SFD (001002)76953 Calle Mazatlan
001002
This permit becomes void if work not commenced' within 180 days from date
of issuance. -OR, -it work has been suspended or abandoned fora period.of .180 days..
'• i- '" f -' _ : c, '
CERTIFICATE OF-EXEMPTIONFROM WORKERS'COMPENSATIONINSURANCE, This -section need not be completed if
LICENSED' CONTRACTORS DECLARATION: 1 hereby affirm that I am licensed under. provisions .of. Chapter 9
' the permit is,for one hundred (5100) o. less.. l:certify that in the performance of the work for which this permit is ,
(commencing with'Section 7000) of Division Sof the Business and Protessions'Code„and my license is in -full force- . '
• , issued, I shall not employ any person inany mannersoasto become subject tothe Workers'Compensation Laws of •
and effect.
California.
License Class ' Lc. Nuirlberj✓ '
Date Applicant r,
_ ., v
Dale Contractor t
_
NOTICE TO•APPLICANT: If .aftermakinq this Cerlificate',of,.Exemption. you should become subject tothe Workers' ,
_ _
+the•Con
Compensation provisions of the Labor Code; you must forthwith comply with such provisions or this permit shall
OWNER -BUILDER DECLARATION:' I'hereby'alfirm that lam exempt from ractor's License Law. for the . _
. -
be deemed revoked.
following reason (Sec. 7031.5. 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
,,DIVISION OF INDUSTRIAL. SAFETY PERMIT CERTIFICATION:
such permit to file a signed statement that he is licensed pursuant tothe provisions ofthe Contractor'sLicense Law -.
❑ Ihereoycertifythatnoexcavationfive(5)ormorefeetindepthintowhicAapersonjsreouiredtodescend,willber ,R
'(Chapter 9 (commencing with section 7000) of Division 3 of the Business Professions Code) or that he is exempt
made in connection with work authorized by this permit: and that no building stru6tuie; scaffolding, lalsework, or
therefrom and the basis for the alleged exemption. Any violation.of Section 7031:5 by anyapplicant for a permit-
demolition or dismantling thereof, will be more•thahthirty-six (36) feet high: (Chap 3.2. Grp 2, Art 2, Sec 341, Title 8;
subjects the applicant to a civil penalty of not more than five hundred dollars (SWO.):
C.A.C.)`
0 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, -and the.
❑ 'As,owner-boilAer'I-wilt not employ anyone'to,do work which would require a permit from the Division of •r
-, structure is notintended or offered for sale (Sec. 7044, Business and. Professions Code: The Contractor's License
Industrial Safety: as noteeabdve `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
ASB
' •.through his own employees, provided that such improvements are not intended or offered for sale. If, however, the ..
D.Division of Industrial Safety Permit No.
building or improverrunt is sold within one-year of completion, the owner -builder will have the burden of proving that
Date' Applicant, .,
he. did not build or improve for the purpose of sale.). ..
' 0 I, as owner of the am exculsively contracting with licensed contractors to the (Sec.
'%• . CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
is issued
property, construct project
7044, Business and Professions Code: The Contractor's License Law does not apply to an owner.of property who
of the work for which this.permit (Sec. 3097, Civ: C.).
Lender's Name
° '=builds or improves thereon, and who contracts for such projects with a' contractor(s) licensed pursuant to the
- - t
.Contractor's License Law.).
Lender's Address r
'0 I am exempt under Sec. ' • B. 8 P.C. (Attached Certificate). i .
:; I certify that'I have read this application and state.that the above information is correct. I 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. 7
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, are
certificate of Workers' Compensation Insurance , or'a,certilied-copy thereof (Sec. 3800: Lab. C:).
Signature of Applicant or Agent Date
Policy No. Company-
CERTIFICATE OF COMPLIANCE'AND AUTHORIZATION OF ENTRY: I certify l have read this application and state that .,
• 0 Certified copy is hereby furnished . _ - .. ;,
the informal!ip.give6is`correct. I agree to comply with all state laws,and county ordinances relating to buidling
0 Certified copy is filed with the City Building Inspection Department orCity ` Department.
construction, and a ilhorize; a:representative of the City of La Ouinta Department of Building and Safetgto enter
upon the p oo/pen for which -I have applied for -this permit for the purpose of making inspec io[ns.
Date Applicant
Signature of Applicant or Agent Date,
4
.APPLICANT NAME -(L. F. MI)
Ander (fora.
ADDRESS - '•”
P.O. B=780
CITY/COMMUNITY/STATE/ZIP ,
La Ouinta. CA 92253
JOB SITE ADDRESS/SPACE - . • I ' . ..
76-953 Cabe Mazatlan
CITY/COMMUNITY/STATE/ZIP - -
La Quinta CA 92253
BOK
PAG
PRC •'
C - TNM
RNG
SE
S
TRACTY
14469-3
LOT,
MOD
IG -3
SB
-
TRACT NAME '
nt l
OWNER NAME (L. F, MI)
AMpn
-CONTRACTOR-FIRM NAME •• - ..
ADDRESS '. .. .
above
CITY/COMMUNITY/STATE/ZIP
. above .,, ,
PHONE 0LICNC
•.564-1315
333762
ARC/ENG FIRM NAME '. .. .-
Barry Berl=
ADDRESS -
1531 C3]anala Street
CITY/COMMUNITY/STATE/ZIP . '
Santa Barbara, M. 93101_
PHONE NLICNC w
805.963--8901 '
.. ,
USE OF PERMIT Siml a family d ,,+; ng ..
7
BL
ZON
FSB
SSB
SSB
ASB
OFC,
ZONE ORD N. •. `
LOT SZ •.
;i, END
SIDE,., -
Print Applicant/Agent Name
APPL/P.RMTDATE - -
410-19-84 S.F'.D:'
Permit to famstnict 2.326 sq. • ft. of sinal
family dWelling-with attatched caarage.
Nisch. Fee 26.00
Plan CSugck Fee 291.204
CJonst. Fee 448.00
Elect. Fee 36.90 .
&MII F 7.39 -
Plumbincr Fee 73.00' T
Firm. Devel.. Mee x50.00.
O
Ta
EDlNG.O PA 1Nta`
TOTAL r
FEE •' 1.332.49 •,
+• - VALUATION 105,867:&0
BLDG. DEPT. -
i, 44
Ir.
Ah
NO.
OPERATION DATE
INSPECTOR
NO.
OP ,ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade 3
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
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)
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/I
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring a2Al,
29A Gfbbwdi Wire
29B Bonding
30 Fixtures
j, ,
31 Seivice
•..
32 FinaL;, {?1•'.' [b , is