SFD (001003)76943 Calle Mazatlan
001003
APPLICANT NAME (L, -F. Mill
Andet Opirp.
ADDRESS
PERMIT APPLICATION 4,
City of La Ouinta. ••.
Department of Building and Safety
This permit becomes. void if -work not commenced within 180 days front date of issuance -OR. if work has been suspended or abandoned lora period'of 180 days..
JOB SITE AODRESSISPACE -
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
LICENSED CONTRACTORS DECLARATION: I hereby affirm that [ 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 s permit is 41.f.
(commencing with Section 7000) of Division 3 of the Business and Professions Code and my'license is in full force
.-issued, I shall not employahy person inanyman ner so as to become subject to the Workers'Compensation Laws of
and effect.
pber Z
LicenseCla :'! L'
California.
Date r Applicant pplicant
Date 7✓ Contracto w.
NOTICE TO APPLICANT: If'itI making this Certifica I i of Exemption, yo usho uld beco me s ubjectto the Workers" -
OWNER-BUILD61 DECLAWIbN:*,l hereby affirm -that I am exempt from the Contractor's License Law 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
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:
.such per mil to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
0 1 hereby ceitify that no excavation . five (5) . or more feet in depth into whicha person i . s required to descend, will be
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and ProfessionsCOP-or that he is exempt
maide*in*connecfion*with work authorized by this permit, and that no building structure, scaffolding, falsework, or.
-therefrom and thelbasis for the alleged exemption. Any violation of Section,7031.5 by any.applicant for a permit
'demolition ordismantling there6f, will be more 111iin thirty-six.(36) feet high::(Chap 3.2; Grp i=Art.2. Sec341.Jitle8,
subjects the applicant to a civil penalty of not more than five hundred -dollars (5500.): . I . 1,
C.A.C.)
0 I. as -owner of theproperty, or my employees with wages as their sole compensation, will do the work, and the
-b Asowner-builder, I will notemploy 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 Code: The Contractor's License
'Industrial Safety, as noted above, unless such person has a permit to dosuchwork from that division.
Law does not apply to an owner of property who builds, or improves thereon, and who does such work himself or
OWNER NAME (L, F. MI)
Arxkm
through his own employees, provided that such improvements are not intended or offered for sale. It.howeverpthe
0 Division of Industrial Safety Permit No.
building or improverrint is sold within one year of completion, the owner -builder will have.the burden of proving that
[)ale Applicant
he did not build or improve for the purpose of sale.), . , , ..* : 0;! . - , :. ; .
-
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance - ti
.0 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 issited'(Sec. 3097, Civ. C.).
'7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
Lehder's Name-'
builos 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
0 1 am exempt under•Sec.. B..B P.C. (Attached Certificate).
I certify that I have read this application and state that the.above information is correct. I agree to comply with all
liale Owner
city and county ordinances and state laws relating to building.construction, and hereby authorize representatives
• single fw&ly &elling
of this county to enter upon the above-mentioned properly for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, ora
ZON
certificate'of:Workers' Compensation Insurance ..or a certified copy thereof (Sec. 3800. Lab. C.).
.
Signature of Applicant or Agent Date
y No. Company
Policy
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this applica, iorfand state that
0 Certified copy is hereby furnished.
the information given is correct l agree to comply with all state laws -and county.ordinances relating to buidling
0 Certified copy is filed with the City Builaing7lnspeclion Department or City, Department.
...con. and lautflorize a *representative of the City of LaQuinta Department of Building and Safety to enter,
nstructio
ZONE ORD a -7
upon the prope e
Z l hav' applied for this permit for the purpose oLmaking inspections.
Date Applicant
•
Signaturelo'!.Applicant or Agent Date
SIDE.
Print Applicant/Agent Name
APPLICANT NAME (L, -F. Mill
Andet Opirp.
ADDRESS
P.O. Box 780
CITY/COMMUNITY/STATE/ZIP
Ia Quinta, Ch 92253
JOB SITE AODRESSISPACE -
76-943 CaUe Mazatlan
CITY/COMMUNITY/STATE/ZIP ' . . :.. . • . . ... .
.La Quints CA 92253
BOK
PAG -1-PRC
I C
I .1
TWN
FIND
SE
S
TRACT
LOT
-7-TI
Do
SB
14496-.1
24
Cr -3
TRACT NAME
Santa Rma Calve
OWNER NAME (L, F. MI)
Arxkm
CONTRACTOR -FIRM NAME
Arglen
ADDRESS -
ab mm
CITY/COMMUNITY/STATE/ZIP
abicae
PHONE
564-1315
LICNC 0
333762
ARC/ENG FIRM NAME
Barry nerkun
ADDRESS
1531 Chapala Street
CITY/COMMUNITY/STATE/ZIP
Santa Barbara, CA 93101
PHONE 4
LICNC N
USE OF PERMIT
• single fw&ly &elling
BL
ZON
FSB
SSB
SSB
RS8
OFC.
ZONE ORD a -7
END
SIDE.
APPUPRMTn*3.' DATE
_n 1 n tj a
1.0-19-8
Permit .to amstruct . 2,326 scr. ft.
t. of
single family dwelling with attached
garage.
mech. Fee 26.00
Plan Check Fee 291.20
Const. Fee 448.00
Elect. Fee 36.90
SMI Fee 7.39
Plu incr Fee 73.00
PrIm. D evel. Fee !i5,0.
"M -"Fr . , 'I- .. — I - ' . -
L-'.
_F '1, 17,332.49,-
,VALIuA+ior l 105,867A •:L/{.
,4 t %Z-
11LDG. DEPT.
I-1
Ah
NO.
OPERATION I 3rTE 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
o23
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.
❑
NO
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
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
P/L P/1
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire a
29B '. Bonding. S .:
1 V
30 Fixtures:
31 "' Service
32 Final