SATT (001260)77102 Calle Mazatlan
001260
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 -DECLARATION: I hereby.affirm that I am licensed under. provisions of 'Chapter 9
(commencing with Section 7000)'of Division 3 of the Business and Professions Code, and my license is in full force.
and effect. /J
License Class Lic. Nu b —
Date Contractor
OWNER -BUILDER DECLARATION: I hereby affirm that 1 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 pursuantto the provisions of the Contractor's License Law
.(Chapter 9(commencing with section 7000) of Division 3 of the Business and Professions Code)orthat he is exempt
therefromand 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 (S500.): I _Ar.r;
O 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 Professions 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 i mprovemnt 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 of the property, am exculsively contracting with licensed 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
'builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
❑ 1 am exempt under Sec. B. 8 P.C. (Attached Certificate).
Date ` Owner -
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
certificate of Workers'. Compensation Insurance .or a certified copy thereof (Sec. 3800. Lab. C.).
Policy No. Company
❑ Certified copy is hereby furnished.
❑ Certified copy is filed with the City Building Inspection Department or City Department.
Date Applicant
APPLICANT NAME (L. F. MI) Larifte-irk
ADDRESS P.O. BM 1000
CITY/COMMUNITY/STATE/ZIP L3 Quinta, CA 92253
JOB SITE ADORESS/SPACE 71-101JO'
Cal I fAamt a
CITY/COMMUNITY/STATE/ZIP L3, Quini , CA 92253
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LOT 47
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Elect. Fee
57.51
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TRACT NAME Tkmis Villas
OWNER NAME (L. F. MI) AW11cant I
CONTRACTOR -FIRM NAME app.callt
ADDRESS abom -
CITY/COMMUNITY/STATE/ZIP a1/G -
PHONE . 345--2888'
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LICNC
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP- '
PHONE .
LICNC N
21814.17 ..
USE OF PERMIT Cmido
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END
SIDE.
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed it
the.permit is for one hundred ($100) or 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 to the Workers'
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:
O l 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 AA -2, Sec 341• Title 8,
C.A.C.)
0 As owner -builder; Twill novemploy 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.
❑ Division of Industrial Safety Permit No.
Date ,Applicant -
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
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. a '
Signature of Applicant or Agent Date
CERTIFICATEOF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
the information given is torr ct. I agree to comply with all state laws and county ordinances relating.to buidling
construction, and a lhoriz representative of the City of La Ouinta Department of Building and Safety to enter
upon the p{qpe r wtlic . 4 pplied for this permit for the purpose of making inspections.
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPL/PRMT Mill 2,90
.3-0r1TEi$!tj MW
Plano to mwtn=t
Wo sq. rt. or c3ono
plus 12U sq. tt. or porch am 451 sq. Ye.
ot garage as Per approved plansa
Mach. 1. ler
39. U '
Plan Check Fee
290.65
Const. Fee
399.U0
Elect. Fee
57.51
:til Flee
5.01
Plumbing Fee
73.00
Infrastubcture Fee
21000.00
TFEEL
21814.17 ..
A 0 4 1 4
BLDG!. DEPT.
3 20 L8
VALUATION rY' ya. ,n
Ih
Ah
NO.
OPERATION VKTE
INSPECTOR
NO.
OPER TION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
35
1 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.
❑
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
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
2f' 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