SFD (000888)77129 Calle Mazatlan
000888
APPIINnCAyN`TnNAMr ra ..
ADDRESS - - ..
P.O. Box 780
- L PERMIT
APPLICATION
City of La Og a
Department of Building and Safety
- T- e`--4-, !•A 011=1
_JA I
.This permit becomes void if work not commence;within 180 days from date of issuance. OR, if work has-been suspended or abandoned for a period of 180 days.: ' .. .. ..: ! '..' . , n. " /
. - .. :v>'•.:•
CERTIFICATE OF EXEMPTION FROM WORKERS'COMP.ENSATIONINSURANCE: This section need not becompletedif.jJ:J.
-LICENSED CONTRACTORS DECLARATION: Ihereby affirm that.) am,.licensed under provisions of Chapter 9.
the permit is for one hundred ($100) o; less: I certify4hat 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 imfull force
- issued, l shall not employ any person'inany Manner soasto become subject to the Workers' Compensation Laws of +•% ij,
and effect.
California.
-. License Class Lic. Number
Date Applicant '
' •Date' Contractor„-.
NOTICE,TO.AP.PLICANT; If: after making this Certificate of,Exemptioo. you should become subject to the Workers'
'J ':'
: Compensation,provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall i .+
OWNER -BUILDER DECLARATION: hereby affirm [hal I am exempt from the Contractor's'Lieense Law for the
be deemed revoked. .yv
"following reason (Sec. 7031.5. Business and Professions Code: -Any city or, county which. requires a.permit to
1Oi
' construct, alter, improve, demolish, or repair any structure: prior to its issuance; also.requiies the applicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: - ,
• • such permit to file a signed.statement that he is licensed pursuant to,lhe provisions of the Contractor's License Law_
..:' O thereby ceitifythat no excavation .five (5) ormore feet in depth into which a person is required lodescend,will be I,
' '(Chapter 9(commencing with section 7000) of Division Sof the Business and Professions Code) or that he is exempt ,.
made in connection' with work authorized by this permitrand that no building structure,.scatfolding; falsework, or
.therefrom and.the basis -for the alleged exemption: Any violation of Section 7031.5:by anyapplicant for a permit
;;[,demolition or dismantling'thereof will be more'than thirty-six (36) feet high: (Chap 3.2, Grp 2, -Art 2, Sec341. TitfeB,
subjects the applicant to a civil penalty of not more than five. hundred dollars (SSDO.g
. ?js.'C.A.C.)
0, I, as owner.of the properly,;pr my,employees with wages as their sole compensation, will do the work, and the,.❑
As owner -builder; I will •not employ anyone to do work which would require a permit from the Division of '• Q;
structure.is not intended or offered for sale (Sec. 7044, -Business and Professions Code: The.Contractor's License :
Law builds, improves thereon, does himself
Industrial Safety, as noted above, unless such person has a permit'to do such work from that division.
does notw or and who such work or
apply to an owner of property who
;•x through his nwn employees, provided that such improvements.are notintended or offered for sale. If, however, the •
r
• •.O.6ivision 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...
Date Applicant ! 7
he did not build or improve for the purpose of sale.).,y,•, - . •'
CONSTRUCTION LENDING AGENCY: I hereby affirm Ihat there is a construction lending agency for the performance r a '
V. ❑ I, 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 Professions Code: The Contractor's License Law does not apply to an owner of property who
Lende"r'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.I am exempt under Sea 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
Date^'Owner "
city and countyordinances and state laws relating to building construction, and hereby authorize representatives , vi
20N
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'
"SS8 •
' certificate of Workers' Compensation' Insurance;, or a certified'copy'thereof (Sec. 3800. Lab. Q:):.. - , -
Signature of Applicant or Agent .' Date' +
f Policy No, Company \
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:'I certify I have read this application and state that-,
O Certified copy is hereby furnished : •
' a
the information given is correct. I agree to comply'with all state 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
❑Certified copy is tiled with the City Buildin Inae tmen o City_` Department.
i -upon
the property for whicfil have applied for this permit for the purpose of making inspections..
Date Applicag'"'
SIDE
_ Signature of Appticantfor.Agent _ Date
Print Applicant/Agent Name f`1
APPIINnCAyN`TnNAMr ra ..
ADDRESS - - ..
P.O. Box 780
CITY/COMMUNITY/STATE/ZIP
la Quinta, CA -92253
.JOB SITE AOORESS/SPACE -
77129 Calle Mazatlan
CITY/COMMUNITY/STATE/ZIP
- T- e`--4-, !•A 011=1
86K__
'0WG___`PRC
sq. ft,
• C
".
TWN
FIND, •.
SE ,
S
n
.H
fajv -
' 7
373.00
,Elect. Fee
.
SNC Fee ..•
5+57 ;
P1iW:dng Fee
,449fr 3 .
1Oi
300.00
•- •” •F . •
ity-4 La
1FAX" Al 11 11,
MOD . sB
a ..
TRACT NAME
Santa. RAa Cove '
OWNER NAME (L. F. MI)
CON RACTO FIRM NAME -
-
Move
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE • +LICNC
• '
564-1315
333762
ARC/ENG FIRM NAME
ADDRESS,
CITY/COMMUNITY/STATE/ZIP
a
PHONE N -
LICNC •,
,.
USE OF PERMIT ' . _
Single family dwell im
8L
20N
FSB
"SS8 •
SS8
'RSB,
OFC .
„ ZONE ORO •
!'END.
SIDE
APPL/PRMT n o n fl
DATE
• 8-16-84 'S.F.D.
Permit • to aonstmct Ma%l P-2 1 .
Dwel.l:ing.. ` ' 1,390
sq. ft. .
Pohl 112
sq. ft.
Garage 422
sq. ft,
i c - .Fee .
31.00
Plan Check Fee
242045'
Const. Fee
373.00
,Elect. Fee
31.25'
SNC Fee ..•
5+57 ;
P1iW:dng Fee
48.50
D = '
.. AUG
300.00
•- •” •F . •
ity-4 La
1FAX" Al 11 11,
i
TdTAL-
FEE $ 1,031.77•
• / .► ' ... ` . r aX' tr Yp.• ia+.h .Y `+e ..r , 7 Lr i' 'i • t
= •• ° ". i ~ t o • " , R` E a ''• , BLDG DEPT.Y ,7u :t &
? v
VALUATION ; 7S3a1a3'2a „i
Ah
NO.
OPERATION ATE INSPECTOR
NO.
0 AW TION 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
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.
❑
OP'N
NO.
ADDITIONAL INFORMATION
I
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
r13 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 A
'
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/t
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 .. Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final