SATT (001256)76944 Calle Mazatlan
001256
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, if work has been suspended or abandoned for a period of 180 days. • -
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed underprovisions 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 issued, I shall.not employ any person inanymannersoasto become subject to the Workers' Compensation laws of.
and effect. California.
License Class Ember/ 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 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 cily.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 permit to file a signed statement that he is licensed pursuant to the provisions oftheContractor's License Law , 01 hereby certify that no-excavationfive(5)ormorefeetindepthintowhichapersonisrequired-todescend,willbe
.(Chapter 9(commencing with section 7000) of Division 3 of the Business and Professions Code) or that heis exempt made in connection with work authorized by this permil, 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 for a permit, demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2. Art 2, Sec3411..Title8,
subjects the applicant to a civil penalty of not more than live hundred dollars ($500):. e C.A.C.)
O I. as owneF'of the properly, 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 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 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. lf, however, the ❑ Division of. Industrial Safety Permit No.
building orimprovemntissold within one yearofcompletion ,the owner -builder will have the burden of proving that n— A,,,,u.=„r
he did not build or improve for the purpose of sale.).
❑ I, as owner of the property, am exculsively contracting with licensedcontractors to construct the project (Sec.
7044. Business and Professions Code: The Contractors 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
Contracto'r's License Law.).
..O 1 am exempt under Sec. - . B. 8 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 copythereof (Sec. 3800. Lab: C.).'
Policy No. Company
O Certified copy is hereby furnished.
❑ Certified copy is filed with the City Building Inspection Department of City Department.
Date Applicant
APPLICANT NAME (L, F, MI) ,'. rkrja' l -
ADDRESS . P.O. Fit 1000
CITY/COMMUNITY/STATE/ZIP T w A.1int , CA -92253
JOB SITE ADDRESS/SPACE 76-944 Calle M zAtlan .
CITY/COMMUNITY/STATE/ZIP i b / into, CA 92253
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BOK
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Elect. Fee 57.51
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TR T 65-2
LOT31
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2, 814
TRACT NAME t.Li:3L2 ds - V
OWNER NAME (L. F. MI) Awl Zt
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CONTRACTOR -FIRM NAME
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ADDRESS
7M._L.,.w.`JYG
CITY/COMMUNITY/STATE/ZIP
PHONE a 345-2888
LICNC r
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE N
LICNC II
USE OF PERMIT cam
BL
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I ZON
FSB
SSB
SSB
RSB
OFC
ZONE ORD
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LOT SZ
END
SIDE
CONSTRUCTION LENDING AGENCY: I hereby 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
of this 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) have read this application and state that
thOnformation given is correct. I agree to comply with all state laws and county ordinances relating to buidling
constructio ,and authorizy A'representative of the.City of La Ouinta Department oUBuilding and Safety, to enter
upon the opI or whic ave a plied for this permit for the purpose of making inspections.
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPUPRMT n n i 2S.641
S6 3166 E8
i
Peanit to =%trwt XHX MO sq. rt, of
condo Pus 12.0 sq tt. of porch and
451 sq. tt. of garage as per approvea plans.
Meeh. Flee 39.00
Plan Check Fee 290.65
'0onst. Fee 349,00
Elect. Fee 57.51
SW Fee 5.01
Pitmbing Free 73.00
InfrastrulaWre Fee 2,000.00
TOTAL
FEE
2, 814
A 0 4 1 0 3 20 28
VALUATION
BLDG. DEPT.
Ah
n
NO.
OPERATION TE
INSPECTOR
NO.
OPE ATION 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
-6-13,1 AT
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
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick ..
Vaallue
7A Walls (Batts) ;
12B Ceiling (Batts)
12CT Ceiling (Blown)
14 Final
PLUMBING APP OV LS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer 7 .
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/I
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring s -
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final