwelliM with attached'
Ma h. Fee 26.00
Pian Check Dee 291.20
Cl ., Fee 448.00
Elect. Fee 36.90
SM Fee • 7,39
Piw bing Fee, 73.00 i
Prop. aviel, Fee 450,00: ;'.
ven
.'TOTAL ..
-,,....-a•.+l k .air 'FEE '. 332.49
,:
=
y,na i .p 1 ... .. a 1• t- _ u ",,, 4f.,.i-a t a" • w.r , t. i w. •y s • .
qty l 1 1 a.. t'S 'moi iV. x RT t• i, E .VALUATION 1d5,86s
VT w ,,BLDG:DEPT s ;„ . , • .. 4 _ .
'APPL/PRMT DA
u [ i 0..11{ , TEs S.F.D.
PenUt bo aonstb t 2,326 Sq. ft. of.
suigle, fame iy dwelliM with attached'
Ma h. Fee 26.00
Pian Check Dee 291.20
Cl ., Fee 448.00
Elect. Fee 36.90
SM Fee • 7,39
Piw bing Fee, 73.00 i
Prop. aviel, Fee 450,00: ;'.
ven
.'TOTAL ..
-,,....-a•.+l k .air 'FEE '. 332.49
Alk
Ak
NO.
OPERATION v TE
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
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
J Compressor
6
Roof Deck
39
1 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
7 07 7
l/ C> G.
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 P/I
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final