SATT (001254)76940 Calle Mazatlan
001254
PERMIT APPLICATION
• City of La Og a
Department of Building and Safety
This permit becomes void if work not commenced within 180 days from date of issuance, OR, ifwork has been suspended or abandoned for aperiod of 180 days.
,LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division Sof the Business and Professions•Code, and my license is in full force
and effect. n
License Class Lic. Nu berl
Date Contractor
OWNER-81JILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License. Law for the
following reason (Sec. 7031A.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) o1 Division 3 of the Business and Professions Code) orthat he is exempt
therefrom and the basis for the alleged exemption. Any violation of Section 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 do the 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, acid 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 improvertnt is sold within one year of completion. the owner-builderAill have the burden of proving that ,
he did not build or improve for the purpose of sale.). r_•
0 1, as owner of the property, am ezculsively 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 1 am exempt under Sec. B. & 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) Lwxlrakk T iii '
ADDRESS POO. Box l(f 1(3(:o
CITY/COMMUNITY/STATE/ZIP +r'a,, CAL 92253
JOB SITE ADDRESS/SPACE 76-940+ 'QCa 7`•e 1J:,, at .•, .
C. L X><L9222..53311
CITY/COMMUNITY/STATE/ZIP la Quintal
BOK
PAG
PRC
C
42.00
TWN
RNG
SE
S
T GU765-2
LOT .29
SCSI Fee
8.30
Afpp
SB
Infrastructure Fee
TRACT NAME "JLCi nis Villas
•
ppliimntt1.1G7 ,
OWNER NAME (L. F. MI)
CONTRACTOR -FIRM NAME a1 i , lv+
ADDRESS above
CITY/COMMUNITY/STATE/ZIP -
CITY/COMMUNITY/STAT
PHONE • 345-2888
LICNC •
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP '
PHONE N
LICNC N
3,110.52
USE OF PERMIT ^_ n _., _
BL
ZON
FSB
SSB
SSB
RSB
OFC .
ZONE ORD 0,
. LOT SZ
.. END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE. This section need not be completed if
the permit is for one hundred ($100) o, less. I certify that in the performance of the work for which this permit is
-issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of
California.
Date Applicant
NOTICE TO APPLICANT: IL 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 1 hereby certify that no excavation five (5) or more feet in depth into which.a person is required to descend, will be
made in 'connection with work authorized by this permit, and that no building structure, scaffolding, lalsework, or
demolition'or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2,.Gfp 2, Art 2, Sec341, Title B. -
C.A.C.) .. -
w 0 As owner-builddr, I will not employ anyone to do work which would require a permit from the Division of
Industrial Safety, as notedabove, 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: Thereby affirm that there is a construction lending agency for the performance
-of the work for which 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
orchis 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 nd author'ze a'representative of,the City of La Ouinta Department of Building and Safety to enter_
upon therrpe yl ich I ave applied for this permit for the purpose of making inspections.
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPL/PRMT fl fl l 7
3-'-AT-E85 C'ICN10
Pennit to aanstructl931 sq. ft. of two-story
omido plus 166 sq.
ft. of porch and 451
sq:'ft. of garage as per approved plans.
Mech. Fee.
42.00
Plan Check Fee.
399.19
Ctmnst. Fee
480.50 •
'Elect. Fee
77.53
SCSI Fee
8.30
Plianb.ing Fm
Infrastructure Fee
21000.00
TOTAL'
FEE •
3,110.52
A 0 4 3 2
BLDG. DEPT.
3 20 3-1
VALUATION 118,389.00
Ah..
NO.
OPERATION I ITTE 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
02,2 1 ' 77-(
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 p /7 ,S
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts) 44
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 PA
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring S'
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final -