SFD (000884)77177 Calle Mazatlan
000884
PERMIT
APPLICATION
City of La Quinta
Department of Building and Safely
a CA
T - Oninta. 92253
JOB SITE ADDRESS/SPACE %
This permit becomes void it work not iommenced within. 180 days from date of issuance. OR, if work has been. suspended. or abandoned for a period of 180 days.
• CITY/COMMUNITY/STATE/ZIP
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section neeIinot be completed it 1"I
*LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9-..:.
'the permit is for one hundred ($100) o. less. I certify -that in the performance of the.work for which this permit is
(commencing -with, Section 7000)-ol. Division 3of.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.
California.
License Class Lic..Number
Date Applicant
Date -Contractor: •
NOTICEJO APPLICANT:. If, after Making this Gertificatiof Exemption, you should become subject to the Workers'
-BUILDER DECLARATION I'h'er'eby affirm that I I am 6emp fr'
.OWNER R' om the Contractor's License Law for the.
Compensationprovisions of the Labor Code, -you must forthwith comply with such provisions or this permit shall.
be deemed revAed'
ifollowing reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires.a permit to
idemolish,
Y
construct, alter,. improve. or repair any structure: prior to its issuance, also requires the applicant for
DIVISION OF,IND.USTRIAL SAFETY PERMIT CERTIFICATION:
such permit to file a signed statement that he is licensed pursuant.to the provisions of the Contractor's License Law0.
1 hereby'certily that'no excavation five (5) or more feet in depth i nto which a person is required to descend. will
(Chapter 4(commenqing with,.section.7000).of Division 3 of the Business and Professions Code) or that he is exempt -
made in connection withworkauthorized by this permit, and
nd that no building structure, scaffolding: falsework,.or,
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,ptherefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
demolition ordismantling thereof,,will'be more than thirty-six (36) feet high:(Chap 3.2. Grp Z Art 2, Sec341; Title8.
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subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
V'C.A.C:1 _ \.- . . .
P.I. as owner of,the.propeoy, or my employeeswith wagesas 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'sLicense .
Industrial 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-himsell or
PHONE 0
throu6h:his own employees, provided that such improvements are not intended or offered for sale. If, however. the
0 Division of Industrial Safety Permit No.
,_bu it d ing o r i In prov e mn I is so I If w i I hi n o ne yea r of comp] etion, th e o wn er-bu i Ider wit I have the bu rden o I prov in g that
Date Applicant
.Oe did not. build or impr oye for the, purpose.of,sale.).
CONSTRUCTION LENDING AGENCY: I heireby affirm that there is a construction'Cending ageAcy 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.)._
7044. Business and Professions Code: The Contractor's License Law does not apply.lo 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
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Contractor's License Law.).
Lender's Address
'and
'0 Vam exempt undet. Sec. B. & P.C. (Attached Certificate).
I certify that . I have read this application state that the above information is correct. I agree to comply with all
'relating
Dateper•
city and county ordinances and state laws to building construction, and hereby,authorize.representatives
Z014
of thiscountyto enter upon the above-mentioned property for inspection purposes.•.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent 10 self -insure, or a -
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certificate of Workers' Compensation Insurance . or:a certified copy thereof (Sec: 3900. Lab. C.)!".-.
RSB
•Policy No. Company
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
0 Certified copy is hereby furnished.
the information given iscorrect: I agree to comply with all state laws and county ordinances relating to buidling
construction. and. authorize a 'representative of,the City ofrLaOuinta Departmentof Building and Safety to enter
0 I!nr,.ection Departmen _or_Cily_ Department.;
'eBuilding7
Date
upon the property for Which I'have ,applied for this permit for the purpose of making inspections'
Ap pnt
lic.
V
SignatureofA o rAgent Date
_ 16nt •
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Print Applicant/Agent Name
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APPLICANT NAME (L. F. MI) -
APPUPRMT
DATE
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ArlanADDRESS
P_n, -Pn-x 78()
CITY/COMMUNITY/STATE/ZIP
a CA
T - Oninta. 92253
JOB SITE ADDRESS/SPACE %
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• CITY/COMMUNITY/STATE/ZIP
TA r%4ir%+-A_ M IM.Sl
130K PAG
427 ccr ff---
TWN,
FING
SE
S
TRACT
LOT
242.45
Corist. Fed
Electrical Fee
moo
S
5.57
14496-3
3
1b
OF Property, Dev. Fee.
300.00
J13
I P-2,
"A
LWA MN
TRACT NAME
OWNER NAME (L. F. MI)
CONTRACTOR -FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
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0
.11
AAA -111 121 q
1.LICNC
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE 9
LICNC 4
USE OF PERMIT
Single Fmily'tlmlling
OL
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SSB
RSB
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.END
SIDE
e 11
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AnTait- tn- d4w+,_nv+_ MMP -I, P -2-A'
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1.391 ft
1Prsnrh1,12
sa. it
427 ccr ff---
Mecharddal Fee
31.00
'Plan dc Fee
242.45
Corist. Fed
Electrical Fee
373,00 -
31,25-
8M fee
5.57
Armbing, Fee 1.,.
48.50
1b
OF Property, Dev. Fee.
300.00
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-,,TOTAL, il
FEE 1.031J71- u.zl
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NO.
OPERATION L m
INSPECTOR
NO.
OPEWIVION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
G
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
f=ireplace T.O.
❑
OP'N
NO.
ADDITIONAL INFORMATION
/C z
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 APP OVALS
15 Ground Plumb a p2
16 Water Piping
17 Rough Plumb r44
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/1
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring 0Af
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final