SFD (0882)77181 Calle Mazatlan
0882
PERMIT APPLICATION •,
d 1-3
tr City of La Ouinta
w r. Department of Building and Safety. .;z mss• `:,
Ss- S I g =%yam •z r
CITY/COMMUNITY/STATE/ZIP
iA -U=ta, 'CA 92253
N-
PAG
/ This permit becomes void if work n l commenced within 180 days from date of issuance,
OR; if work has been susp_ende0 or abandoned for a period of 180 days. ;-
/
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:,CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE: This section need not be completed it
' LICENSED CONTRACTORS DECLARATIONA hereby affirm thal,l am licensed, under provisions of Chapter 9 r. ' ; `
rM 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) of Division -3 of the Business and Professions Code, and my license is in lull force . :.... ,. issued. I shall. notemployany person in any manner so as to become subject to the Workers' Compensation Laws of ,
and effect.L `
California,
r License Class Lic. Number'
Date Applicant
Date Contractor ' a . •
. NOTICE TO APPLICANT: If. after making this Certificate'of Exemption, you should become subject to the Workers'-, ,-
OWNER -BUILDER DECLARATION: • j hereby alfirm that f'am exempt from the Contractor's -License Law for the
r 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
be deemed revoked.: , T
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for . r '. • DIVISION OF., INDUSTRIAL SAFETY PERMIT CERTIFICATION: .•
,.. such.permittofile asigned statement that heislicensed pursuant tothe proyisionsof.theContractorsLicense Law " • ,
O (hereby certifythat noexcavationfive (5)ormorefeet indepth into which apersonisrequired todesceud,willbe' ':S
(Chapter 9(comrnencing,with section 7000) of Division 3 ot.the Business and Professions Code),orihat heis exempt
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or -
therefrom and the basis for the alteged exemption. Any violation of Section 7031.5 by any applicant for a•permit
*'
'.
-demolition or dismantling thereol;will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2 Art 2; Sec341, Titog.
subjects the applicant to a civil,penalty of not more than five hundred dollars ($500.):.
C.A.C.) a
O L.as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
_
O' As owner-buifdei, l will not employ anyone to do work which would require a permit from the Division of
structure is not intended or offered for sale (Sec: 7044, Business and Professions Code: The Contractor's License
Industrial'Safety, as noted above, unless such person -has a permit to do such work from that division.
Law does not apply to an owner of property who builds; or improves thereon, and who does such work himself or ,. • ,'
t i
Division Industrial Safety Permit No. ' !
through his own employees, provided that such improvements are not intended or offered for sale. If, however, the "-;•
Q of
!, • buildingor improvempt is soldwithin one year of completion, the owner -builder will have the burden of proving that }
Date Applicant j
~ he did not build or improve for the purpose of sale.). ,. ; , ± } =
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is'a construction lending agency for the performance
L .O I, as owner of the.property, am exculsively contracting with.licensed contractors to construct the project ($ec;
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
Lender's Name r'
builds or improves thereon, and who.contracts for such projects with a contractor(s) licensed pursuant to the
BL
Contractor's License Law.). • ,
Lender's Address
O I am exempt under Sec: B. B.P.C. (Attached Certificate). -
I certify -that l•have.read this application and state that the above information is correct. I agree to comply with all
' "Date • • 'r Owner '. -,,j, 10
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
'
of this county to enter upoif the above-mentioned property for inspection' purposes...
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, ora
, ,• • ?,. .. _ . -
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.). • - +
, Signature of Applica'n't or Agent T ' 'Date
9 DD 9 ..
1 Policy No. Company --- 1
- • I
,
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read thisapplicationand statethat
'. ❑Certified copy is hereby furnished. t. e 1!//
y
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling (,
O Certified'copy is filed with the City Building Inspection Deaar tmenEorClty ! Department.
construction, and authorize a representative of the City of La Ouinta Department of Building and Safety to enter ry,
f r rJt `v °''
upon the property for which I have applied for this permit for the purpose of making inspections.
Dated Applicant`
-.y Zi
LOT SZ
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Signature of Applicant or Agent Date
ted. /,
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Ir _ + • : -• -
Print Applicant/Agent Name
i
f.•
APPLICANT NAME, (L..F, MI) ..
..brratisin
ADDRESS 7 _ _1
` T jio• - •780 •.
CITY/COMMUNITY/STATE/ZIP• 92253 .• .
CA
JOB SITE ADSDJRCE7SS//1;ntA,
SPPA CE,
-Ytt Cal le Mazatlan
CITY/COMMUNITY/STATE/ZIP
iA -U=ta, 'CA 92253
BOKr
PAG
PRC
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TWN
RNG
SE •
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Construction Fee
385.00'
Eldctrical Fee
5i' Fee
5.85• '
'rP?- inq Fee
48:50 LLa
Dev..Fee
.TRACT
i 4a 3
- ;• LOT -
12,
moo 1
• SB
,
TRACT NAME
`
Santa lei, a ` . ..
iiFii.'
OWNER NAME !L. MI) •+• .. .
CONTRACTOR -FIRM NAME „s•. ••
team, as a'aow
ADDRESS . - - •• 3 ..
CITY/COMMUNITY/STATE/ZIP 7,..- .. .. " - t _,•-.
•, s
PHONE a
%414.316 _,_
LICNC 11 - `
337b2•
. •
ARC/ENG FIRM NAME ' .._ • , - :. „
ADDRESS ' } .q •- •. . _
CITY/COMMUNITY/STATEJZIP
u"
PHONE N a
LICNC M-. ..
• _ ..'
•F_
USE OF PERMIT ,,,,, •• ; ,.
SIF/D wihtattach6 ral _tea
BL
ZON
FSB
SSB
SSB
RSB__
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OFC
ZONE ORD... '::
LOT SZ
END.. ..
SIDE
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APPL/PRMT
DATE r '
Pernlf t to construct 1, 903 sq.-: ft.,
family 8cJel:linlg vJi,.tti •att •t. :hdd '
( s pin'pgle-
biiechanical Fee
• 31.00. .
' Plan Ck Fee
250.25.
Construction Fee
385.00'
Eldctrical Fee
5i' Fee
5.85• '
'rP?- inq Fee
48:50 LLa
Dev..Fee
• .
450:00' '
12,
F7:
St.
SAT ~ y 4'Z ! 7 „F' M+ ..f. • l , i.Q<F fY• I- a
BLDG: •"7 4t,
'Ai . - - _ v. - ? _ ryY Y• ki.id* . ._ - ..._ f- ' ... ,ter `' Lam.- _ .- , i.
x
TOTAL jj •: s
FEE •
VALUATION'p
NO.
OPERATION I MTFE INSPECTOR
NO.
OP ,_ TION I DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
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35
Furnace Compart.
3
Steel
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
�� I
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.
❑
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
22 Water Softener
23 Water Service
24 Gas Test i
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
PSL P)
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29. Wiring a
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final