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SFD (000890)76959 Calle Mazatlan 000890 - ''•_ ., , This permit'becomes void, if work not commenced within 180 days from date -of issuance, OR, ifYwork has been.suspended or abandoned for a period -of 180 days. CERTIFICATE OEEXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not completed if ' LICENSED CONTRACTORS DECLARATION: I -hereby affirm.that I:am licensed under provisions of Chapter„ 9 the permit is toxone hundred ($100) o, less. I'certify thal.in the performance of the.work for which this permit is :y r• (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 in any manner soasto become subject to the Workers' Compensation Laws of r4•e and effect. California. •_ License Class Lic: Number Date Applicant • Date — - .= - Contractor; '• NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject -to the;Workers'. -BUILDER `'I hereby I from'lhe Contractor's License Law for Compensation provisions of the Labor Code, you must forthwith comply with such provisions -or this permit shall^ •,a. ut OWNER DECLARATION: affirm that am exempt the , following reason (Sec. 7031.5, Business and Professions Code: Any city or. county which requires a permit to. be deemed revoked. •' 'r± - ' '„ - • •• construct, alter..*improve, demolish; or repair. any structure, prior to its issuance, also requires the applicant for DIVISION OF. INDUSTRIAL. SAFETY PERMIT CERTIFICATION: y . ' such permit to file a signed 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 I eel in depth,into whieh a person is required to descend, will be', _(Chapter 9(commencing with section 7000) of Division 3 of the Business,and Professions Code)or that hers exemptmade in connection with -work authorized by this perinit, and that no building structure. scaffolding;.falsework; or •,., • -. • therefrom and the -basis for the alleged -exempt ion.:Any violation of Section 7031.5 by any applicant for a permit ••., ... " demolition ordismantlin*9 thereof, will be more than thirty:six (36) feet high. (Chap 3.2, Grp 2, Arl'2; Sec 341: Title 8, « subjects the applicant to a civil penalty of not more than five hundred dollars ($500.): - 0.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 require a permit from the Division of ry 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 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.. ZON 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 or.improvemnt-is sold within one year of completion, the owner -builder will havetheburden ofproving 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, 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.). 7 `: 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who r ender's " LName ' builds or improves thereon; and who contracts for such projects with a contractor(s) licensed pursuant,to the .. Contractor's License Law.). _ Lender's Address 4 O 1 am exempt under Sec. B. 8 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 — _.Y ' Date Owner ' city and county ordinances and.state laws relating to building construction;and hereby authorize representatives 4 ' of this coOnty'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. y' ' • yrs r '- certificate of Workers' Compensation Insurance..'ora certified copy lhereof,(Sec. 3800. tab. C.)' ,Y V Signature of Applicant or Agent Date. Policy No, Company. l CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read Misapplication and state that r Y• ❑ Certified copy is hereby furnished r „; • ; the information given is correct. I agree to comply with all state laws and county ordinances relating to buidlmg ria O Certified copy is filed with the City Building In p ction epart q of o --- Department.. construction, and authorize a' representative of the City.of, La Ouinta Department of Building and Safety to enter 'r ` / upon the property'for which I have applied for this'permit.for the purpose of making. inspections. Date Applicant, Signature of Applicant or Agent Date Print Applicant/Agent Name APPLICANT NAME (L, F, MI) Atmel ('rarKx r. ati a rt ADDRESS ' - _" •' •- 1P_+7_ R[YX 780 ' CITY/COMMUNITY/STATE/ZIP La (Ad_T*a. • CA 92253 JOB'SITE ADDRESS/SPACE - 76-959 Calle A zatlax CITY/COMMUNITY%STATE/ZIP • •• Ta Qii_ _A 92253 BOK PAG PRC. C TWN- RNG SE S TRACT 1.4496-3 LOT... 26 Const Fee 373.00 MOD 2M 2 ' SB , TRACT NAME /'y Santa Rosa Uwe OWNER NAME (L. F. MI) .. .. .. - CONTRACTOR -FIRM NAME ADDRESS CITY/COMMUNITY/STATE/ZIP - - • T. PHONE. '- • Sb4-1315: ' LICNCd s.ss 162 ARC/ENG FIRM NAME. ADDRESS ' CITY/COMMUNITY/STATE/ZIP - r• . ' PHONE . - LICNC M , USEMIT ly DW11T_ .. . S ' 7 g F C1 BL ZON FS8 SS8 „ SSB, RSB OFC •. - . • •ZONE ORD . ' .LOT SZ •' ^" END ' "' SIDE'- APPL/PRMT' " DATE '+ 8-i6-84 S.F.D.. Pp_rffat to =strict Model P --2B Dyr,1 ellina `' -.1.3900 sq. ft. Pbrch 112 scr. ft. f '-Carte 422 sly. ft. 'harLicalqee 31.00 " Plaza Cbeck Fee' 242.45 Const Fee 373.00 Fact.. Fee 31.25 5.57 - Plimbiz a Fen— 48.50 D r)P_ _,' Ff T 300.00 C E la V G ® G A 7 1984 777 TOTAL ' FEE $ 3 031.%7 e BLDG. DEPT._ - VALUATION $ 79,103.20•''] a AL NO. OPERATION I IJ TE INSPECTOR NO. OP TION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS 1 Set Back 33 Ventilation System 2 Ftgs & Frms o 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 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 i 13 Finish Grade INSULATION Thick R Value 7A Walls (Batts) 12B Ceiling (Batts) r 12C Ceiling (Blown) 14 Final PLUMBING APPROVALS 15 Ground Plumb 01 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 P) STREET NAME 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring X02 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service 32 Final