SFD (000894)76961 Calle Mazatlan
000894
APPLICANT NAME (L. F, MI) . I . . . . . .
anden oqrwrat]A
ADDRESS-
P.O. B= 780
PERMIT
APPLICATION
City of La Quinta
Department of Building and Safety
BOK
PAG
7X
This permit becomes void if work not commenced within 180 days from date ofJssuance. OR, it work has been suspended or abandoned for a period of 180 days.
- I .. .. . , - . . I I . .. I I . .,
, . ' CERTIFICATE OF EXEMPTION 60 M WORKEW C`DMPENSATION INSURANCE:. This section need not be completed if i
LICENSED -CONTRACTORS', DECLARATION: I hereby, affirm that I'am licensed. under'provisions of Chapter.9
the permit is for one.hundred ($100) o, less. I cer.tify.that in the performance of the work for.which this permit is
(commencing with Section.7000) of Division3of the Business and Professions Code, and my license,is in full force
issued, I shall not employ any person,in any manner so as to become subject to the Workers'Compensation Laws of -.71,'
and effect.
California.
License Class Lic. Number..
Date Applicant
Date Contractor.
NOTICE TO APPLICANT: 11, after making this Certificate of Exemption, you should becomesubject to.the Workers'. oc,l
OWNER:601L D*ER' DECLARATION:' 1.64by*affirm that I am exempt froirri"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 Prolessiong Code: Any city or county which requires a. permit to
e deemed revoked.
b. . : - . .
constructiCatter, 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.sta ement that he is licensed pursuant to.the provisions of the Contractor's License Law
.11. . -
01 hereby certify that no excavation five (5) oi more feet in depth into which a person is iequired to descend, will be,,
(Chapter 9 (commencing with section 7000) of Division Sof the Business and Professions Code) or that he is exempt
made in connection with work authoriz6d by this permit, and that no building structure, scaffolding; falsework; or
therefrom;ancl 4he basis for the alleged exemption. Any violation.of Section 7031;5 by any applicant -for a permit
demolition ordismantling thereof, will be more than thirty-six (36) feet -high. (Chap 3.2,Grp 2;'Art 2, Sec 341, Title 8,
subjeci's, ihe applicant to a civil pinalty' of not more than. five hundred dollars (i500:):
C.A.C7j
0 1, as owner of the property. or my employees with wages as their sole compensation, will do the work, and the..
0 As owner -buil , der. .1 will not,employ anyone to do work Which would require a permit,from the Division -of
• structure isnot intended or offered for sale (Sec..7044. Business .a - ndProfessions Code: The Contractor's License
Industrial'Safety; as noted above, iinless'such person has a peimit.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
. - . . I . . " - ' ' ' ' ` " . . I .:
-through his own employees: provided that such improvements are not intended or offered for sale. If,however,the
Division,of Industrial Safely Pe.rmi! No.
..building or improvemntis sold within one year of completion, the owner-buildei,) i!l have the -burden of provingthat
Date Applicant..•
he did not build or improve for the purpose of sale.).: . - : . , ,., "'. . . I
... . :.. . .. .: . . . .
CONSTRUCTION LENDING AGENCY: .1 hereby affirm that there is a,construction lending agencyfor the performance.
0 1. 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
builds or improves thereon, and who contracts.for such projects with a,contractor(s) licensed pursuant to the,
LOT ,,SZ
Contractor's License Law.).
Lender's Address
0 1 am,exempt under Sec. •- B. & P.C. (Attached Certificate),
I certify that I have read this application and state that theabove 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 i
of this county to enter -upon the above-mentioned property for inspection purposes.
WORKERS'- COMPENSATION DECLARATION: I hereby affirm that I have atertificate of consent to.self-insure, or a
certificate of Workers' Compensation Insurance :.or a.cerlified copy thereof (Sec. 3800. Lab: Q.
Signature of Applicant orAgentDate
Policy No Company
I
CERTIFICATE'OF COMPLIANCE AND AUTHORIZATION OF ENTRY:,( certify lhave read this application and statethat
0 Certified copy is hereby furnlished-
rfioLJQ__ eartme
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
construction, and authorize a 'representative of. the City of La Ouinta Department of Bu ilding and Safety to enter,
0 Certified copy is filed with the City Building Inso Department.
5,
upon the property for which I have applied for this permit for'the purpose of making inspections.
Da ApplLriL.'
Signature of•Afiplicant or Agent,- Date ,
Print Applicant/Agent Name
APPLICANT NAME (L. F, MI) . I . . . . . .
anden oqrwrat]A
ADDRESS-
P.O. B= 780
CITY/COMMUNITY/STATE/ZIP
12 Quanta, CA 92253"
JOB SITE ADDRESS/SPACE
70---961 Laile Mazatlan
OMMUNITY/STAa CA 9TE/ZIP - Arm2253
Cl)2CQL
BOK
PAG
7X
PRC
Q.9 7'
.-C
TNM
RNG.
SE.
'S
TRlfl;r
L4 0,_3
LOT
27
Elect. Fee
31,25
LMQD
so
PlurdbirigMee
TRACT NAME
Santa Rosa Cavi
OWNER NAME (L F. MI)
CONTRACTOR -FIRM- NAME
atime
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE
. 564 133.5
LICNC
333162
TOTAL
FEE
ARC/ENG FIRM NAME
ADDRESS..
CITY/COMMUNITY/STATE/ZIP
PHONE 0
LICNC.#
USE OF PERMIT
slxwle—family dwelling .
OL
ZON
FSB
SSB
SSB .1
RSB
OFC;.
ZONE 9110 10.
I•
LOT ,,SZ
END..
SIDE
.APPUPRMTDATE
n-
-nnHq.4
8 -I:6_84 -F-011
pelyait to obnstruct 1,903 sq. ft. of
ile-fa 4lyfdmllinq with attached'
garage.
mechanical Fee,
31.00
Plan Ck..%,%d..
250,25'
Omist. Fee
385,00'
Elect. Fee
31,25
SM1 FEE
5,85
PlurdbirigMee
48.50:.
Prop: Dev, F& t
450.00*
E C E I V
AUG 171984
-'L
TOTAL
FEE
1,,,201.85
eL, e`
N AL
UAT'10 3 EQ..
BLDG. 4 .
J? N
8L 4t
A
A&
NO.
OPERATION MTE
INSPECTOR
NO.
OPE ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
Q
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.
❑.
NPON
ADDITIONAL INFORMATION
'
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall 02
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb 6v -T ,
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
'P/L
REAR OF PROPERTY LINE
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