SATT (001259)76988 Calle Mazatlan
001259
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. '
LICENSED CONTRACTORS OECLARATION:.I"hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division Sof the Business and Professions Code, and my license is intuit force
and effect.
License Class Lic t6nbal
Date Contractor.
"
OWNER -BUILDER DECLARATION: I he affirm that'Nm 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'sLicenseLaw
(Chapter.9 (commencing with section 7000) of Division 3 of the Business and Professions Code) o r 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.P.rofessions 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 o1 the property, am exculsively contracting withlicensed 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
buil(1s 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. & P.C. (Attached Certificate).
'Dale Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
certificate o1 Workers' Compensation Insurance , or a certified copy thereof (Sec: 3800..Lab. C:).
Polity No. Company
0 Certified copy is hereby furnished.
0 Certified copy is filed with the City Building Inspection Department or City Department.
Date Applicant
APPLICANT NAME (L. F. MI) l a11L.lilldrk Land
ADDRESS P.0. BOX 1000
CITY/COMMUNITY/STATE/ZIP T.•.. Quin . , C 92253
•L7 -988888
JOB SITE ADDRESSISPACE
Calle L fAw.+. t + .
vMi 922533i1
CITU/COMMUNITY/STATE/ZIP T ^
, i
BOK •
PAG
PRC
C
- 'TNM
SMI Fee 5.01
RNG
SE
S
M15765-2
LOT 42
1_
I!W3
sB
TRACT NAME fR- rat s Villas 9 s
OWNER NAME (L. F. MI) ArClimnt -
CONTRACTOR -FIRM NAME am11C8Y1t
ADDRESS above .
CITY/COMMUNITY/STATE/ZIP abCM
PHONE • 345-2888 ,
LICNC 1
'
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE a
LICNC 4
USE OF PERMIT '
BL
ZON
FSB
SSB
SSB
RSB
OFC
ZONE ORD #
LOT SZ
-
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE: This section need not be completed It :
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 totheWorkers'
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:
0 1 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 341. Title 8.
C.A.C.)
O As owner -builder, I will noP2mploy' 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.
0 Division ol,lndustrial Safety Permit No.
Date 4Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
l -of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
I certify that I have 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 authorize a representative of the City of La Ouinta Department o1,Building and Safety to enter
upon thpraRelAy IqJ ich hav lied for this permit for the purpose of making inspections.
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPL/PRMT * R t ' l ? g r , 31TS L<AYiJV
Pemit to construct 1130 sq. ft. of omxb
p luips( 1120 sq.ft. of porch ,_an+d 451 sq. ft. of
7ariage as pe approved plans •
Mch. Fee 39.00
Plan Check Fee 290.65
Qonst, Fee 349.00
Elect. Fee 57.51
SMI Fee 5.01
Pll + : g Fee 73.00
Snfrastr cture Fee 2tM000.00
TOTAL
FEE •
A 0 4 1 3
BLDG). DEPT.
3 .20 .L8'{
. VALUATION i,J1
dh
Ah
NO.
OPERATION V TE
INSPECTOR
NO.
OPE TION I 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
!O S
,
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. ❑
N
NO.
O.
ADDITIONAL INFORMATION
_
1 '
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall ay
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts) `f
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 Pi
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final