SATT (001267)76982 Calle Mazatlan
001267
LICENSED CONTRACTORS DECLARATI
(commencing with Section 7000) of Divi
and effect. A
License Class Lic. Numb rf
Date Contractor
OWNER -BUILDER DECLARATION: I hereby affirm 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
suchpermit 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 3 of the Business and Professions Code) or that he is exempt
' therefrom and the basis for thealleged exemption. Any violation of Section 7031.5 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. It, however, the
building or improvemnt is sold within one year of completion, the owner -builder will have the burden ofprovingthat
he did not build or improve for the purpose of sale.).
O 1, 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
builgs or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the'
Contractor's License Law.). .
O 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 of Workers' Compensation Insurance , or'a certified copy'thereof'(Sec. 3800. Lab. C.).
Policy No. Company -
F
PERMIT APPLICATION
City of La Ouinta
• Department of Building and Safety
'This permit becomes void if work not commenced within 160 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 '
ON: 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 '
sion 3 of the Business and Professions Code, and my license is in full force issued, I shall not employ any person inany manner soasto become subject to the Workers'Compensation Laws of
California.
O Certified copy is hereby furnished
O Certified copy is filed with the City Building Inspection Department or City Department
Date Applicant
APPLICANT NAME (L, F. MI) I,arX%rk_=k .L.LiI d
ADDRESS P.O. BOX 10/00
•yam
CITY/COMMUNITY/STATE/ZIP Ja Q.ilnr,..a, Ci'ft . .9225J
JOB SITE AOORESS/SPACE 76-1 Calla Mazatlan
CITY/COMMUNITY/STATE/ZIP Ia Qu;*Lnta, CA 92253 .
BOK
'PAG
PRC
C 1
Ganga,, Fee' 445.50
TWN
RNG
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5-%5-765=2
.0039.
MOD
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3,020.18
TRACT NAME IT="V i i AA -
.
OWNER NAME (L. F. MI) -Wlilcaht
C RACTOWFIRM NAME
applicant
ADDRESS above
CITY/COMMUNITY/STATE/ZIP -
above
PHONE a 3455-2888,
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP '
PHONE .
LICNC 0
USE OF PERMIT SAI do
BL '
ZON
FS8
SSB.
SSB
RSB
OFC
ZONE ORD
LOT SZ
END
SIDE
Date Applicant
NOTICE TO APPLICANT: If, 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:'
O I hereby certify that 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• will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, AA 2, Sec 341, Title 8.
C.A.C.)
O As owner•6uilder, 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.
O Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm IhaCthlire is a construction lending agency for the performance
of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Address
I certify 'that h ve read/thls.vapplfcatiotand 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 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
construction nd. 4uthorize/a representative of the City of La Ouinta Department of Building and Safety to enter
upon the .41 prp e • for which4 v applied far this permit for the purpose of making inspections. '
V Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPL/PRMT ■ ' n i m 32'1-85 71DO
Permit to oDnstrwt 1632 sq. ft. of two' -story
omido plus 530 sq: ft. of porch and 451 sq.
dt. of garage as Per approved Plans.
Nisch. Fee 42.00
Plan Check Fee, 368.30
Ganga,, Fee' 445.50
Elect. Fee 70.06
SMI Fee 7.32
Plumbing Cee 87.00
infrastrIalature 'Fee 2,000.00
TOTAL '.
FEE
3,020.18
A 0 4 2 3 3 20 31
VALUATION 1041473.00
BLDG. DEPT.
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
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.
❑
NON
ADDITIONAL 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)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb L.(
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 pig
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final