SFD (000883)77179 Calle Mazatlan
000883
APPLICANT NAME (L, F. MO
ArK en C orporaUon
ADDRESS.. - .. . .. _ .. ,.
P.O. Box 780
x PERMIT
APPLICATION , • y ? t '
City of La Duinta
• • Department of Building and Safety - •
BOK
,. 7
PRC 7
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This permit becomes void -if work riot commenced within 180 days from date of issuance. OR, if work has been suspended or abandoned for a period of 180 days.
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CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATIONINSURANCE: This section need not be completed if-.;
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'LICENSED CONTRACTORS DECLARATION: I hereby affirm that 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
- the permit.is for'one hundred ($100) o, less: [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'CompensationLaws of";,.
and effect.
California.
• License Class Lic. Number
Date Applicant
'Date Contractor
' NOTICE TO APPLICANT: If, after making this Certificateot Exemption, you should become subject to th'e'Workers'xi;
'OWNER -BUILDER DECLARATION: 1 hereby'aftirm that I am exempt from the Contractor's License''Law for the
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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
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be 4eemedievoke.d. ,
construct, alter, improve, demolish, or repair any structure; prior to its issuance, also requires theapplicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
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such permit to file a signed statement that he is licensed pursuant tothe•provisionsof the Contractor's License Law "
0 Ihere6y`certiij*t1fiatnoeica'vk ion five (5) or morefeet in dept h into which a person is required to descend, will be ;
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) orthat heisexempt' '
.. -made in connection with work authorized by this permit, and thatno building structure, scaffolding, falsework, or` -
therefrom'and the. basis for the alleged exemption. Any violation of Section 7031.5 by,- ny applicant for a permit' _
demolition or dismantlinglhereof,,will be more than thirty-six (36)'feet high,z(Chap 3.2, Grp 2: Art 2; Sec341, Titfe8, .'r•►
subjects thea applicant to a civil enalt of not more than five hundred dollars ($500,1?. ..
PP penalty
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C.A.C.1,'•
I. as owner of the my employees with wages as their sole compensation, will do the work, and the
0'As owner -builder, Twill not employ anyone to do'work .whicWwould'require a permit from the Division of .
structure isnot intended or offered for sale,(Sec. 7044,.Business and Professions Code: The Contractors License' •
. ': Industrial Safety. -as noted above, unlesssuch person+has a permit to do'such•work from that division. x
Law does not apply to an owner of property who builds, or improves thereon, and who does such work himself or •
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Safety
through his own employees. provided that such improvements are not intended or oflered:for.safe. If, however, the
❑Division ot.lndustrial Permit No.t
building orimprovemntissolid within one year ofcompletion, the owner -builder will have the burden of proving that
Date Applicant 1
he did not build or improve for the. purpose of sale.).
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agencyforthe performance ^
❑ I: as owner of the property, am exculsively contracting with licensed contractors to construct theproject (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 ofproperly.who
1
- `Lender's Name •
builgs 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
O 1 am exempt under -Sec. B. 8 P.C.{Attached Certificate).:
I certify that l have read this application and state that the above.infarmation is correct. I agree to comply with all
' 1 - •
,Date Owner.'
city and county ordinances and state laws relating to building construction, and hereby authorize representatives '
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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 nsent to sell -insure, ora
" cenificate'oi Workers' Compensation Insurance';`or a certified copy thereof (Sec.3800. Lab: C.).
s.
Signature of Applicant or•Agenf Date
Policy No. Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION • OF ENTRY:.I certify I have read this application and statethat ...
O Certified copy is.hereby furnished. • , >• •v
O Certified copy is tiled with the City.ffuildi g'Inspection Depart ent•or•Oity-^" Department.....'
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
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upon the property for which 1 -have applied for this permit for the purpose of mi king* inspections.' r
Date c_ _ Applicant
pl
.- ..
n - Signature 6l'Applicanho},Agent . Date, •
Print Applicant/Agent Name
APPLICANT NAME (L, F. MO
ArK en C orporaUon
ADDRESS.. - .. . .. _ .. ,.
P.O. Box 780
CITY/COMMUNITY/STATE/ZIP -
La . Quinta, CA. 92253
JOB SITE ADORESS/BPACE " •- 77-179 Calle Mazatlan
CITY/COMMUNITY/STATE/ZIP • ' -
La Q=ta, CA 92253
BOK
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PRC 7
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TWN
PING
SE
S
TRACT
14496-31
LOT
2
31.00
Plan Ck Fee'
MOD
11-2
SB
-
TRACT NAME
^.,NN .., -
Santa rpga Cme
OWNER NAME (L. F. MI) •
.CONTRACTOR -FIRM NAME - >
Above
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE Ir'` -
564-1315
-
LICNC 114'
333fif 2
Fee
ARC/ENG FIRM NAME
ADDRESS
CITY/COM MUNITY/STATE/ZIP -
PHONE I
'
LICNC 11 '•
`
USE OF PERMIT Fai y.Dwelling.ty
BL
ZON
... " • t `•
FSB
SSB-
SSB
RSB
OFC -
ZONE ORD N -
.LOT SZ k-"
_
• •END ,"
SIDE
...
APPL/PRMTDATE
P RON4. 8-16_84 - .: S.F-D,
Pemi t to . construct Niel P -2-B
Mellincr ` ° `' 1,390
scr. ft.
Porch 112
scr. ft.
E'z'1nacm 412
smi ft.
mechanic -&T Fee,
31.00
Plan Ck Fee'
242.45
4
Construction Fee
373100
Fl er_t 3 coal Fee
31.25
SMT' "Fee
5.57 '
API.-ba.xtta
48,150
Fee
Pxc np 'Dev6l. Fee
mtkr
300.00
'
1
,
... " • t `•
TOTAL' 7-7
%?. i
". Ak,,`,.►+<'' { s ":«; DEPT..Fi
'FEE
.1,031•, 7
VALUATIONgrW3,i
r1
r1
NO.
OPERATION !(E INSPECTOR
NO, OP 1,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.
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) i
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb d
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 s'
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.