SFD (000886)76991 Calle Mazatlan
000886
APPLICANT NAME (L. F. 1)
Ater og=ration
ERIII!IT
1111111 AT 10 N
City C
Department of Buildingand Safety, ,• _ :
CITY/COMMUNITY/STATE/ZIP
. La 0 =*ta, CA 92253
BOK PAG PRCJ
This permit -becomes void if work not commenced within 180 days from date.of
issua*nce. OR, it work:has been suspended orabandoned for a period orlBO*days.
112 sa. ft.
RNG
SE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if,
LICENSED: CONTRACTORS -DECLARATION: I hereby affirm that I am 'licensed- under provisions of Chapter 9
the permit is for one.hundred ($100) o, less. I certify that:in the performanceof 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 forc;
A issued. I shall not employ any person in any mannerso as to become subject to the Workers'Compensation Laws of
-
and effect. ti.. Lf
JCalifornia.
License Class. Lic. Number
Date Applicant
Date' Contractor
`,-NOTICE TOAPPLICANT: If, after making this-Certificate'of Exemption, you should become subject to theWorkers,,
OWNER -BUILDER DECLARATION;' 'hhereibi'liffirin that I am-exinipt from the Contractor's License Law;for they '
-.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 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 Contractor's License Law
'
&l hereby certify that no excavation five'(5) or more feet i n depth into which a peison is required to descend, w it I be
.(Chapter9(commencing with section 7000),of Division Sof the Business siness and Professions Code) or that he is exempt
made in connection with workauthorized by this permit, and that no building structure, scaffolding, falsework, or..
(the alleged exemption; Any violation of Section 7031.5 by any applicant for a permit
,therefrom and the basis 1! r
n or thirty-six(36) feet high; (Chap 3.2. Grp 2, Art 2, Sec3iltt-Title A
demolition Aisnijntling thereof, will be more than thirty 8,
subjects -the applicant to a civil penalty of not more than five hundred dollars ($500.): %
C.A.C)
0 .1. as owner of the properly, or my employees with wages as their sole compensation; will do the work, and the.It
0 As owner build -I will not employ anyone to do work which would require apermit from the Division of
r,
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
ASS
through his own employees, provided that such improvements are not intended or offered for said. It, however; thei .
0. 6ivision 6f.i.ndustr-ial Safety Permit No.
building or improvemnt is sold within one year of completion, the owner -builder will have the burd,enof proving that
Date Applicant.•
he did. not build or improve for the purpose of sale.). . . . i - . .. . I i""." , .,! *
.
CONSTRUCTION LENDING AGENCY: I hereby affirm thamheri is a construction lending agency for the performance
the.
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 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.
Contractor's License Law.).
Lender's Address
0 1 am exempt under. Sec. B.,& P.C. (Attached Certificate)..
I certify,that I have read this application and state that the above information is correct. I agree to comply with all
Datesr•"Owner
city and county ordinances and stale.laws relating to building construction, and herebyauthorize 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 selfrinsure,.or a
certificate of Workers' Compensation Insurance , or.a certified copy.thereof (Sec. 3800. Lab. C.).
Signaturb @Affpiicaht or Agent Date
Policy No. Company,
is furnisheda
CERTIFICATE OF'COMPLIANCE AND AUTHORIZATION OF ENT6:.1 certify I have read this application and statelhat- .-.t
0 Certified copy hereby
the information given is correct. I agree to comply with all,stale 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
0 Certified copy is filed with the City Buildingeltion`.Dep., Department.
artment.or-cit
.
upon the property for which I have applied for this permit for the purpose of making.inspections.
Date Applicant
. . .." . . - .. .. . 11
Signature of Applicant or Agent Date
APPLICANT NAME (L. F. 1)
Ater og=ration
ADDRESS
P.O. Box 780
CITY/COMMUNITY/STATE/ZIP
* la Quinta, CA 92253
JOB SITE ADDRESS/SPACE . : . : - . .. . ., . I
1 76-991 Calle Mazatlan'
CITY/COMMUNITY/STATE/ZIP
. La 0 =*ta, CA 92253
BOK PAG PRCJ
CTWN
Porch
112 sa. ft.
RNG
SE
..S
TRACT -LOT.
14496-31
1 16
31.00
Plan Ck. Fee
MOD •
P03
J-5
448.00
TRACT NAME•
Santa Rosa VOm
OWNER NAME (L. F. MI)
CONTRACTOR -FIRM NAME
Abow
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE
564-1315
LICNC S
33376
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE#
USE OF PERMIT
Siwle raAmi-, _V ninll inn,
ZON
FSB
SSB
:SSB'
ASS
ZONE ORD#
I,'-
LOT SZ
_*END
" P S! DE
Print Applicant/Agent Name
APPUPIRMT.
DATE I * -, ' -
8-16-84 S.F.D._
PL-mdt to cmstn=t Model P-3-' ,"
Dwelling (1st floor 1,616 sir.' ft.
-.,,(2nd-f1Mrf 277 sm.': ft.
Porch
112 sa. ft.
Garacre
433 sa. ft.
Ylag-banical Fee'
31.00
Plan Ck. Fee
291.20
Const. Fee
448.00
P'lect-, Fee
31.25
sm rep-,
7.39
4500
TOTAL'
-'31104
FEE .919
;BLDG. BL P t
VALUATION $J05,699A
AML
NO.
OPERATION I ME
INSPECTOR
NO.
OPE . ION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
. 6v
35-
Furnace Compart.
3
Steel
"
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
/g
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.
❑
NON
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 o y
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