SFD (000891)76939 Calle Mazatlan
000891
APPLICANT NAME (L: F, MI)
n rPf gmrft
PERMIT APPLICATION
! City of La Dg „
• - ,. -Department of Building and Safety .. •'
a
` 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..
"
•`l.: ' -... • , ., • '
, CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be cornpleted.d.
' LICENSED CONTRACTORS DECLARATION, I hereby affirm that.l am licerisede Under provisions of Chapter 9z
the permit is for one hundred (5100) 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 ProtessionsCode, and'my license is in full force
issued, I shall not employ any person inanymannerso as to become subject to the.Workers'.CompensationLaws of
and effect.
- California.
License Class Lic. Number " _
_.. a Date Applicant.
Date " - Contractor' -- `
- ..• -NOTICE TO APPLICANT: If, atter making this.Certificate of Exemption, you should'become subject to the Workers'
' •'- ^
OWNER -BUILDER DECLARATION: • I hereby affirm that I am exempt from the Contractor's License eaw 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
bedeemed 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 Law111
hereby certify that no excavation five (5) or more feet in depth into which A person is required to descend, w ill be
(Chapter 9.(pom mencing With. section 7000) of Division 3 of the Business and Professions Code) or that he is exempt
made'in cohrieclidh' with work authorized by this permit, and that no building'structure, scaffolding, falsework,or,
.; therefrom and,the.basis for the'alleged exemption. Any yiolation;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, Sec341, Title B. '
subjects the applicant to a civil penalty of not more.than.jive.6undred dollars (5500.):'
C.A.C.), ,t
. •0 I. as'owner•ot.the property: or my employees with wages as their sole compensation, will do the'work, and the
O As gwner,builoer, Twill not employ anyone to do work which would require a permit from the Division of
structure isnot intended or, offered for sale (Sec. 7044, Business, and Professions Cbde; The Contractor's License.-..'
'- :.: Industrial Safety, as noted above. Lnless 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 •
• • ' , .
through his own employees. provided that such improvements are not intended.or offered for sale. II. -however, the
Q Division. of. Industrial Safety, Permit No.
building orimprovernnt is sold within one year of completion, the owner -builder will have the burdenofprovingthat
'Date ' - Applicant -
he did not build,.or improve for the purpose of sale.).
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agericyfor""the performance
❑ 1, as owner of the.properly, am exculsively contracting with licensed contractors to construct the project (Sec: 1
. .. - of'the work f& 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 .
CITY/COMMUNITY/STATE/ZIP
• Contractor's License Law.):..
Lender's Address
• O 1 amexempt; under Sec. .;B.'8 P.C. (Attached Certificate).` '
1 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 thaM have a certificate of consent to self -insure, or A'
BL
' certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab: C.)rfo;.
Signature of Applicant or Agent Date
Policy No. Company .
CERTIFICATE OF COMPLIANCEAND AUTHORIZATION OF ENTRY: I certify I have read thisapplication and statethat' '
= O Certified copy is hereby furnished.
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling•
b Certified copy is tile d1 with the City Building Inspe tion Dep amen or Department..
•r construction,. and authorize a'representative of the City of Ca Ouinta Department of Building and Safety.to enter
Applicant
upon the property for which l have applied for this permit for the purpose of making inspections. -
_Date
C1
Signature of Applicant or Agent z Date
Print Applicant/Agent Name
SIDE
APPLICANT NAME (L: F, MI)
n rPf gmrft
ADDRESS
CITY/COMMUNITY/STATE/ZIP -•
T.m Bohn#-, . M. 922%'A
JOB SITE ADDRESS/SPACE
76-939 C;a12e Mazatlan
CITY/COMMUNITY/STATE/ZIP -
Lot (ieiiniha.. ra
BOK
C
T. ,
RNG
Plm Check Fie
242X45
7r AG
a 9
Tbe
1E!
SKI Fee'
5,57
Plumbing Fee
48.50'
14"436-3
300.00
M`
, 1 '
SB .
` r
td
TRACTNAME
` R g Pow Cme .. .. • ...`
OWN ERiN AAMcEs (L. F. MI) - • -
CONTRACTOR -FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE. •
' LICNC Y
561-131
333762 •
ARC/ENG FIRM NAME
ADDRESS I'
CITY/COMMUNITY/STATE/ZIP
PHONE 1 .
..
LICNC It
.
l
USE OF PERMIT -
Single family dwelling
•
BL
ZON
FSB
SSB
SSB
RSB
OFC'
. ZONE ORD:..
• LOT SZ
END' •
SIDE
APP RMT WORM.
rR>e(
DATE
-1 --R4 S.F.D.........
Dweilirg `' 4 't
1,390''S110- ft.
Parch..
132'q. ft •
422 .sq. ft.
_ Mechanical': Fee:
31.00
Plm Check Fie
242X45
Const. Fee
373.00 .
Tbe
1E!
SKI Fee'
5,57
Plumbing Fee
48.50'
; v, Fee'
300.00
M`
UG e -e
•
` r
TOTAL
.i
l,03L77
VALUATION `I 7 103,Gt7
;t v' .4 BLDG. DEPT.
i
NO.
OPERATION I DTT E
INSPECTOR
NO.
OPE TION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
O
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.
❑
O.
NO.
N
ADDITIONAL INFORMATION
,
If, --I
1(1421t v
/✓t
r '
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall S
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
126 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
PSL _ P)
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures,
31 Service
32 Final