SFD (001000)76973 Calle Mazatlan
001000
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed d
LICENSED CONTRACTORS DECLARATION: 1 hereby affirm that I. am licensed under provisions 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; l shall not employ -any person inany mannerso as to become subject to the.Workers'CompensatioIt S of • j
and effect.
California. ,
License Class •`•L'ic'Number—
Date _ Applicant
Date.Contractor ri •
s . NOTICE TO.APPLICANT: II,•afler making this Certificate of Exemption, you should become subject to the Workers' • ` ev
OWNER -BUILDER DECLARATION: I hereby affirm chit I am exempt Irom'the Contracfor''6cense 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 city 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•lor.:
DIVISION OF INDUSTRIAL SAFETY. PERMIT CERTIFICATION:,.
• such permit to file a.signed statement that he is licensed pursuant to the provisions of the Contractor's License Law t
+O- I her6by certify that no excavation five (5) or m6ie feet in depth into which a person is reIiu ired to descend, will be
• (Chapter 9(commencingwith section 7000)of. Division .3of. the Businessand ProfessionsCode) orthat heisexempt,
made in connection with work authorized by this permit, and that no buildingstructure, scaffolding;falsework,or •,
therefrom and the basis for the alleged exemption: Any violation of Section 71p1..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, Sec341, Title B, t '.
subjects the applicant to a civil penalty of not more than live hundred:dolfars ($500.): • :
C.A.C.)
❑ I. as owner of the property, or my employees with wages as their sole compensation, will do the work, and -the
❑ As ,owner -builder, -1 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 awowner of property who builds, or improves thereon, and who does such work himself or,
CITY/COMMUNITY/STATE/ZIP ..
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 improverrint is sold within one year of completion, theowne.r-builder will have the burden of proving that .,
Date 'Applicant,-'
he did not build or improve for the purpose of sale).
CONSTRUCTION LEADING AGENCY: I hereby affirm that there is a construction lending agency for theperformance:
. . ❑ 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.). •.• .. ,. • .. , , .. .; • \ •
7044, Business and Professions Code:•The Contractor.'s License Law does not apply to an owner of property who.
'
,w Lender's Name
builds orimproves thereon, and who contracts for such projects with a contractor(s)licensed pursuant to the
Contractor's License. Law.).
Lender's Address sy
O I am exempt under Sec. B; & P.C. (Attached Certificate)..
• . I certifyAhat (have read this applic lien and state that the above information is.correct. I agree to comply with all
' Date Owner ` /
city and county ordinances and state jaws relating to building construction; and hereby authorize representatives
•
of lhis'county lo'enlerupon the above-mentioned property for inspection purposes. t
WORKERS' COMPENSATION DECLARATION: I hereby.affirm that I have a.certificate of consent to self -insure, or a
ZON t-_
"%,certificate ol'Workers' Compensation Insurance . or a certified copy thereof (Sec. 3800. Lab. C:)..:
Signature of Applicant or Agent' "' Date i a
Policy No. Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify l have read this application and state that
❑.Certified. copy is hereby furnished. •. _ a
the information given is correct_I agree to comply with.all.state laws and county ordinances relating to buidling
- O Certified copy is filed with the City Building Inspection Department or Ciiy Aepartmenc:
construction, and out orfze a-representative.of the City of La Ouinta Department of Building and Safety to enter.
.
... ..
Date Applicant
,
upon.the\property r which I have applied for this permit for the purpose of making inspections.
,. LOT SZ
—z . ! j '
Signature o;;AppfiLrant•or Agent Date.
APPLICANT NAME (L. F. MI) _
Anden com.
- ... .
ADDRESS
n..
,,,,'
P.O. Alpl. c 700
CITY/COMMUNITY/STATE/ZIP
La 0=ta. CA 92253
JOB SITE ADDRESS/SPACE
76-973 Calle Mazatlan
CITY/COMMUNITY/STATE/ZIP • - - t
La Quinta. CA 92253
BOK-
-PAG -
PRC
C J.TWN
448.00
I RNG
SE
S
TRACT
LOT-
73.0 t
Prop. Devtel. Fee
MOD
SB
14496A,--
21
G3
,
TRACT NAME -
Santa T&vsa rkTi p
OWNER NAME (L. F. MI) • • - •• .. ..
Arickm
CONTRACTOR -FIRM NAME
Wpm
ADDRESS
+ c-Lbove
CITY/COMMUNITY/STATE/ZIP ..
abrAms
PHONE. "- `
564-2315
LICNC..>
333762
ARC/ENG FIRM NAME -. r
Y'T'l7 RPl`3[i74 .
ADDRESS -
- 1531 Cmpala Street -
CITY/COMMUNITY/STATE/ZIP '
Santa EaiJ=a, CA 93101
PHONE805 963:-8901,
LICNI;..
^
USE OF PERMIT s' " "y7 ^ q ,
Cup
7Tf y
BL
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FFSB
SSB
sse
RS8.
OFC _
- •11
ZONE ORD,.; .
77.•
,. LOT SZ
•END
..SIDE
Print Applicant/Agent Name
APPL/PRMTDATE
1 UO
_ - '
10-19-84 S.F.D.
P nuit to construct 2,326 sq. ft. of
shidie fwr 1y dwellinq with attached
• gara` e —
i -
Mech. Fee
26.00
Plan Cheek Fee
291.20.
Const. Fee
448.00
Elect.•Fee
36.90
SM Fee ,
7.39•
Plumbing. Fee
73.0 t
Prop. Devtel. Fee
450.00
e
b `I
l
AL
TFEE
'1OT
•
',332 49
BLDG. DEPT. _ VALUA-ilON 105.867- n
• '
a
A&
NO.
OPERATION ATE INSPECTOR
NO.
OP ,ATION I DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade o23
35
Furnace Compart.
3
Steel
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck 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. ❑
NO
ADDITI.ONAL 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) ,a
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
PSL P/I
STREET NAME
26 Power Pole
27 Conduit
21�:. Service Entrance
2911. Wiring
29A Grounding Wire;,''
29B 'Bonding
30 Fixtures
31 Service
32 Final •= "