SATT (001257)76974 Calle Mazatlan
001257
PERMIT APPLICATION
City of La Ouinta
• Department of Building and Safety
This permit becomes void it 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 provisions 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 Lfc. Ny per
Date Contractor
OWNER -BUILDER DECLARATION: I hereby,aflirm that I am 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 to 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 ;
(Chapter 9 (commencing with section 7000) of Division of the Business and Professions Code) or that he is exempt:
therefrom and the basis for the alleged exemption. Any violation of Section -7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than live hundred dollars ($500.):
❑ I, as owner ol.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. If, 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.
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.).
❑ 1 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 o1.Workers' Compensation Insurance or a certified copy thereof (Sec. 3800. Lab. C.).
Policy.No. Company
O 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) IaTlu4l ark IWC
ADDRESS P.O. Box 1000
CITY/COMMUNITY/STATE/ZIP T,,, ale,±^y„ , CA 92253
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7.: 'fe...,..tli -
JOB SITE ADDRESS/SPACE 76-974
CITY/COMMUNITY/STATE/ZIP ha Quinta, CA 92253
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Elect. Fee 57.51
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TRACT NAME 7t..S41ig Villas
OWNER NAME (L. F. MI) npp j oa.Ly,
CONTRACTOR -FIRM NAME applicant .
ADDRESS abw '
CITY/COMMUNITY/STATE/ZIP a3ove
PHONE • 345-2888
LICNC N
ARC/ENG FIRM NAME -
ADDRESS
CITY/COMMUNITY/STATE/ZIP '
PHONE N
LICNC I
USE OF PERMIT
BL
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SSB
SSB
RSB
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'.SIDE
+ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed It
the permit is for. one hundred ($100).o, less. I certify that in the performance of the work for which this permit is
issued; I shall not employ a ny.person in any manner so as to become subject to the Workers' Compensation Laws of
California.
Date Applicant
NOTICE TO APPLICANT: It.,after making this.Certificateof 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: -
o[hereby cehify tha(n6 excavation five (5) or more feet in depth into which a person is riquired 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; will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec341, Title8.
C.A.C.) ; . r/-
❑ As owner -builder, I will 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.
❑ Division of Industrial Safety, Permit No. r
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is aconstruction 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 [,have read this application and slate that the above information is correct. I agree to complyWith all
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. -
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION -OF ENTRY: I 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
construction1land authorize a'representative of the City of La Ouinta Department of Building and Safety to enter
upon the p ope fors c I av, a plied for this permit for the purpose of making inspections. '
Signature of Applicant or Agent Date
Print Applicant/Agent Name
. APPVPRMT nn J ? C'/ 2 A85 C IDO
Pendt to consttuct 1130 sq. ft. of condo
plusi LZO sq. ft. of parch and 451 sq. ft.
of garage as per approved Plans.
Mach. Fee 39.00
Pian Check Fee 290.65
Const. Fee 349.00
Elect. Fee 57.51
SMI Fee 5.01
Plumbing Fee 73.00
Fee; 2,000.00
TOTAL
FEE •
li.1
A 0 4 1 1 .3. -20 28
VALUATION 71' 918.00
BLDG. DEPT.
iMh
r1
NO.
OPERATION E INSPECTOR
NO.
OPE ION 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
$
39
Appl. Clearance
7
Framing
C
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
ADDITIONAL INFORMATION
T
SEWAGE.SYSTEM SIZE & LOCATION
11 Exterior Lath o2 Y
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APP OVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb d
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
28 Service Entrance
29 Wiring 0
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final