SATT (001253)76936 Calle Mazatlan
001253
-` Y r r r• •
PERMIT
APPLICATION
City
•- r _ Department of
of La Ouinta
Building and Safety
BOK
PAG
• ' • •, This permit becomes void if.work not commenced'within 180 days'from date
of issuance. OR, it work has been suspended or abandoned for a period of 180 days.
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATIONINSURANCE: This section need not be completed if'
LICENSED- CONTRACTORS .DECLARATION. I hereby affirm that Pam 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 S :
(commencing with Section 7000) of Division 3 o1 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. -
''
License Class Lic. Num Prl - =
Date Applicant
• -Date" - Contractor / -
NOTICE.TO APPLICANT: If, aftermaking this Certificate of•Exemption, you should become subject to the Workers' -
OWNER -BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractor's License Law for the
Compensation provisions of the.Labor CodeP;you must forthwith comply with such provisions or this permit shall
• -follow ing 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!
:such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
.' Olherebycerlifyfhatnoexca`ationfive (5)ormore feet indipthinto which apersonisrequired todescend, will be
• (Chapter 9 (commencing 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, falsework, or
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a.permiI ;
demolition or dismantling'thereof, will7be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Ari 2, Sec 341, Title 8; .
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
C.A.C.j
0 1. 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
. structure is not. intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License' ' .
.. ' 'Industrial Safety; a3"noted above, unless such person has a permit to do such work from.thavdivision.
Law does not apply to an owner of property who builds, or improves thereon, and who does such work himself or ':
- •• • ,
through his own employees, provided that such improvements are not intended or offered for sale?If, however, the-. :
0 Division of Industrial Safety Permit No,.
building orimprovemntissoldwithinone year ofcompletion, the owner -builder will have the burden of proving that
Date Applicant -
he did not build. or improve focthe purpose of sale.). ;A...
CONSTRUCTION LENDING AGENCY: I hereby affirm thaLthere is a construction lending agency for the performahce
0- I: as owner of the property, a m.exculsively.contracting with licensed contractors to construct the project (Sec.'
'of`the work'for which this permit is issued (Sec.. 3097, Civ. C.).' • . x
' 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 '
-
Contractor's License Law.).
Lender's Address z ,
0 1 am.exempt under Sec. • B. 8 P.C. (Attached Certificate):
"• I'certify that I have read this application and state that the above information is correct. l agree to comply with all '
Date Owner "`
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.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent -to sell -insure, ora,'-
• • certificate of Workers' Compensation Insurance , or a certified copy thereof:(Sec: 3800.Aab.•C:).
Signature of Applicant or Agent Date
Policy No. Company
-.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY"..1 certify I have read this application and Mate that '
• 0 Certified copy is,hereby furnished.
the information given is -correct. I agree to comply with all+state laws and county. ordinances relating to buidling '
' O Certified co is filed with the Cit Buildin 'Ins ection Department or -City Department..
DY, y' 9 D Y p
v
constructioy,+and authorizAa *representative the City of La auinta'Oepartment of Building and Safety to enter '
th Y r ..i,
for this permit for_ he inspections.
_
Date Applicant
upon pe or.w,ich ave applied purpose of making • .
/
Signature of Applicant or Agent Date '
APPLICANT NAME L. F; MI) Iandmark land
ADDRESS _' P.O. Box /`8.0 ..
I(,1,uJ
CITY/COMMUNITY/STATE/ZIP
LaQ nt I CA- 92253
JOB SITE ADDRESS/SPACE 76-936' Calle NaZatlan '
CITY/COMMUNITY/STATE/ZIP T ..' I .uta ihCA-92253
iCCI 11R .
BOK
PAG
PRC
TWN .
RNG
SE --s
S,
Tes765-2
LOT .27
Elect. Fee
'.
MODS
SB
Plumbing Fee
flgr.•.
TRACT NAME ' m s Villas
OWNER NAME IL. F. MI); applicant '
_
CONTRACTOR -FIRM NAME ' a1V .; C!an {.
...
ADDRESS' above 1
CITY/COMMUNITY/STATE/ZIP
PHONE • 345;-2888:
..
LICNC F
. • ,
ARC/ENG FIRM NAME
ADDRESS -- -
CITY/COMMUNITY/STATE/ZIP _
,PHONE 0 ,
LICNC N
-.3,,110 .52 '
USE OF PERMIT ,,111 f ^
100
81..
., ZON
FSB
SSB.-
SSB'
RSB'
OFC
,
• ZONE ORD:. ,
LOT.SZ ':
END',.
.SIDE
Print Applicant/Agent Name
APPUIPRMT - n ni 2 5
I/* til.
V AYl .
t Al •.
Pemdt -to constrict
1931 sq. ft.. of 6go-
:story ooncb plus 156 sq: ft. of porah'and
451 -sq. ft. of garage as per approved -plans.
Mech. Fee
42.00
Plan "Ck. Fes,
399.19
Const. Fee
-480.50
Elect. Fee
77.53
SMI Fee
8.30
Plumbing Fee
103.001
Fee
1 2,000.00
TOTAL
FEE
-.3,,110 .52 '
A.04'06 3. 2-0 3i
' '• VALUATION i18►389.9A„
• BLDG;. DEPT.
Ah
Ah
NO.
OPERATION ME
INSPECTOR
NO.
OPE 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
o? of
39
Appl. Clearance
7
Framing
S
j
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'N
NO.
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 6
16 Water Piping
17 Rough Plumb. SJ
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test 4-
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