SFD (000995)77003 Calle Mazatlan
000995
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PERMIT APPLICATION'
City of La Quinta
Department of Building and Safety- V
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
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:
77 -003 -Calle Mazatlan
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed it
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am' licensed under provisions of Chapter 9
the permit isforone hundred ($100) o. less. I certify that in the performance of the work for which this permit is' J
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
issued, I shall not employ any person in any manner so,as to become subject to the Workers'Compensatio.n Laws of -
and effect.
California.
L t um
License lic. N
Date Applicant
Date ,)s _.14 Cont,acttor _I, _11
NOTICE TO APPLICANT: IC -after making this Certificittioll Exemption, you should become subject to -the Workers;;;. i,
OWNER -BUILDER DECL'ARATI - 6NI:) hereby "affirm ihal`i,am exempt from theContractor'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 deemedI 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,pursuapt to the provisions,of the Contractor's License Law ,
0 1 hereby certify thatno excavation five (5) or more feet in depth into which a person is required to descend, will be
(Chapter 9 (gommencing with section 7000) of Division'3 of the Business and Professions Code) or that he is exempt
made in connection with work authorized by this permit, and that*no building structure, scaffolding, falsework, or
therefrom and the basis for the alleged.exemption. Any violation of Section 7031.5 -by any applicant for a permit -
demolition ffi . olition o - r dismantling thereof. Will be more thin thirty-six (36 . ) feet high. (Chap 3.2, Grp Z Art 2, Sec 341 . , Titleg,' .
subjects the applicant to a crvil,'pien'aity of not more than five hundred dollars ($500.):
C.A.C.)
0 1, as owner of the property or my employees.with wages as their sole compensation, will do the work; and the
'0 As owner-6uildbr, I will ' not employ anyone to do work -which would require a permit from the Division of
structure is not.intended or offered forsale(Sec. 7044. Business and. Professions Code: The Contractor's License.
Ifidustrial 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'
.., .1 i I . 1. %-..-. . . . . . .
through his own employees, provided that such improvements are nof'ihtended or offered for sale. -If. however, the
P Division of Industrial Safety Permit,No.
building or improvemni is sold within one year of completion. the owner -builder will have the burden of proying that':
Date Applicant
he did not build or improve for the purpose of sale.). f
CONSTRUCTION LENDING AGENCY: I hereby affirm that theei is a construction lending agency for the 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.): --
7D44, 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
ZON
Contractor's License Law.).
Lender's Address
0 1 am exempl'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*th all
Date owner
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
OFC
of this county to enter up & he
I above-mentioned property for inspection -purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell -insure, ora'
I .
certificate'of Workers' Compensation Insurance . or a certified copy thereof'(Sec. 3800. Lab. C.).
. : . .
Signature of Applicgnt or Agent Date
Policy NoCompany-1 1 :
CERTIFICATE OF COMPLIANCE'AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
0 Certified copy is hereby furnished.. I . - - ., : . . . I .. ... .
—
the information given is-66rect. I agree to comply with all state laws and county ordinances relating to buidling
15 Certified copy is filed with the City Building lin4pection`Oi ' rtment -or City -De0art:
Department mirii:
_qnsjLuction, ang authorize a;representative of the City of La Ouinta, Department of Building and Safety to enter.
c
It h, which.) applied
the grope: which) for this permit for thii-purpose of making inspections.
Date Applicant
-e
SignalurerkAtiplicant or Agent Date
Print ApplicantlAgent Name
APPLICANT NAME (L F. MI) -
APPUPRMT DATE
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ADDRESS
P.O. B= 780
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
JOB SITE ADDRESS/SPACE
77 -003 -Calle Mazatlan
CITY/COMMUNITY/STATE/ZIP
La Quinta. Q 92253
BOK -
PAG,
PRC
C I
26.00
TWN
326.95 -
Amit. Fee .503.00
S
TRAC
14496_4
LOT
18
-9ff - Flee
PImbirm Flee
8.9:'> t, r. E
73.00 Aqr,4
OD
Gm -1
SO
X:
TRACT NAME k
Santa Pbsa Cbva
OWNER NAME (L; F. MI),' --a,,.,•.' . - : .* , .. I . .
Ar%dm
CONTRACTOR -FIRM NAME
An&)je
ADDRESS
abom
CITY/COMMUNITY/STATE/ZIP
PHONE a
LICNC 0
TOTAL
5644&y 1
I 13376
-ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
VA
PHONE
80L %3-8901
LICNC 0
USE OF PE . RMIT siNle family dmlLin-
BL
ZON
FSB
SSB
SSB
RSB
OFC
ZONE ORD#
LOT Sz
.:j -END
SIDE"
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Permit to cmistruct 2j758 sq. ft, of
single family.dwelling
with attached
garage,
Mwfi. Fee
26.00
Plan Check Fee
326.95 -
Amit. Fee .503.00
Xlect. Fee.
42.16
-9ff - Flee
PImbirm Flee
8.9:'> t, r. E
73.00 Aqr,4
Proa. Devel. Fee
450.00
X:
60 OF
ON NG DOM"T
B Di
OMNI
--77—
TOTAL
I . U:.- 160 -
BLDG. DEPT.
VALUATION
r
Ah
NO.
OPERATION ATE INSPECTOR
NO.
OP ATION 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 If39
Appl. Clearance
7
Framing40
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. ❑
O.
NO.
NO.
• 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)
12CT Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb S
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 P)
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29
29X' —Grounding Wirt.•
296 Bonding:.` . •t•,
30. Fiictures.
31 Sgrvice'
32 Final r