SATT (001261)76942 Calle Mazatlan
001261
: PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety."; `
• • A
This permit becomes void if work not commenced within 180 days from date"of issuance. OR, it work has been suspendedor abandoned for a period of 180 days.
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APPLICANT NAME (L. F. MI) Larkbark Land
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
• LICENSED CONTRACTORS DECLARATION:'I .hereby affirm that Iam 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 70DO) of Division 3 of the Business and Professions Code, and my license is in full force
issued. I shall not employ any person in any mannerso asto become subject to the Workers'CompensationLawsof
and effect.
California.
License Class Lic. umhe //i w
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 hereby affirm that I am exempt from the Contractor's License Law for the
Compensation. provisions ofthe 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. «y
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 tolile asigneb statement that he is licensed pursuant to the provisions of the Contractor's License Law
01 hereby certify that no excavation five'(5) or more fiet in depth into whichapersonis required lodescend,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 fora permit •,
demolition or dismantling thereof, will be more than 'thirty-six (36) feet high. (Chap 3:2, Grp 2, Art 2, Sec341jitle 8;•
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
C.A.C.)
O I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the:
❑ As owner -builder, I will not employ anyone to do work which would iequire;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 Safety, 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
through his own employees, provided that such improvements are not intended or offered for sale. If, however, the
❑ Division of Industrial Safety Permit No.
building orim"provemntissold within one year ofcompletion, the owner -builder will have the burden of proving that
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 agency for the performance I.
❑ 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
builps or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
Lender's Address
❑ 1 am exempt under Sec. B. & P.C. (Attached Certificate). "
I certify that I have read this application and state that the above information incorrect.) 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
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certificate,of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.).
Signature of Applicant or Agent Date
Policy No. Company
"
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that • M
❑ Certified copy is hereby furnished.
the information given is correct. I agree 10 comply with all state laws and county ordinances relating to buidling
❑ Certified copy is filed with the City Building Inspection Department or City Department.
construction a authVize a'representative of the City of la Ouinta Department of Building and Safety to enterrl
upon the perry fob hich 1 have ap lied for this permit for the purpose of making inspections.
Date Applicant
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Signature of Applicant or Agent Date
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APPLICANT NAME (L. F. MI) Larkbark Land
ADDRESS P.O. Box ggg 1000
CITY/COMMUNITY/STATE/ZIPLa Cain a, CA. 92253
JOB SITE ADDRESS/SPACE 76-942 Calle Mazatim "
CITWCOMMUNITY/STATE/ZIPJa QUinta CA 92253
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TRACT NAME
OWNER NAME (L. F, MI) 4plimnt ..
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CONTRACTOR -FIRM NAME
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ADDRESS
above
CITY/COMMUNITY/STATE/ZIPG..L. ve •. .
PHONE .3A C_2888 `+
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ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE I
LICNC .
USE OF PERMIT MnAo -
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END
SIDE
Print Applicant/Agent Name
APPL/PRMT t , O^•,C+
Penni t 't0 can8troct 1.632 sq. rt • opt tuv-
Story ' plus _.).su sq. rt. Or PoLun am
451 sq.'tt. Ot garage as per aPPXUVea per.
+
Meeh. Fee 42.OU
Plant Check Fee 360.30
Const. Fee 445.50
Elect. Fee 70.06
SMI Fee 7.32
Pltmnbing FIM.87.00 (07.00)
-Infr ; Free 2,000.00
TOTAL .
FEE •
3',020,18 -
A 0 4 1 5 3 20 3,1
VALUATION 104,473.00;'
BLDG. DEPT.
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NO.
OPERATION I I MTE
INSPECTOR
NO.
OPE ATION 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
3
, -
39
Appl. Clearance
7
Framing
f
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.
❑
NO.
NO.
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall p7 /
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts) y
12C Ceiling (Blown)
14 Final
PLUMBING APP OVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal .
20 Sewer /% S'
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
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 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final