SATT (001273)77104 Calle Mazatlan
001273
ADDRESS
P.O. Box 1000 ,
PERMIT APPLICATION - - • . ,
City of La
y
Ouinta
t Department of Building and Safety /
PAG '
PRC-
This permit becomes void it work not commenced -within 180'days.from date of issuance.
OR, if work has been suspended or abandoned for a period of 180 days.. '.
'
WORKERS' COMPENSATION
CERTIFICATE OF EXEMPTION FROM WORKECOMPENSATION• INSURANCE: This section need not be completed if-
LICENSEO'CONTRACTORS 'DECLARATION: I hereby affirm that.) am licensed under' provisions of Chapter' 9
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 full force
issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of,
and effect- nCalifornia.
r
License Class Lic.. umpef' - ed
Date Applicant
- Date Contractor ' _ '
_NOTICE TO APPLICANT: If; after making this Certificate of Exemption, you should become subject to the.Workers' •.'
' ' -
OWNER -BUILDER DECLARATION: I hereby affirm that I im exempt from the Contractor's License Law for the
(Compensation provisions•ot the Labor,Code, you must forthwith comply with such provisions or -this permit shall ..:
(=ion
be,deemed revoked.
following reason (Sec. 7031.5.'Business and Professions Code: Any city or county which requires a permit to 0. _
CITY/COMMUNITY/STATE/ZIP.
- construct, alter, improve. demolish, or: repair any structure, prior to its issuance, also requires the applicant for:.* ..': •
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:, , ...
such.permittofile asigned statement that heislicensed pursuant tothe provisions ofthe Contractor's License Law-
ofyI-hafnoexca6ationfiJe(5)ormorefeefin'depthintowhichapers nisrequiiedI descend,wilIbe
(Chapter 9 (commencing with section 7000) of Division,3 of the Business and Professions Code)or that he is exempt
made in connectionwith 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 :. 4&,
". demolition or dismantling thereof; will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2 Art .2, Sec 341, Title8;
,• subjects the applicant to a civil penalty of not more than five hundred dollars ($500.): + • r ztv,
C.A.C) '
• 0 I. as owner,of.the property, or -my employees with wages as their sole compensation, will do the work, and the
0 As owner-builder:'I will not employ anyone 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 Safety, is 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
r
' through -his own employees, provided that such improvements are not intended or offered for sale. If, however, the :..i •
0 Division. of Industrial Safety Permit No.
- building or improvemnt is sold within one year of completion, the owner -builder will have the burden of proving that
DateApplicant
. t he did not build or improve for the purpose of sale.). ;F,t; .. ? .'
CONSTRUCTION LENDING AGENCY: I hereby affirm that there iS'a construction lending agency for the performance
. 0. 1, as owner of the property: am exculsivelycontracting with licensed contractors to construct the project (Seca ' ..
of the work for which this permit is issued (Sec. 3097, Civ. C.).. k _ .. - •. .,. -. .
' '7044, Business and Professions'Code: The Contractor's License Law does not apply to an owner of property who
4 .
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 -
a I am exempt under Sec. B: 8 P.C. (Attached -Certificate).- - _
I certify that I have read this application and state that the above, information is correct. ) agree to comply with all- • .•:
s Date " Owner. "'
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. +
WORKERS' COMPENSATION DECLARATION:-( 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.).a
Signature of Applicant or Agent` Date
Policy No. Company f
CERTIFICATE OF'COMPLIANCE AND AUTHORIZATION OF ENTRY:' I certify I have read this application and state that ' y
O Certified -copy is hereby furnished. ... .. .. _, . _
the information givemis correct. I agree to comply with all state laws and county ordinances relating to buidling '
' 0 Certified copy is filed with the City Building Inspection Department'or.City Department='' ;
construction, and,authorize a' representative of the City of La Ouinta Department of Building and Safety to enter I
fif h'ch I have for this for.the inspections.:
Date Applicant -'
upon.(p3o/erty applied permit purpose of making ..
Signature of Applicant or Agent Date
APPLICANT NAME (L, F, MI)
ADDRESS
P.O. Box 1000 ,
CITY/COMMUNITY/STATE/ZIP.
L a Q<ubnta, CA 92253
JOB SITE ADDRESS/SPACE -7 104 'Calle Maza• tlan .
CITY/COMMUNITY/STATE/ZIP Ila ()tjiiita, -fM 92253
BOK
PAG '
PRC-
C
- .. ,T
WN -.
PING'
SE:.
S
TR1 876-5- .
LOT'_
8
70006
MOD 5
..58.
Pluming Fee
TRACT NAME n Villas
OWNER NAME (L. F. MI) aWy jea. ft
CONTRACTOR -FIRM NAME -
applicant
ADDRESS .,{, ,.,, ,,,., - - -
above
CITY/COMMUNITY/STATE/ZIP.
PHONE .
345-2888
LICNC
.
ARC/ENG FIRM NAME
ADDRESS -
CITY/COMMUNITY/STATE/ZIP .. . .
PHONE 11
LICNC 0
- -
USE OF PERMIT , ,,aa '
Cbrido
BL .
-
ZONFSB
SSB
SSB
RSB
OFC .
,,. 'ZONE ORD ..
; LOT SZ
;; ,END .,'•. S
SIDE
o Print Applicant/Agent Name
APPL/PRMTn i 273'3-7-85
IIIIAAAA
DATE
(X3NID0 `
Permit to construct 1632 sq. ft.r+e5f two-story
condo plus 530 sq. -ft.
of porch and 451 sq.
ft. of garage as per approved plans,,
v'
Meah. Fee %
42.00
Plain Check Fee .'
368.30
Const. Fee
445.50
Elect. Fee
70006
SMI Fee' "
`7.32
Pluming Fee
87.00
Infrastructure -Fee
2,000.00
' - TOTS .a.3
FEE
i 020:18'.
A04.2-9'., 3 .20 3;
VALUATION fQ ,47'.00
BLDG. DEPT.'
26
Power Pole
27
Conduit
28
NO.
OPERATION =i1,r3. ;iNSP CTQR .,
`#,
NO,.
; .•t ;p "'
• „ P,QA.-k',i .TION DATE INSPECTOR
Grounding Wire
29B
BUILDING APPROVALS
30
MECHANICAL APPROVALS
1
Set Back
32•
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
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.
❑
OPO'N
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts) ?5
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 ,
22 Water Softener
23. Water Service
24 Gas Test
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
26
Power Pole
27
Conduit
28
Service Entrance
29
Wiring
29A
Grounding Wire
29B
Bonding
30
Fixtures
31.
Service
32•
Final
I STREET NAME
i