SATT (001265)76976 Calle Mazatlan
001265
PERMIT APPLICATION
City of La Ouinta
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:
.
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
LICENSED CONTRACTORS DECLARATION: 1• hereby affirm, that I am licensed under provisions of Chapter 9
:. the permit is for one hundred ($110) o. less. I.certify that in the performance of -the work for which this -permit is
(commencing with Section 7000) of -Division Sof the Business and Professions. Code, and my license is in full force
issued. I shall not employ any person -in any mannersoasto become subject tothe Workers' Compensation Laws of .
and effect.
4
California.
License Class - - Lic. Number
Date Applicant
Date Contractor
NOTICE TO:APPLICANL If'after making this Certificate of Exemption, you should become subject to the Workers'
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
be deemed revoked'.
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to
COR 3
construct; alter, 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 signedstatement'thatheislicensedpursuanttotheprovisionsoftheContractor'sLicenseLaw
•01 hereby certify that iio excavAtion fiJe (5) or more feet in depth into which a person is required to descend, will be
. (Chapter 9(commencing with section 7000) of Division 3 o1 the Business and Professions Code) or that he is exempt
made in connection with work auttioriied by this permit, and that no building structure, scaffolding, falsework, or
therefrom and the basis for the alleged exemption. Any.;violation of'Section 7031.5 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 8.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):-
LICNC •
O I, as owner,ot the property, or my employees with wages as their sole compensation, will do the work, and the:
0 As owner•builder, I will hot 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 an owner of property who builds, or improves thereon; and who does such work himself or
I .
through his own employees, provided that such improvements are not intended or offered for safe. If, however; the
0 Division of Industrial Safety. Permit No.
building orimprovemntissold within one year ofcompletion; the owner -builder will have the burden of proving 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 '
0 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
Lender's Name "
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
0 1 am exempt under Sec. B: &.P.C.•(Attached Certificate).
I certify -that I have read this application and state that the above information is correct: l agree to comply with all.
Date Owner. " "
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.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a'certificate of consent to self -insure, ora
_
• certificate of Workers' Compensation Insurance . or a certified copy thereof (Sec: 3800. Lab., C.).
Signature of Applicant or Agent Date
Policy No. Company
CERTIFICATE OF COMPLIANCE AND:AUTHORIZATION OF ENTRY: I certify I have read.thisapplication and state that
0 Certified copy is hereby furnished. _
the information given is correctM agree to comply with all state laws and county ordinances relating to buidling
0 Certified -copy is filed with the City Building Inspection_ Department or City Department.
constructions and authorize a representative of the City of La Ouinta.Department of.Building and Safety to enter
, 1141 .
upon th pr yr which I ve applied for this permit for the purpose of making inspections. -
Date Applicant
Signature of Applicant or Agent Date
APPLICANT NAME (L. F: MI) larjdmazk, i1a.Slr..l'
ADDRESS P.O. Bok 1000
CITY/COMMUNITY/STATE/ZIP l Qu:i v.t;a,'!7T 12253
JOB SITE ADDRESS/SPACE 76-176 Calle Mazatlan
CITY/COMMUNITY/STATE/ZIP J ,;. Qu z*a; CA . 12253
BOK
PAG
PRC
•C
Mech. Fee
TWN•'-
RNG
SE
• S
TO -65-21
1 LOT
36
SMI Fee
COR 3
SB
87.00
TRACT NAME ITi, v. ..', t Villas
/ACillii
OWNER NAME (L. F. MI) t.`
1
CONTRACTOR•FIRM NAME app
ADDRESS abow'
CITY/COMMUNITY/STATE/ZIP^M
PHONE .345_2888
LICNC •
ARC/ENG FIRM NAMES
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE.
TOTAL
FEE
LICNC
USE OF PERMIT CNb '
BL
ZON
FSB
SSB.
SSB
RSB
OFC-,.'.
` ZONE ORD . ,.','`"
LOT SZ
..
END
. SIDE -
Print Applicant/Agent Name
APPL/PRMT ^ n n l 2 g`
3-211-185CONbo
Pendt to construct 1632 sq. ft. of two-
story aond3 phis 530 sq. ft. of porch and
451 sq. ft. of garage as per approved plans.
Mech. Fee
42.00
Plan Cock Fee
368.30 '
Const. Fee
445.50
Elect. Fee
70.06
SMI Fee
7.32
Pltmabing Ftp
87.00
Infrastructure Fee
2,000,00
TOTAL
FEE
:3,020,18
A 0 4 2 1 .-_ 3 20
1
BLDG.DEPT.
3 1 1 4 47 .00
VALUATION
Ah
r1
NO.
OPERATION VKTE
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
38
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.
❑
OP'NO.
ADDITIONAL INFORMATION
SEWAGE.SYSTEM SIZE.& LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall 42 5-
13 Finish Grade
INSULATION Thick R"
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb /9 ,
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 40 :- H
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final