SATT (001251)76938 Calle Mazatlan
001251
PERMIT APPLICATION
City of La Duinta
Department of Building and Safety
`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.
• CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This 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 ofthe 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. ifT l
Date Contractor (
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to .
construct, alter• improve• demolish, or repair any structure, prior to its issuance, also requires the applicant for
such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
(Chapter 9(commencing with section 7000) of Division 3 of the Business and Professions Code) or that he is exempt
therefrom and the basis for the alleged exemption. Any violation of7Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
0 I. as owner of the property, or my employees with wages as their sole compensation, will clothe work, and the
structure is not intended or offered for sale (Sec. 7044• Business and Professions Code: The Contractor's License
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
building or i mprovemnt is sold within one year of completion, the owner -builder will have the burden of proving that
he did not build a.c improve for the purpose of sale.).•
0 I, as.owner of the property am exculsively contracting with licensed contractors to construct the project (Sec.
7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
'builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).. _
0 Lam exempt under Sec. - B. 8 P.C. (Attached Certificate).
Date Owner
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 (Sec. 3800. Lab. C.).
Policy No. Company
0 Certified copy is hereby furnished. ,
0 Certified copy is filed with the City Building Inspection Department or City Department.
Date Applicant
APPLICANT NAME (L; F. MI) T ,, niftark T w
ADDRESS P.O. Box IU, J
CITY/COMMUNITY/STATVZIP T _ Quinti, CAL 92275^3,
JOB SITE ADDRESS/SPACE 7766_9 3jj88 Calle Mazatlan
CITY/COMMUNITY/STATE/ZIP La-lQu nt , CA 92253
BOK
PAG
PRC
C
42.00
TWN
FIND
SE'
S•
TRAC
LOT 28
SMI Fee
7.60
4130OR
L SB
Infrastructure Fee
TRACT NAME Itn N' 'Villas
OWNER NAME (L, F. MI) AWliwnt
-
CONTRACTOR -FIRM NAME applicant
ADDRESS ababove.. .
CITY/COMMUNITY/STATE/ZIP abom
PHONE. 345-2888\
LICNCI
-
ARC/ENG FIRM NAME
ADDRESS -
CITY/COMMUNITY/STATE/ZIP
PHONE I 1
-LICNC 4
3-069.61
if
USE OF PERMIT corifto'
BL
ZON
FSB
SSB
SSB
RSB
OFC '
ZONE ORD .
LOT SZ
END
SIDE
Date Applicant
NOTICE TO APPLICANT: If, after making this,Certificate of Exemption, you should become subject to the'Workers'
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
0 I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, w ill be
made in'connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
demolition or dismantling thereof, will be more than thirty-six. (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341, Title B:
C.A.C.)
O As owner -builder, I will not employ anyone t6 do work which would require a permit from the Division of
Industrial Safety, as noted above, unless such person has a permit to do such work from that division.
0 Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agencyfbr the performance
of the work forwhich this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
I certify that I have read this application and state that the above information is correct. I agree to comply with all
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.
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
construction, and authopife a' representative of. the City of La Ouinta Department of Building and Safety to enter
upopertorcwhi2h Ive a ple i` ed for this permit for the purpose of making inspections., .
✓ Signature of Applicant or Agent Date
Print Applicant/Agent Name
.APPUPRMT >f%
•
3947-85 V0WO•
PleYnnit to crostruct 1736 sq. ft. of two-
story cando plus 288
sq. ft. of porch and
451 sq. ft. of garage as per $pprcmed plans.
Mech. Fee
42.00
Plan Check'Fee
379.85
Const. Fee
455.50
Elect. Fee
72.66
SMI Fee
7.60
plumbing Fee
102.00
Infrastructure Fee
2,000.00
TOTAL •'
FEE
3-069.61
if
A 0 4 0 4 3 20 31•
.l
BLDG. DEPT. VALUATION 108,275.00
•
Ah
Ah
NO.
OPERATION V E
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
1 Furnace Compart.
3
Steel
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
0%i 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.
❑
NPON
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 41W15 -r
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 7
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 Wiring9,57
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final