SATT (001263)76970 Calle Mazatlan
001263
PERMIT APPLICATION
City of La Duinta
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. • • `
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed' under•p'rovisions of Chapter. 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
and effect.
License Class Lic. N6 bef 5a Ot
Date Contractbr .•
OWNER -BUILDER DECLARATION: I hereby afliim that lam exempt from the Contractor's License Law -for the
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,lo its issuance, also requires the applicant for
such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
(Chapter9 (commencing with section 7000) of,Division 3 of the Business and Professions Code) or that he is exempt
therefrom and the basis for.the alleged,e_zemption. Any violation of Section 70311.5 by any applicant for a permit. .
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
O I, as owner of the property. or my employees with wages as their sole compensation, will do the work, and the
structure is not intended or offered for sale (Sec. 7044•. Business and Professions Code: The Contractor's License
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. ll, however, the
building or improvemnt is sold within one year of completion, the owner -builder will have the burden of proving that
he did not build or improve for the purpose of sale.).
0 I; as owner of the property am exculsively contracting. with licensed contractors to construct the project (Sec:: -f;.
7044. Business and Professions Code: The Contractor's 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
Contractor's License Law.)..
...0 I'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 copy thereof (Sec. 3800: Lab. C.). '
Policy No. Company
0 Certified copy is hereby furnished.
•'Certified copy is filed with the City Building Inspection Department or City Department.
Date Applicant
APPLICANT NAME (L. F. MI) Imubark T ,;.r
ADDRESS' P.O. b= 1000
CITY/COMMUNITY/STATE/ZIPLa 0,11 ta, CA 92353
JOB SITE ADDRESS/SPACE 76-970 Calle Mazatlan '
7
CITY/COMMUNITY/STATE/ZIP
L intagg, CA 2253
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T9765--21
1 LOT. 331'COD
Elect. Fee
70.06 `.
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TRACT NAME . s. Villa
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OWNER NAME (L. F. MI)
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CONTRACTOR -FIRM NAME - -
ADDRESS ab .
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CITY/COMMUNITY/STATE/ZIPaboVe
PHONE •345-2888 `
LICNC I
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ARC/ENG FIRM NAME -
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ADDRESS
CITY/COMMUNITY/STATE/ZIP '
PHONE /
LICNC N
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USE OF PERMIT Comb
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SSB
RSB
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LOT SZ
END .
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This'section need not completed if
the permit is for one hundred ($100) o,'less..l certify that in the performance of the work for which this -permit is
issued: I shall not employ any person in any manner so as to become subject -to the Workers' Compensation Laws of
California.
Date Applicant
NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you.should become subject to the Workers'
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 hereby certify thai no excavation five (5) or more feet in depth into which a person'is required to descend, will be*
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
demolition or dismantling thereof, viiltbe mole than thirty-six (36) feet high. (Chap`3.2, Grp 2, Art 2:Sec 341, Title 8. .0--
C.A.-C.)
'0 As owner -builder, IOwill not employ anyone to do work which would require •a permit from the Division of
Industrial Safety, as noted above: unless such person has a permit to do such work from that division.
0 DiKision of Industrial Safety Permit No,
Date Applicant
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 herebyauthorize representatives
of this county to enter upon the' above-mentioned property for inspection putposes.
Signature of Applicant of Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY 4 certify I have read this application and state that
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
construction a representative of the City of La Ouinta Department'of Building and Safety to enter
upon the rbp'o I have applied for this permit for the- purpose of making inspections.
Signature of Applicant or Agent
Print Applicant/Agent Name
Date
. APPL/PRMT no
17 8
78 6.
VY -85 _J CMW• .
Permit to construct 1632 sq. ft. of two-
story condo plus 530
sq. ft. of poreh -arid
451 sq. ft'. of garagge ' as per approved n.1--an—s.
Mech.,Fee
42.00
Plan Check Fee
368.30
Cdist. Fee
445.50
Elect. Fee
70.06 `.
all Fee
7.32
Plumb4ng Fee
87.00
Infrastructure Fee
2,000.00
TOTAL
T
3,020.18
A 0 4 1 9
BLDG. DEPT.
3 2 0 3 I,
VALUATION 104,473.00 .
Ah
Ah
NO.
OPERATION IYKTE
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
35
Furnace Compart.
3
Steel
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
J% s
,
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
r
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath oZ
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
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final