SFD (000903)76919 Calle Mazatlan
000903
Y
PERMIT APPLICATION
City of
La Og
•1}y
' Department of
a
Building and Safety "
CITU/COMMU_.. NI,TY/S TAaTr ZILa P' 92253' - -
JOB SITE ADDRESS/SPACE
• Thispermit becomes voidif work not commenced within 180 days from date of issuance: ORr if -work has been suspended or abandoned for a period of 180 days., •''' .
r,
CERTIFICATE OF EXEMPTION FROM.WORKERS' COMPENSATION INSURANCE: T.hi3 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 as to become subject to the Workers Compensation Laws of
and effect. ` - _ . -
California. + • . ;y
License Class - Lic. Number
Date- • Applicant.
' Date " •Contractor
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers
c ^'
OWNER -BUILDER DECLARATIONr I hereby alhrm tnat I am'exempt from the Contractor's License Law for the
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.
" ' H
r"•construct.'alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for :
- '-,OIVISION.OF INDUSTRIAL -SAFETY PERMIT CERTIFICATION:_.
such permit to file a signed statement that he is licensed pursuant to the provisions ofthe Contractor's License Law, '
1i I her6Vceirtify that no excavation five (5) o,r'm. ore feet'in depth into which a person is required tQdescend,.w ill be yy
' (Chapter 9.(commencing with section 7000) of Division 3 of the Business and''Professions Code) orthat he is exempt'
made in connection with work authoriieb by this permit; and that no building structure, scaffolding; falsework; or r
therefrom and the basis for the.alleged;exemption: Any violation of Section 7031.5 by any applicant;for a permit
demolition'or dismantling thereof, willbe more thamthirtysix (36) feet high. (Chap 3.2, Grp 2 Art 2; Sec341, Title B, u-
subjects the applicant to a civil penalty of not more than five.hundred dollars (5500.): . • - '
C:A.C.p ' . ^/-'h`^?
❑ I. as owner of the property, or my employees with wages as their sole compensation; will do the work, and the
"' O'As o, w-ner•builder,il will not employ anyone'to'do work which would require a permit from the Division of. y
structure is not intended or offered for sale (Sec. 7044: Business and Processions Code: The Contractor's License
r 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, or improves thereon, and who does such work himself or
V. ' • . .
' 'through his own employees, provided that such improvements are not intended or offered for sale'.If, however; the
❑ D+yision of Industrial. Safety Permit No.
building or Improvemnt is sold within one year of completion, the owner -builder will have the burdeoof provingthat
Date 'Applicant
.;
he did not build or improve for the purpose of sale.):
CONSTRUCTION LENDING AGENCY: I hereby affirm that there ,is a construction lending agency for the performance !
O 1: as 'owner of the property, am exculsively contractingwith licensed contractors to construct the project(Sec.
-0 1 the work for 'which this permit is issued (Sec. 3097, Civ: C.). • - `:.y
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.
ARC/ENG FIRM NAME •- •• .t•--• '
)
,Contractor's License Law.). __
Lender's Address
O 1 am exempt under Sec. "' B. & P.C. (Attached Certificate), . ' ..
-..+ I certify-that.l have read this application and state that the above information.is correct. I agree to comply with all
Date Owner h ' "'
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
-
of this county to enter upon lie 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 (Seo. 3800. Lab. C.).
Signature of Applicant or Agent Date
Policy No. Company ' ~
' 'I
'
• O Certified copy -is hereby. furnished.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: certify I have read ihisapplicationand statethai =• '•
the information given is correct. l agree to comply with all state laws and county ordinances relating to buidling
~ _ :
'•"O Certified copy is filed with the City Building'InspecuodDepart` nt or City^' DeparlmenL '
construction•, and authorize a.re resentative of the Cit of La Ouinta De
P y Department of Building and Safety to enter
"c : j'; - i • '1 / . . 3/' - • .
Date Applicant
upon the property for which f have applied for this permit for the purpose of making inspections..:
r. ,. .. ... t
r Signature oj'Appticiint r;Agent Date
'END,
. SIDE • ' '
Print Applicant/Agent Name
APPLICANT NAME IL. F. MI)
ATOen dim tion
ADDRESS' - •' '
Q_ 780
CITU/COMMU_.. NI,TY/S TAaTr ZILa P' 92253' - -
JOB SITE ADDRESS/SPACE
7C-919 Calle Mazatlan
CITY/COMMUNITY/STATE/ZIP
La 92253
BOK r
31
'PAG
7
PRC C
y/
Garac;e
TWN '
RNG
SE
S
mechanical `Fee
31.00.
.
'TRACT
LOT. -' -
4480'00`
MOD
SB
3.125
1449F; 3
:SII Fee
41
P-3
52.50.
'
-
TRACT NNA,. , A.;M..E,
yy , y ,,
Sc -m a Jibsa CWe
OWNER NAME (L. F: Mq .. i :' . «• . .
CONTRACTOR -FIRM NAME'
ADDRESS
CITY/COMMUNITY/STATE/ZIP
,
PHONE a '
5b4-1315
ni
L.4
,LICNC.o
1333762
-
ARC/ENG FIRM NAME •- •• .t•--• '
)
ADDRESS ('
CITY/COMMUNITY/STATE/ZIP
PHONE a
LICNC M
-
USE OF iMie family cNell ng -
BL
ZON
FSB
SSB
SSB
RSB
.OFC
- :..ZONE ORD .'
LOT SZ
'END,
. SIDE • ' '
APPUPRMT fl R'fl % 3 DATE • ' .' •' ''
rr 11!! Ar
p'e nit to wYial P-3 A
i9valr llfix llzl- •fllrywl
1 _Flti 'ccx_
_
r (2nd floor)
277 sq.
it.
Pozrh .
112 scr.
ft.
Garac;e
433 sq.
ft.
mechanical `Fee
31.00.
.
ponst..Fee
4480'00`
Elect. Fee
3.125
:SII Fee
7.39 •
pl Fee _
52.50.
'
Pro pi Dev. Fee • y
450000.
' '
i .., 1 71984 " .-1
1
i , i i
ni
L.4
Cit Oi',.L•a t •f+J 9. '
TOTALFEE.$ 1; 31Y.34
.•. - • T . ' sS1T . ,, y USG+; Od a .•t '• sl . v • •• I _ -
,f,•, .il•. •t` . X3's.•yr ••"' ,. 4
Al-
f .tt4r yi z t • ! VALUATION`i '105' 40
.., BLDG Dk -E. ':' ._ • tet' a '
Alk
Ah
NO.
OPERATION DATE
INSPECTOR
NO.
OP TION 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
Compressor
6
Roof Deck
39
Appl. Clearance
7
Framing
40
Fire Damper
8
Vents
17
41
Smoke Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P.L.
❑
43
Final
10A
f=ireplace T.O.
❑
OP'N
NO.
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
1.3 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 g
29A Grounding Wire
29B Bonding
30 Fixtures '
31 Service
32 Final