SFD (000901)76937 Calle Mazatlan
000901
PERMIT APPLICATION
a=
• City of La Dg a
Department of Building and Safety
CITY/COMMUNI,TY/STATE/ZIP
la QW nta, CA 92253
JOB SITE AODRESS/SPACE
76 -9 -JI r alie Mawtlan
This permit becomes void if work not commenced within 180 days from date of
issuance, ORJf work has been suspended or -abandoned for a period of 180'days.
rlicensed
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section neednot be completed if
° LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am 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 employany person in any manner so as to become subject to the Workers' Compensation Laws of
and effect.
California.
License Class tic. Number
Date •Applicant
Date Contractor '
NOTICE TO APPLICANT: -if. after making this Certificate of Exemption, you should become subject to the Workers:
OWNER -BUILDER DECLARATION: I her affirm that 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.
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..
0 thereby certify that no excavation five (5)'or more feet in depth into which a person is required to descend, 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 permit
demolition 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'tive hundred dollars ($500.):
C.A.C.)
0 I, as owner of the property, or myemployees 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
IndustrialSafety, 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
. 1.
through his own employees, provided that such improvements are not intended or offered for sale. If; however; the
O Division.of Industrial Safety Permit No.
building orimproverrint issoldwithin one year of completion, the owner -builder will have the burden of proving that .
Date ' Applicant's
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 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. 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) licensed pursuant to the
' ZONE ORD. '.
Contractor's License Law.).
Lender's Address
O 1 am exempt under Sec. . B.4 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 .
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 self -insure, or a
certificate of Workers' Compensation Insurance , or a certified cop-Ahereof (Sec: 3800. Lab: C.).
" -
Signature of Applicant or Agent Date
Policy No. Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I ceitify I have read this application and state that
O, Certified copy is hereby furnished.
the information given is correct. I agree to comply with all stale laws and county ordinances relating to buidling
construction, and authorize a'representative of the City of La Ouinta Department of Building and Safety to enter
O Certified copy s fit ith ihe'City Buildin specliog De ent ICity=- • Department.
-r - •
upon the property for which I have applied for this permit for the purpose of making inspections. -
Date Applicant
APPLICANT NAME (l Rural_ _'
ADDRESS'
7P.n• B{ 780
CITY/COMMUNI,TY/STATE/ZIP
la QW nta, CA 92253
JOB SITE AODRESS/SPACE
76 -9 -JI r alie Mawtlan
CITY, /^GMrMu-__ NITI/ta, ZIP _ 92253
IA x7,-,7,0030
277 sq. ft.
PPAAG} bG/PPRCC
/wl",0
03
.. C
433 sq. ft.
TWN
RNG
SE
S
14496-3
L 30
Pian ' Ck. Bee
291.20
?.3
58
Elect. Fee.
TRACT SantaCow "
OWNER NAME (L• F. MI) -
CONTRACTOR -FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE o 4. ' '
564-1315
•
LICNC
333762
ARC/ENG FIRM NAME
ADDRESS a
CITY/COMMUNITY/STATE/ZIP -
PHONE II
LICNC
f
USE OF PERMIT'
Single family dwelling
BL
ZON
'FSB
Sse
'SSB
RSB
OFC'
' ZONE ORD. '.
LOT- SZ
END. .
SIDE
R
Signature of Applicant,or Agent
Print Applicant/Agent Name
Date
APPL/PRMTATE
pn`1 8 -ib -84 S•F. •
Permit to construct Model P-3 H
Dwelling (1st floor)
1,616 sq. ft.
(2nd floor)
277 sq. ft.
Porch
112 sq ft.
Garage
433 sq. ft.
Mischar ical ' Fee
33.00
Pian ' Ck. Bee
291.20
Const. Fie
448,00
Elect. Fee.
31,25
SMI Fee
7.39
PiW.bing Feet,
52.50
Prop. Dev. Fee
450.00
t 19 E®
At1G 17l'1984
tX Of 14 Oumn'aN
TOTAL
FEE $ 1,3 ,1 •34
BLDG. DEPT.
VAL,UATIorv;[ ' 105,69-4.40
IMI
r1
NO.
OPERATION I b XTE INSPECTOR
NO.
OPE TION I 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
S
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.
❑
NON
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) YZ12
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer S
21 Water Heater
22 Water Softener
23 Wate; Service
24 Gas Test YZI&S- '7714-
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
PSL P1
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring 2
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final