SFD (000998)76933 Calle Mazatlan
000998
PERMIT APPLICATION
ADDRESS
P.O. B= 780
City of La Quinta
Department of Building and Safety
JOB SITE ADDRESS/SPACE
76-933 Calle'Mazatlan
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
BOK
PAG -
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:
26.00
"t"
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE, This section need not be completed if
SE
LICENSED CONTRACTORS "DECLARATION:. I.- he(eby-affirm- that I am licensed under, provisions of .Chapter 9
the permit is for one.hundred ($100) o, less. I cerlify.that in the performance of the work for. which,this permit is
LOT00
31
(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'Compensation Laws of
X
and effect.
California.
Ze
TRACT NAME
Santa Hoisa, Owe
License Class
Applicant
ADDRESS
above
Date A; 12—? - ell - Contract r.
NOTICE TO APPLICANT: If, after.making this Certificati.,of Exemption, you should becoriie subjec"to the Workers'
IJ
OWNER Law for the
-BUILDER DECLARATION: I hereby affirm that I am exempt from. the t4tradfor's License L'
Compensation provisions of the Labor Code, you must forthwith compty,with such provisions or this permit permit shall
.
"revoked'
fiery
".,following reason (Sec. 7031.5. Business and Professions Code:,Any city of county which requires a permit -to
be ed
deem.
PHONE 0 -
805 963-89011
construbt,,all6r, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for
DIVISION OFANDUSTRIAL SAFETY PERMIT CERTIFICATION:
such permit to file asignid statement that he is licensed pursuant to the provisions of the Contractor's License Law
0-1hereby certify that no excavation five (5) or more feet in ddoth into which a'person is required loclescend,will be
i.
(Chapter 9.(commencing with section 7000) of Division 30f the .Business and Professions Code) or that heisexempt
made intonnection with work authorized by this permit, and tfiatnti building structure, scaffolding, falseworklor
I SS8.
therefrom and the basis for the alleged exemption eAny violation of Seciion.7031.5 by any applicant for a permit .
demolition of dismantling thereof, will -be more than thitty-six (36) feet high. (Chap 3.2, Grp 2 Art '2, Sec 341; Title 8,,
-
subjects the applic Ito a civil penalty of not more than live hundred dollars ($500.):
nproperty,
4
O.I.as owner ofthe oi.myemployees with wages as their sole compensation,will do the work, and.the
is intended for 704.4, Business Professions Code: The Contractor's
0 As owner -builder, I will not employ anyone to do work which would require a permit from the Division of
-
,structure not Proffered sale (Sec. and License
Industrial Safety, as noted iiboVe.- 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 I . I Industrial . . . . . . . . I . _.. . . . . . '. . .
q Division o Industrial Safety Permit No
through his'own employees, provided that such improvements are notintended or offered for sale. If,.howeverjhe
buildingor improvemnt is sold within one year qfqompletion, the o.wner-builder will have the burden of proving that
Date - Applicant
he did not build or improve for.the purpose of sale.). . , , 1, . I . - .. . . .
."
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
?`a
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
Lender's Name
builds or improves' thereon, -and who*contracts for such projects with a contractor(s)Aicensed:pursuant to the
.-Conitactor's License Law.),
Lender.'s 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
-,4,
U ate'— Owner
city and.county ordinances and state laws relating to building construction, and hereby authorize representatives
J. . .
of this county to enter.upon the above-mentioned property for inspection purposes.- -
WORKERS' COMPENSATION DECLARATION: I hereby.affirm that,I have acerlificale of consent to self -insure, or a;
s, certificate of Workers' Compensation, Insurance 7 or a certified copy thereof (Sec. 3800. Lab. -C.).
Signature of Applicant or -Agent Date
Policy No. Company
e
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
,ID,Certified copy is hereby furnished..
the information given.is corr—ectl agree.to.comply-with all state,laws and county ordinances relating to buidling
Certified copy is filed With the City Building Inspection DepaFtment or City; Departments.-
Oy
construction and athodzea 'representative of the City of La Quinta Department of Building and Safety to enter
•
Oat Applicant
gportftlpro for whidlfiaA applied for this permit for thli purpose of'miking inspections..
SignatureptAppl'icant or Agent Date
APPLICANT NAME (L, F. M111
ADDRESS
P.O. B= 780
CITY/COMMUNITY/STATE/ZIP
La Dainta, M 92253
JOB SITE ADDRESS/SPACE
76-933 Calle'Mazatlan
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
BOK
PAG -
PAC
C
26.00
TWN
RNG
SE
S,
TRACT
1449603
LOT00
31
SMI Fee
1'
r1
1 M -
S8
Prop. D6vei,
TRACT NAME
Santa Hoisa, Owe
OWNER NAME (L. F. MI) kxlen'
CONTRACTOR -FIRM NAME
: . ..
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
above
PHON E a i' i ' .
564-1315
I L NC#
3'c33762
.7
ARC/ENG FIRM NAME
Berkas
ADDRESS 1531 Oia Street
CITY/COMMUNITY/STATE/ZIP
Santa Barbara, CA 93101
PHONE 0 -
805 963-89011
- ",I
LICNC 0
USE OF PERMIT
I sirma faallly dwelling
13L
ZON
FSB
I SS8.
SSB
'ASS
OFC
ZONE ORD 4
LOT SZ
END
SIRE'
Print Applicant/Agent Name
APPL/PRMT
nn 998
DATE
Permit to cimstrutt 2,758 sq. ft. of
sAngle family dwelling with attached
• garage.
mech...Fee
26.00
Plan Check Fee
326.95
Coana. Fee
503.00
Elect. Fee
42.16
SMI Fee
8,93
Plumbincr Fee
73.00'
Prop. D6vei,
4 50-..04 0"
of
14
.7
TOTAL
FEE
.1.430.
-,J
4L
VALUATION 127,658.
IL
'Q ION
A f
8'LDGFDEP:t.
Ah
Ak
NO.
OPERATION MTE 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
S
35
Furnace Compart.
3
Steel
Sr
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 // 0 7
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 G