SFD (000887)76989 Calle Mazatlan
000887
PERMIT APPLICATION
City of La Ouinta
Department of Building and Safely
This permit becomes.void-if work. notcommencedwithin 180 days from date oi.issuance,,OR, if work has-been suspended'or abandoned for a period of 180 days.'
JOB SITE ADDRESS/SPACE
76-989 Q311e Mazatlan
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need'n6l be completed if -
LICENSED 'CONTRACTORS DECLARATION: I hereb9 iiflirm. that. I am licensed under provisions of Chapter 9It.
the permit is for one hundred ($100)'o, less:l 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 lull force
issued, I shall not employ any person inanymannerso asto become subject tothe Workers'Compensation Laws of
and effect.
California. r
License Class Lic. Number
Date Applicant
TRACT
LOT
17
Date Contractor
NOTICE TO APPLICANT:.If, after making this Certificatiof.Exemption; you should become subject to the Workers'
OWNER' -BUILDER DECLARATION: II hereby affirm . that I . am exempt from the'Contractor'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'rivoked.
construct, alter, improve.' demolish, or repair any structure, prior to its issuance, also requires the applicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
.such permit to.file a signed statement -that he is licensed pursuant to the provisions ofthe Contra.clor:s License Law
01 hereby certify that no excavation five (5) or m(ire feet indeptNinto which a person is required to descend, will be
(Chapter 9(commencing with section 7000) of Division 3of the Business and Professions Code) or that he is exempt
madeinconnection with work authorized by this permit, and that -no building itrbctwe, scaffolding, falsework, or
therefrom and the basis for the alleged exemption: Any violation of Sectionr7031:5 by any applicant for a.permit -
demolition or di6mantling-theredf, will be more than thirty-six (36) feet high. (Chap , 3.2, Grp 2, Art 2, Siac341; Title B,
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
C. A. C.) S.
13.1. as o
. owner of the properly..or my employees wages as their sole compensation, will do -
'
C3 'As owner -builder; I will not employ anyone to, do wo&'which would require a permit from the Division of
• structure is not intended or offered. far sale (Sec. 7044, Business and Professions Code: The Contractor's License
bove. unless such person has a permit to do such work from that division.
Industrial Safety, as noted above,
Law does not apply to an owner of property who builds, or improves thereon, and who does such work himself or
.. I . . I . . . ... . ... I . '. .
through his own employees, provided that such improvements arenot intended or offered for sale: It, however, the
I
0 Division of IndustriaLSafety Permit No.
building or improvemnt is sold within one year of completion. the owner -builder will have the burden of proving that
Date Applicant
he did not build or improve for the purpose of sale.).
.1 - . - . - I . .. . .
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for thi,performance
0 1, as owner of the property, am exculsively contracting with licensed contractors to. construct the project (Sec:
of the -work for which this permit -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 contractor(s) licensed pursuant to the
ZONE ORD F
Contractor's License Law.).
Lender's Address—
0 1 am exempt under Sec., B. & P.C. (Attached Certificate).
I certify. that'I hive read this application and state that the above information is correct. I agree to comply with all
Pate Owner,
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above=mehtioned -property for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have'a certificate of consent to self -insure; or a
"-',cerlilicate,of Workers' Compensation Insurance : or a certified copy thereof*(Sec. 3800: L&. C.).
7
Signature of 4pplicint or Agent Date
Policy No. Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that., -
0 Certified copy is hereby.furnished.
.
'z Deioparl.-enl
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 of Building.and Safety to enter
ilding lil specli.n orCity•Department.'
0 Certified 6pj is filed with the City Building
•upon
the property for which I have. applied, for this permit for the purpose of'making inspections.
Da can.
Appli
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPLICANT NAME (L. F. MI)
Andggm Co"3oration
ADORE
V. PDX 780
CITY/COMMUNITY/STATE/ZIP
La 0=ta.CA 92253
JOB SITE ADDRESS/SPACE
76-989 Q311e Mazatlan
CITY/COMMUNITY/STATE/ZIP
la Ouinta. CA 92253
BOK PAD
0
PRC
C
(2nd`floor)277'
TNM
RNO•
1 SE
'S
TRACT
LOT
17
433.
sq. -ft.
MOD
SB
_14496-1
TRACT NAME
Santa RO-C;a VA WP
OWNER NAME (L. F. MI)
CONTRACTOR -FIRM NAME
Abetun
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE
564 J'Al 1;
Man Ck Fee
LICNC 0
_1117
ARC/ENG, FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE 0
31.'25
LICNC N.
SM, Fee
IJSbingleE OF PERMIT
Fa 4y DmIl-ing
OL
ZON,
De
SSB
SSB'.
RSB
OFC
TOTAL': . ri FEE
A.
ZONE ORD F
1,311.34
LOT SZ,:
.'END
SIDE',
APPUPRMT
DATE
VS -1-6-84•
S.F.D.
Permit to construct Model P -3B,'
nqpl I i I'm 'finewl
I _Alr.
QfV, f+
(2nd`floor)277'
sq: ft..
Pdrch., N
sq.., ft,`,
Qmmge
433.
sq. -ft.
F6e'
31.80
Man Ck Fee
291.'20
Const. Fee
448.00
Elect. Fee
31.'25
SM, Fee
7.39
De
450.00
01 La
TOTAL': . ri FEE
A.
$
1,311.34
UU,
-VALUATION 1$ 195,699.40-1
BLDG. A,
0.1
a
Ah
NO.
OPERATION 7"K 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
Q p26
35
Furnace Compart.
3
Steel
,
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Decko`
<
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.
❑
OP'NO.
ADDITIONAL INFORMATION
,
SEWAGE SYSTEM SIZE & LOCATION
1,1 Exterior Lath
12 Internal Lath
12A Drywall 34
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 r i
21 Water Heater
22 Water Softener
23 Water Se vice
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 d
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final