SFD (000897)76921 Calle Mazatlan
000897
'APPLICANT NA
Allen Coxoration
ADDRESS
P.O. B= 780
PERMIT
APPLICATION
City of La 06intia
Department of Building and Safety'
SOK PAG
1, 7
'go
PRC
7
This.permit becomes void if work not commenced within 180 days from date.of
issuance, OR, if work has been suspendedorabandoned-for-a peii6d of 180 days.,
TWN
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%
-CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
e-1
—LICENSED CONTRACTORS DECLARATION: I hereby affirm that'.1 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-!, k
and effect.
California. Y"
License Class Lic. Number
Date— Applicant,
Contractor
'Date0
APPLICANT
N
NOTICE T T: aflW;riaking0is Certificatiot Exemption, you should become subject to the Workers',. _-
OWNER -BUILDER DECLARATION:. I hereby affirm that I am exempt from thd Contractor's License Law for the
Compensation -provisions of the Labor Code;you must forthwith comply such provisions or this permit shall..v
following reason (Sec. 7031.5: Business and Professions Code: Any city or county which requires a permit:to
be deemed revoked.
construct, alter.,improv6, demolish, or repair.any structure, prior to its issuance; also requires the applicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
such permit to file a signed statement4hat he is licensed. pursuant to the provisions of the Contractor's License Law,..
01 hereby certify that no - excavation five (5) or mdr6 feet in it e . pth into which a person is required to descend, will be
(Chapter. 9 (co in men ci ng 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 permit. -and that no building structure, scaffolding, falsew6rk or'
therefrom and the basis for the alleged exemption. -Any violation of Section 7031.5 by any applicant for a permit'
,,demolition or dismantling.tHireol, will be more than thirty-six (36) feet high. (Chap 3.2.'Grp 2SArt 2, S6041, Till 8,
subjects the applicant to a civil penalty of not more than five hundred dollars -(S500.):
C.A.C.J-
P 1, as owner of 'the property: or my employees.with wages as their -sole compensation, ' will do the work, and the
b As`o vner-builder, I will-,not,employ,anyone to do work which would require a permit -from the Division of ; z
structure is not intended or offered for sale (Sec. 7044,.Business.and Professions Code: The Contractor's License
Industrial Safety.'as noted atokdo such :6nlesi such person has a permit to c -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
SSB
through his own empioyees, provided that such improvements are not intended or offered for sale lf, however, the
0 Division of Industrial Safety Permit No. .
. . 1.
' '
building or improverrint is sold within one year of completion, the owner -builder will have the burden of proving that
- . 1 1 1
- -
-Date Applicant '
p purpose of.sale.).
he,did not build or improve for I .:: 6 , -;
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agencifor the performance
0 1, 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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Lender's Name
builds or improves thereon, and'who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
Lender's Address
• 0. 1 am exempt under Sec. B. B.P.C. (Attached Certificate).
Owe,
I certify'that I have read this applicatiortand state that the above information is correct. I agree to comply with all
`Dati' Owner
city and county ordinances and state laws relating to building construction, and hereby authorize representatives. 4
or this county to enter upon the above-mentioned property for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have acertificate of consent to self -insure, or a
. . '. . "a. -:z - " - \ " i. -.. . - . .
certificate of Workers' Compensation Insurance , or a certified'copy thereof,(Sec: 3800. Lab.-C.).'Signatui6
of App!rcanfor,_Agent Date
Policy No. Company
ii
• 0 Certified copy is hereby furnished.,
I
CERTIFICATE OF COMPLIANCE AND AUTHORIZATIONI:01` ENTRY.Ic ertify I have read this application and state that .
ttie information given is correct. I agree to comply -with all state laws and county ordinances relating to buidling
construction, and a 'representative the City La Ouinta Department Building Safety
uildih Department..' City B
0 Certified'copy is filed with the g Inspection or.Cify y
authorize of of of and to enter
t-3 '4
up on I he propert y for which I h ave app lied for this permit for the purpose of making insp(itions.
date Applicant
. . I . . . . .
'Signature•of Applicant orAgent Date
•
Print Applicant/Agent Name
'APPLICANT NA
Allen Coxoration
ADDRESS
P.O. B= 780
CITY/COMMUNITY/STATE/ZIP
La .CA 92253
JOB SITE ADDRESS/SPACE
76-921 Calle Mazatlan,
CITY/COMMUNITY/STATE/ZIP
la Quinta, CA 92253
SOK PAG
1, 7
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PRC
7
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TWN
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SE
S
TRACT
14496_3
Canst. Fe e
LOT
42
ElectFee
MOD
P6-1 .
S B
SB
5.85
TRACT NAME
OWNER NAME (L. F. MI)
CONTRACTOWFIRM NAME
AWve
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE a
C;9ZA_1 111 q
=.I VAr-qJ
A U G 171984
LICNC I
—City ofLa Quirila
ARC/ENG FIRM— NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE 0
TOTAL'
FEE
LICNC
USE OF PERMIT
family dwelling
OL
ZON
FSB
SSB
SSB
I RSB
OFC
• ZONE ORD* 1
'LOT
SZ
END
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. i& 4' .1 r ce BLDG. DEPT -.,,V-!,.*-
APPL/PRMT
%I. DATE
8-16-84 9,
S.F.D.
Permit to cgfistr61f,903 sq. ft. - of
,_4in4lehk&Nr --'dwellihng with
attacbed garage.
Mechanical Fee
31.00
Plan Ck. Fee
250.25
Canst. Fe e
85'00
3.
ElectFee
31.25
SMI Fee.
5.85
+
Plumbing ii,lg F&
48.50
PLW Dev, Fee t
450.00'
=.I VAr-qJ
A U G 171984
—City ofLa Quirila
TOTAL'
FEE
1,201.85
V'A L UAT i O'N' t
r7
Ah
NO.
OPERATION DATE
INSPECTOR
NO.
OPE 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
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.
❑
OP'NO.
ADDITIONAL INFORMATION
_
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick al
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APP OVALS
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 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