SFD (000895)76941 Calle Mazatlan
000895
PERMIT APPLICATION
City of
La Quinta
Department of
Building and Safety
This permit becomes void if work not commenced within 180 days from date of issuance. OR, if work has bedn'suspencled or abandoned for a period -of 180 days:
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0.31
CERTIFICATE OF -EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be'completed if
LICENSED. CONTRACTORS DECLARATION:, I hereby. - affirm that .1 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 of the Business and Professions Code, and my.license.is.in full force.
ssued, I shall notlemploy any person inany manner so asto become'subject to the Workers: Compensation Laws of
and effect.
California.
License Class Lic. Number
Date Applicant
Date -Contractor -r
NOTICE TO APPLICANT: If, aftuViiking . this Gertiticatiof Exemption, you should become subject to the Workers' - A 1
OWNER -BUILDER DECLARATION: I hereby affirm that I 'am exempt from; tWe Contractor's'License Law ior.the
Compensation provisions of.the Labor Code, you must forthwith comply with such provisions or this permit shall i
following.reason (Sec. 7031.5, Business and Professions Code, Any city or county which requires a-permil-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:
• suckpermit to file a signed statement that he is licensed pursuant to the proyisions of the Contra.ctor's.License Law
0 1 heieby certify that nd6cavation five (5) or more feet in depth into which a person is required to descend,'Will be
(Chapter 9 (commencingyith'section 7000) of Division 3 of the Business and Professions Code)or that he is exempt.
made in connection with wo - rk authorized by this permit, and that - no building structure, scaffolding, falsework, or
therefrom and the basis for, the alleged exemption, .Anyviolat ionol Section 7031.5 by any applicant for a.permit
demolition or dismantling thereof, Will be more than thirty-six (36) feel high. (Chap 3.2, Grp Z Art 2, Sec 341, Title 8. %
subjects the applicant to a civil penalty of not more than -five hundred dollars ($500.):
C.A.
)C
.0 1, as owner of the ,property, ,or my employees with wages as their sole compensation, will do the work, and the
O,As wi-builder,' I'will not employ-inyone 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 Sitely; as rioted -above, unless such'pers6n has a*permit lo,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'
• . - ' afiety.Per
.through his own employees, provided that such improvements are not intended or offered for sale. -If. however. the.
0 Division of Industrial nit No'
building orJmproverk is sold within one year of completion, the owner -builder will have the burden of proving that
Applicant
he did.nol build or improve for I he purpose of I sale.)
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the
.
• 01. as owner of the property..am exculsively contracting with licensed contractors to construct the project.(Sec.,
g performance
of thelwork• lor,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.Nam.e
'builos or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the
Contractor's License Law.):._
Lender's Address
0 1 am exempt under Sec.a B:*& P.C. (Attached Certificate)..'I
cerlifythat I have read this application and state that the above information is correct. I agree to comply with all
-pate" 'Ownercity
and county ordinances and state laws relating to building construction, and hereby authorize representatives
WORKERS' COMPENSATION DECLARATION: 'I hereby' affirmthat I have a certificate of consent to elfminsur6;or a
of this county to enter upon the above :mentionbl property f6r inspection purposes.
certificate of Workers' Compensation Insurance or a'certifiedcopy thereof,(Sec. 3900..Lab. C.).
Signature of Applicant or Agent Date
Policy No. Company,.
0 Certified copy is h'ereby. furnished.
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
ig InTedio B
O*Certified copy is'filed wilh:lhe City Building 7wu. i7rlll or City Department'
T—i
cOnslruction, and authorize a 'representative of the City of La Quinta Department -of Building and Safety to enter
upon the property for which I have applied for this permit for -the purpose of making inspections: -
Date Applicant
SignatureLof Applicant or Agent Date
APPLICANT NAME (L. F.'MI)
ADDRESS
P.O. per,.,.' 780
.CITY/COMMUNITY/STATE/ZIP
Ia-Quinta, CA 92253
.1913 SITE ADDRESS/SPACE
79—QAI r-OlIm t1a7n*1An
CITY/COMMUNITY/STATE/ZIP
La Q-mmta,, CA 92251
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PAG
KOO
PRC
OW
C
mechanical Fte
TNM
RNG
SE
S
4
14TRACT96-3
2LOT8
31,25
SMI Fee
lie,
SB
48.50
TRACT NAME
&a Rosa Cme
Sar
OWNER NAME (L. F. MI)
CONTRACTOR -FIRM NAME
Rxwe
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PH5ONE64#m-1315
311ICNC
374
TOTAL*
FEE
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE #
LICNC 0
USE OF PERMIT
s nglefamjl y dwelt incr
not
BL
ZON
FS8
SSB.'
SSB-
RSB
ZONE ORD#
LOT SZ.
END,y
'.'SIDE
1A
Print Applicant/Agent Name
,APPUPRMT
8-19-81i
Pit to. instruct 1,003 sq. ft. of'
single-family dwelling E dth attached
garage.
mechanical Fte
31.00
Const. Tee
'385,00,
Meqtt Fm'-.
31,25
SMI Fee
r 5.85'
Plumbing Ped r.
48.50
Prop. Deri. "Fleeg
450*.00
E
AUG 17 L984'
Uinta
TOTAL*
FEE
1,2
SLOG: DEPT.
wi k
VALUATION`;$3,889.r.
n
NO.
OPERATION I ? TE
INSPECTOR
NO.
OP .TION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
d
n:
34
Plenums & Ducts
2A
Slab Grade
6
,
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.
❑
NPON
ADDITIONAL INFORMATION
7 Q
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) r
12C Ceiling (Blown)
14 1 Final
PLUMBING APPROVALS
15 Ground Plumb Q
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer 3 ,
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 PyI
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring 7
29A Grounding Wire ,
29B Bonding
30 Fixtures
31 Service
32 Final