SATT (001258)76980 Calle Mazatlan
001258
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 it
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 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, I shall not employ any person inany mannersoasto become subject to the Workers' Compensation Laws of
and effect.
California.
License Class Lic. Numhe
Date Applicant
`,Date • Contractor ('Y
NOTICE TO APPLICANT: If, after making this Certificate of.Exemption, youshould 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
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 for
DIVISION.OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
such permit to file asigned statement that he is licensed pursuan! to the.provisions of the Contra.clor's License Law
❑ 1 hereby certify that no excavation five (5) or more feet in depth into which aperson is required to descend. will be
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) or that he is exempt
made in connection with work authorized 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.):
C.A.C.) ° ='/'x•• '
❑ I. as owner of the property, or my employees with wages as their sole compensation, will do the work; and tae.
p As owner -builder, I 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 an owner of property who builds, or improves thereon, and who does such work himself or
PHONE M
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 orimprovemntissoldwithinoneyearofcompletion,theowner;builderwillhavetheburdenofprovingthat
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
, • O I, as owner of the property, am excufsively contracting with licensed contractors to,construct the project (Sec.
of the work for which this permit is issued (Sec. 3097, Civ. C.)., - -
7004, 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
RSB
Contractor's. Licenseaaw.).
Lender's Address
❑ 1 am exempt under Sec. B. 8 P.C. (Attached Certificate). ,
, I certilij1hat I have read this application and state that the above information is correct. I agree to comply with all
.Date Owner "
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
certificate of Workers' Compensation'lnsurance , or a certified copy thereof (Sec. 3800. Lab. C.).'
..Policy No. Company _
• ❑ Certified copy is hereby furnished.
❑ Certified copy is filed with the City Building Inspection Departmentror City Department.
Date Applicant
APPLICANT NAME (L; F; MI) I jxlu k Land* an•
ADDRESS P.O. Baas 1000
CITY/COMMUNITY/STATE/ZIP La Quiftta] CA 92253
JOB SITE ADORESWSPACE 76-980 CW le Ma. 7 t' +_
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CITY/COMMUNITY/STATE21p La Qdnt`J'
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Plumbing Fee 73.00
Fee 21000.00
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TRACT NAME iervds Villas '
OWNER NAME (L. F. MI) Applicant
CONTRACTOR -FIRM NAME applicant ,
'a LiaUow'
ADDRESS
CITY/COMMUNITY/STATE/ZIP ab(M '
PHONE *345-2888 \
LICNC I
ARC/ENG FIRM NAME
ADDRESS - -
CITY/COMMUNITY/STATE/ZIP `
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END
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J 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 thisapplication and.state that
the information, given is corlect. I agree -to comply with all state laws and county ordinances relating -to buidling .
construction r nd auth0 2,4 a representative of the.City of.La Ouinta Department of Building and Safety to enter
upon the o_pert for w le h ve applied for this permit for. the purpose of making inspections.
LJ' Signature of Applicant or Agent . Date
Print Applicant/Agent Name
APPL/PRMTn"i 268. D'TE5 S
Pemit to constn=t 1130 sq. ft. of condo
plus 120 sq. tt. of porch aW ol sq. tt.
of garage as per - ppproned plans.
Mcch. Fee 39.00
Plan Check. Flee 29 0f.65
'•a st. FM 347iV0 '
Elect. Fee 57.51
SMI Fee 5.01
Plumbing Fee 73.00
Fee 21000.00
TOTAL-
FEE
21814.17
A 0 4 1 2
BLDG. DEPT.
3 20 .28
VALUATION 711918.00
A Ak
NO.
OPERATION E
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
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.
❑
OPON
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath -711 7
12 Internal Lath
12A Drywall -
7/1
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
PSL P/I
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
296 Bonding
30 Fixtures
31 Service
32 Final