SFD (000999)76993 Calle Mazatlan
000999
J
T
.. PERMIT
APPLICATION, 't A
City
Department
of La Quinta-. : ; a•^... r r e g >nk tri
of Building and Safety
PAG
'PRC
This permit becomes void if w000rk,nottcommenced within -180 days from.date'of
issuance.. OR, if work has been suspended or abandoned f6r a period,of 180 days;
TWN
R NO
SE
CERTIFICATE OF EXEMPTION FROM WORKERS' OMPENSATION INSURANCE: This section need not be completed i
LICENSED CONTRACTORS DECLARATION: I,hereby affirm that I:arfi-lice'hsed under provisions' of Chapter 9
the .permit. is for,one hundred ($100).o, less..) certify that in the performance of the work for which this permit is
• (commencing with Section 7000) of Division Sof the.Business and.Professions Code,"ifid'my license is in full force.-
issued; l shall not employany person inanymanneirsoasto become subject to the Workers'Compensa tionLa s of,,.:'
'and effect.
California.
License Class I ber—Dal
Applicant
Date .Contractor'
.'NOTICE TO APPLICANT: If,'after, making this Certificatiof Exemption,,you should become subject to the-Workers'..1-4151
u iCompensation
OWNER-BUILDEWDECtARATIOW. I,hiareby'affirm that I am exempt rom.the C66tractor'§ License Law for the'
provisions.of the Labor Code, you must .forthwith comply with such provisio ns or this permit'shall
be deemed
following reason (Sec. 7031.5. Business and Professions Code: Any city or. county. which fequires.a permit to
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,pursuantio the.provisions ofthe Contractor's License Law
I tie,reby, certify that no excavation fiVe (5jonmorefeet in depth'into which a pirson is required to descend, Will
(Chapter 9(commencing with s.ectio.n:7000) of.Division 3 of the Business and Professions Code) or that heis exempt-.*
made in connection with Work authorized by this permit, and that no building structure; scaffolding, faliework.or i' ,
therefrom and the basis,foEIhe alleged exemptiorr.Any.violation of Section 7031.5,by any applicant for a permit
' - i
t
-demolition or disma'ntlihg- therieof; will be more than thirty-six (36) feet high -(Chap 3.2. Grp 2- Art 2. Sec34,1, Ti lell:
• ;
subjects the applicant t alclvil penalty of not more than five hundred dollars ($500.):
C.A.C.).
O I. as owner of the property, or my employees with wages a§,their sole compensation, will do the work, and the' -
-OAs oWnie'4uilder, I will,*61 erriploy'anyonia 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 Safeii, as noted abo'veunless_ 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
or
0 Division of. Industrial. Safety Permit No:
through hisownemployees, provided that such improvements are not intended offered for sale. If, however; the
OFC
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 improveforthe purpose of sale.):.: , . . 7'.. . . , .. . . . :
.. .
CONSTRUCTIONIENDING AGENCY: I hereby affirdRat there is a construction lending agency for the performance
0 1, as owner 6f1he 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 town ownerof 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. & &,P:C.'(AtIaChed Certificate)..
z
' '.
I cei' ifylhatfl'h 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
Date Owner,'
'of this county to`inter upon the above4mentioned property for 'inspection'purposes.
WORKERS' COMPENSATION DECLARATION: I hereby'affirm that I have a'certificale of consent to'self-insure, ora
certificate of Workers' Compensation Insurance or.*a,certified copy'thereof (Sec: 3800. Lab,C.).* -
'Sighalur4'of'Applicant or Agent Date
Policy No. Company CERTIFICATE
OF C . OMPLIANCE AND AUTHORIZATION OF ENTRY I certify I have:read this application and staleth;t
0 Certified copy is hereby, furnished.
the -information given-is'do—rrictl agree to comply with all state laws and county ordinances relating to buidling
i Inspection Department City en,,
b Certified copy is filed with the City Building ljr s Departm' t
. .
u ut
,.constr c horize a represintative of the City of La Ouinta Department of'Building and Safety.tP enter f, ti
' * ' . I
upon t Vaid
he p , for wh icji.l.hadapplied for this permit for the purpose of making inspections.
Date Applicant.
q
Signature of"Ali.plieant or Agent Date
APPLICANT NAME (L. F; MI)
Onrn
ADDRESS.
P.O. Box 780
CITY/COMMUNITY/STATE/ZIP q
La Quinia, CA 92253
JOB SITE AOORESSfSPACE
. 76-993 Calle Mazatlan
CITY/COMMUNITY/STATE/ZIP - 1, . I . . .
. La Qum—ta, CA 92253
BOK
PAG
'PRC
C
TWN
R NO
SE
S
TRACT -
4496-3
LOTM
19
Elect.' Fee
36.90 -
Oil
G-3
SB
Plumbing Fee
TRACT NAME
Santa Rosa Cbve
OWNER NAME [L.'F. MI)'
Arden
CONTRACTOR -FIRM. NAME
Andem
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
above
PHONE . X
564a-.1315
LICNC 9
311782
ARC/ENG FIRM NAME
Parry Rpxkus
ADDRESS 7
IL531 chanala xtmppt
CITY/COMMUNITY/STATE/ZIP
R ht Ra4jara. rA (Mm
PHONE805' '90-89011
LICNC 0 .
USE OF PERMIT
tingle fiamily dwelling'
BIL'
TF
__E 7T.1,332.49
ZON
FSB
SSB
SS8
RSB
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'ZONE. ORD 0
LOT, SZ
.END
SIDE
Print Applicant/Agent Name
APPUPRMT
tj
Permit to mnstmat
2,126 -sn_ ftOf
sinale fare 0ti chi
lling ati-Airl-ted
claracre.
dth
1z
mach -rr-4*-
26,M)
Film Check Fee
291.20
obrist. Ree
448.66
Elect.' Fee
36.90 -
SM Fee.
7.39
Plumbing Fee
- 73. OW`d"
Prop*- Devel. Fee
450.00
4, 7
—All 4
Vrx
TF
__E 7T.1,332.49
VALUATION
1 1 105,867.
BLDG. D,EPTz,
a
NO.
OPERATION'TATE
INSPECTOR
NO.
OP TION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Firms
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
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.
❑
NO.
ADDITIONAL INFORMATION
N
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
126 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 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 P/I
STREET NAME.
26 Power Pole
27 Conduit
28; Service Entrance
29 Wiring 4
29A Grounding Wire f `
29B Bonding ; •,.
30 Fixtures 4• y
31 Service
32 Final
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at .