SATT (001268)76984 Calle Mazatlan
001268
• * - PERMIT APPLICATION r '
ADDRESS - • '- -
P.O. Box 1000,
CITY/COMMUNITY/STATE/ZIP - '• - '
La Quin ta,• •' CA 92253
City of La Ouinta• ?
.• .. _ z • ti - 1 Department of Building and Safety
C
• .x,. 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.
"PAG
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not completed if
'LICENSED CONTRACTORS DECLARATION: I hereby affirm, that 1.•am licensed under, provisions of Chapter 9.-.
Ahe 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 in any manner so as to become subject to the Workers^Compensation Laws of.
and effect. -
California. +
License,Clsss Lic..N it har'
Date - Applicant
Date Contractor / - •'
NOTICE TO APPLICANT: If. alter -making this Certificate of Exemption, you should become subject to the Workers'
OWNER -BUILDER DECLARATION: Thereby affirm.that I am exempt from the'Contrac(or'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 fo its issuance, also requires the applicant for-
._.• DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:4
Such permit to file a signed statement that he is licensed pursuant to the provisions,of the Contractor's License Law
❑Iherebycertifythatnoexcavationfive(5)ormorefeefindepthintowhichapersonisrequIredtodescend,willbe
• ..(Chapter 9 (commencing with section 7000j 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' -
r. • therefrom and the -basis for the alleged exemption. Any violation of Section 703L5 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, Sec 341, Title 8.. '
subjects the applicant to a civil penalty of not more than five hundred dollars, (5500.): •
C.A.C.)-
❑ I. as owner of the property, or my employees with.wages as their sole compensation, will do the work, and the.
, -❑ 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
r
17 Division 'of Industrial. Safety Permit No.
through his own employees, provided that such improvements are not intended or•offered for sale.ft, however. -the ,
• .. -
building or improvemnt issold within one year of completion. the owner-builderwill have the burden of proving that .
. Date Applicant.
he did noLbuild or improve for the purpose of sale.).
-
CONSTRUCTION LENDING AGENCY:.1 hereby affirm that there is a construction lending agency for the performance ` -
q Las owner of the, property. am exculsively, contracting with licensed contractors to construct the project (Sec.`
of -the work for which this permit is issued '(Secr 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 . .
builps or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
.,. ZONE ORD !•.,- /•
Contractor's License Law.). 2
'Lender's Address
❑ 1•am exempt under Sec. B..B P:C. (Attached Certificate)..
'I certify that I have.read this application and state that the'above information is correct.) 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 sell -insure, ora •.
'certificateof 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 this application and state that
O. Certified copy is hereby furnished. ;. • . - .. .t
the information given is correct. I agree.to comply,with,all state laws and county ordinances relating to buidling.
❑ Certified copy is filed with the City Building Inspection Department or City Department.
canstructio land auth%ize a ;representative of the City of La Ouinta Department of Building and Safety to enter
the p(Cop& I hav applied for this•permit for the inspections. `
Date .. ., Applicant
upon yfot whlc purpose of making ••T
rf p' / "
_
Signature of Applicant or Agent : Dale
Print Applicant/Agent Name •+
APPLICANT NAME (L, F., MI) TiatidAw* Land
ADDRESS - • '- -
P.O. Box 1000,
CITY/COMMUNITY/STATE/ZIP - '• - '
La Quin ta,• •' CA 92253
JOB SITE ADDRESS/SPACE -76-984 -Calle Mazatlan
CITY/COMMUNITY/STATE/ZIP La "tap C'A 922 -53
BOK -
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TWN ' .,
RNG
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T,CTM-2 ..
L040
70.06
J=-`ee
4
SB
`
TRACT NAME e
1. Tennis Villas ..
OWNER NAME IL. F. MQ •, `,aipiicant
CONTRACTOR -FIRM NAME,,.. }.
` "T! 2'1 i... _
ADDRESS
CITY/COMMUNITY/STATE/ZIP _•, _ .. .
ow
PHONE 0 -2888 '
LICNC /
s
ARC/ENG FIRM NAME -
ADDRESS
CITY/COMMUNITY/STATE/ZIP. • •'
PHONE N
TOTAL ; .
FEE
LICNC M
USE OF PERMIT •• -
BL
- ZON
FSB
I SSBL
SSB
RSB
OFC
.,. ZONE ORD !•.,- /•
. ; LOTaSZ
.
,END -
, ,SIDE'. .
APPVPRMT
_ Pexmit to constract 1632 sq. ft. of . tWx%stary
condo, plus 530 , sq. • ft:
of porch' and 451'
sq. ft. of garage as 'pear approved p]:IAins.
Mech. Fee
42.00
Plan Check Fee. 368.30 •
.Const. Pae
`445:50''
Elect. File
70.06
J=-`ee
Plumbing Fee
87..00
-Infrastructure Else.
2,000.00'
s
•
TOTAL ; .
FEE
3 , u U • ts.
A0:4L'4 3 20
1' wi VALUA ICiN 101 8q 4. 0
BLDG. -DEPT.
Ah
Ah
NO.
OPERATION Im rE
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
o2
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.
❑
OWN
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 B
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)
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring S
29A Grounding Wire '
29B Bonding
30 Fixtures
31 Service
32 Final