SFD (000996)76983 Calle Mazatlan
000996
APPLICANT NAME.(L: F; MI)
Ander lw:Lp.
ADDRESS" - -
P.O. Box 780
PERMIT APPLICATION
_ City
•. Department of
of La Duinta
Building and Safety •-
,This permit becomes void if work not commenced within. 180 days irom:date
F
Yn
of issuance, OR, if work has been suspended or abalidoned for.a period of 160 days. - , ,• '," .. -. 1
• 'r s ;
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed l x
• LICENSED CONTRACTORS DECLARATION: I hereby.affirm that: am licensed under -provisions -of Chapter• 9
the permit is for one hundred ($100) o,.Iess. I_certify that in the,performance of the work for which this permit is ,
.(commencing with Section4000) of Division '3 of the Business and Professions Code, and my license is in full.force.- •
;: issued, I shallnot employ any person in any Manner so:asto become subject to the Workers'Compensation Laws of.
and effect.i
California. ,-
License Class. L bar.
Date Applicant r
Date . f ? % Contractor +^ -"-T - _
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'.
'OWNER -BUILDER DECLARATION: I fierebyaltirm That f am exempt from the Co iractor's'License,Law for the
Compensation provisions Code, you must forthwith comply with such provisions or this permit shall
rovisions of the Lab
s
following reason (Sec. 7031.5. Business and'P.rofessions 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:applicantfor:.'
- - DIVISION OF, INDUSTRIAL SAFETY PERMIT CERTIFICATION: ;
_ -such permit to file a signed statement that he is licensed.pursuanttothe provisionsofthe Contra ,Mor'sLicense Law,
O.1 hereby certify' that no excavation five (5) or more feet in depth finto which a person 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 permit •
`•demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2; Grp 2, Art 2, Sec341, Title Ii,
subjects the applicant to a civil penalty of not more than five hundred dollars.($500.)-, p
C.A.C.) - - - - -
:. O L as owner otthe.property, or my employees with wages as their sole compensation, will do the work, and the -.,
• : O As owner -builder; t will:hdt employ anyone'to do work'whicht'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, orimproves thereon, and who does such work himself or
; l
0 Division Industrial Safety Permit No.
through his own employees, provided that such improvements are not intended or offered for sale: ll, however; the.
of
building or improvemni is sold within one year of completion, the owner-builder#ill have the burden of proving that
Date Applicant
he did not build or improve tor.,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 properly, am exculsively contracting with licensed contractors to.construct the project (Sec: , .
of the work for which this permlt 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 iontractor(s) licensed pursuant to -the
Contractor's License Law.). _
Lender's Address
O I'am exempt.under Sec. B. 8 P.C. (Attached Certificate)..:
I cerlify'thatA have read this application and state that the above information is correct. I agree to comply with all ,
;:bate' '' 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 properly 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 (Secr3600. Lab. C.). -I. -i
Signature of Applicant or Agent Date
Policy, No. Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
O Certified copy is hereby. furnished.. :.6 a 1. .. ..
• 'the information.given is•corTecOl agree to comply with all state laws and.county ordinances relating to buidling .
' O'Certilied copy is filed with the City Building Inspection Department or City •Department.
construction, and author a a're resentative ot.the Cit of La Ouinta Department of Building and Safety to enter
. D, Y P 9 Y '
,
Date Applicant
-- t
upon the pr♦operty, or_which-have applied for'this permit for.the purpose of making inspections,=
•
Signature of'Applicant or Agent Date
M
Print Applicant/Agent Name
APPLICANT NAME.(L: F; MI)
Ander lw:Lp.
ADDRESS" - -
P.O. Box 780
CITY/COMMUNITY/STATE/ZIl Quintal, CA •92253
i .'
JOB SITE ADDRESS/SPACE
76-983 Calle Mazatlan
CITY/COMMUNITY/STATE/ZIP _ • '
La Ovi.nba .iCA 92253
BOK.
PAG
PRC.
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14496-,
20d,
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-
TRACT NAME
..,` y- `rT-= - i V
. :]FSlR 16A1 rbs COW
OWNER NAME L. F. MI) - .. • -
'a
Andmi
CONTRACTOWFIRM NAME _ .. .. , . •.
Andeb
ADDRESS - y,,.,,, ,
t tC imm .
CITY/COMMUNITY/STATE/ZIP
__{{, , ,,..
Abgm
PHONE IILICNC
564-1311%
333762
ARC/ENG FIRM NAME . .
Aa
ADDRESS •' .-
1531 Chapala Street
CITY/COMMUNITY/STATE/ZIP -
Santa Barbara, CA 93101'
PHONE .
- UCNC II
,.
805: 963--8903
USE OF PERMIT
Si mle . f1.a=Uy dwell 9 flQ
BL .
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FSB
SSB
SSB•
RSB
..ZONE ORD •- ., :
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-
END
SIDE
APPUPRMT- DATE s•.
n . g 10--19-84 S.F.D.
Permit to aonstnict 2,758 sq. ft. of
siriale f&' ilv dwlel].incr ftth attached
crara6re.•
wyl-h_ Flee 26.00
Plan Mack Fee 326.95
fbnat.. Fee 503,.00.-
,lact. Fee 42.16
8.93
hm Ar;q rae 73.00
_ 50_00 -,
,
Q.CT"2 3°19
r1=Z% IITY-CIF-LA UINTAJT
- ''TOTAL r • ' ` .
ILA FEE
VALUATION 127.658.80'
K '' . `t..,*.t, BLDG. DEPT: : '+ ,:. '. ` •+„ • r -A
Ah
r-1
NO.
OPERATION I MA TE INSPECTOR
NO.
OP .. 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.
❑
NPON
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
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
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final