SATT (001269)76986 Calle Mazatlan
001269
PERMIT APPLICATION
City of La Ouinta
• Department of Building and Safety •
This permit becomes void it work not commenced within 180 days from date of issuance, OR, if work has been suspended or abandoned fora period of 180 days.
LICENSED CONTRACTORS DECLARATION: •1 hereby affirm that I am licensed under provisions of. Chapter 9
(commencing with Section 7000) of -Division 3 of the Business and Professions Code, and my license is in full force
and effect. '
License Class Lic. Gln eP
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
such permit 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 Professioas Code) or that he is exempt
therefrom and the basis for the alleged 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.):
0 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. If, however, the
building or improvemnt is sold within one year of completion, the owner -builder will have the burden of proving that
he did not build or improve for the purpose of sale.).
0 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
builds or improves thereon• and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
0 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 , ona certified copy thereof (Sec. 3800. Lab. C.).
Policy No. Company.
0 Certified copy is hereby furnished.
10 Certified copy is filed with the City Building Inspecti6 Oepartment'or City Department.
Date Applicant
APPLICANT NAME (L. F. MI) T , k •' Lan '
ADDRESS P.O. BC 1000
CITY/COMMUNITY/STATE/ZIP IJa 1Guinta, Chi 92253
JOB SITE ADDRESS/SPACE 76-986 Call e 14aZatl<an '
CITY/COMMUNITY/STATE/ZIP La Quintal CA 92253
BOK
PRACAG
PRC
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Plan Check Fee 368.30
TWN
RNG
SE'
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CPAAG
T1V / 65-2
LOT 41
MG
SB
TRACT NAME
OWNER NAME IL, F. MI) aWldimsant
CONTRACTOR -FIRM NAME applmcant
ADDRESS above
CITY/COMMUNITY/STATE/ZIP above _
PHONE • 34-1-2888
LICNC I
-
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE •
LICNC
USE OF PERMIT Condo
BL
ZON
FSB
SSB
SSB
RSB
OFC
ZONE ORD N
LOT SZ
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
the permit is for one hundred ($100) o, less. I'certify that in the performance of the work for which this permit is
issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of
California.
Date Applicant
.NOTICE TO. -APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'
CompensMion•provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
be deemed revoked.
.•OIVISION•OF INDUSTRIAL.SAFETY PERMIT CERTIFICATION:
0 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, Art 2, Sec 3411, Title 8,
C.A.C.)
0 As owner -builder, 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. _
❑ Division. of• ridustrial Safety Permit No. ~
Date Applicant '
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name r
Lender's Address
I certify that I e read this application and 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, and au%rize a'representative of the City of La Ouinta Department of Building and Safety to enter
up n th r p rt Itflc`I v .applied for this permit for the purpose of making inspections.
Signature of'Applicantwr Agent Date
Print Applicant/Agent Name
A 0 4 2 5
BLDG. DEPT.
3 20 3,
^
VALUATION IU414/ .
Pemit to oanstrwat 1632 sq. ft. of two-
story cmido '1 u 530 sq. ft. of porch and
451 sq. ft. of garage as per approved Plans.
Mech. Fee 42.00
Plan Check Fee 368.30
Const. Free 445.50
Elect. Fee . 70.06
SMI Fes 7.32
Plumbing Fee 87.00
Infrastxuature Fie 2,000.00
TOTAL
FEE -
if • d
A 0 4 2 5
BLDG. DEPT.
3 20 3,
^
VALUATION IU414/ .
Ah
Ah
NO.
OPERATION VKTE INSPECTOR
NO.
OPE TION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
i
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
35
Furnace Compart.
3
Steel
gs
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
/D r ,
39
Appl. Clearance
7
Framing
p2.
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 -702;19-5
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts) 7
12B Ceiling (Batts)
12CT Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer S' ;
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 PiI
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final