SFD (001011)77203 Calle Mazatlan
001011
APPLICANT NAME IL: F. My q , 77.,,,,,, '
Cikn- Jy
LlLE m
x PERMIT APPLICATION
,. City of La Ouinta►
• Department of.Building and Safety • r
'f
Q22851
K This permit becomes void it work not commenced within 180 days from date of
issuance, OR, if work has been suspended•orabandoned for a period'ot180 days.'' rad.
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° ' • CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed it • ,T
LICENSED CONTRACTORS DECLARATION:: I heieby affirm that I -am licensed under provisions o6 Chapter 9', ' '
the permit is focone 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 61 the Business and Professions-Gode,,and my license is in full force . -
,. issued. I shall not employ any person inany manner so asto become subject to the Workers'Compensation Laws of it,
and effect. -
California. - -
License Class. Cic. Nut be .. .. Date Applicant
..Date + f ' Contrictol,/ r
NOTICE TO APPLICANT: If. after making this Certificate of Exemption; you,should become subject to the Workers' ,
r ' /
OWNER-BUILDER'DECLARATION: ' I hereby affirm that I am'ezempI from the Contractor's License.Law'for 6e
Compensation provisions,ot the Labor Code, you'mustforthwith' comply with such'provisions or this permit shall •-
be deemed revoked.
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit -to"
r
' construct, alter, improve. demolish, or -repair any structure, prior to its issuance, also requires the applicant for -
DIVISION OF INDUSTRIAL'SAFETY`PERMIT CERTIFICATION:
such permit to file a signed statement that he is licensed pursuant to the provisions oflheContractor'sLicense Law. --
0 hereby certify that no excavation five (5) or more feet in depth intd Which a otirson is required to descend, will be
(Chapter,9{commencing.with section 7000) of Division 3 of the Business and Professions Code)or that he is exempt
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or '
' .therefrom and the,basis for the at exemption. Any violation of Section 7031.5 by applicant for a permit C ,
"'demolition or dismantling thereof, will be more thadthirty-six (36) feet highJ(Chap 3.2, Grp 2, Ar62. Sec341; Title8.
'
a,•.' subjects'the applicant to a'civil penalty of not more than five hundred dollars ($500.): ' " .•
CAC) ` . . rlm :, 4
- O I: as owner of the, properly, or my employees with wages as their sole compensation, will do the work, and•'the .'
p'As'owner-builder; I will not employ anyone to 'do work which would'require a permit from the'Division of '
structure isnot intended or offered for sale (Sec.•7044, Business and Professions Code:.The Contractor's License .. • '.
does who builds, improves thereon, does himself
:Industrial Safety; as noted above, unless'such person has a permit to do such work from that division. '
' '•- •' -
Law not apply to an owner of property or and who such work or
' through his own employees provided that such improvements are not.intended or offered for sale..lf; however, the-
r • - -'
.p Division. of Industrial, Safety Permit No. . .
building or i mprQvemnI is sold within one year of completion. the ownec-,builder wil I have the burden of proving that •
Date Applicant ,
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
• ',0 I, as owner of the property, am exculsively contracting with licensed contractors to construct tha project (Sec: .-
•• ' of the work for which thispermit is issued (Sec. 3097, Civ. C.): ' • -
V
' 7044. Business and Professions Code: The Contractor's License Law does not apply to 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
w '
Contractor's License.Law.).
Lender's Address
❑ 1 am exempt under Sec. ' A. & P.C. (Attached Cerlificate).:
I certify that have.read this application,and state that the above information is correct. I agree to comply with all ,
Date Uwner ' +
city and county ordinancesand 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 consent to'self-insure; or.a
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certificate of Worker's' Compensation Insurance . or a certified copy thereof (Sec. 3800: Lab: C.).
°« Signature of Applicant or Agent Date
Policy No. Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY.,A certify I have read this application and state that
' O Certified copy is.hereby furnished..
the information given iiscorrreetFl•agree•to comply -with all'state laws and county ordinances relating lo'buidling j
`O Certified copy is filed''witn the City Building Inspection. Department or City Department. -
canstructio`. and a rt }I orrze a representative.of the City of La Ouinta Department of, Building.and'Safety to enter
Applicant
: upon the pro eertyylor which LtiaveAapplied for this permit for the purpose of making inspections.
- Date
t (/ s"'✓'// ✓f ✓
•
Signature of pplicant or Agent Date
•
Print Applicant/Agent Name s'-
APPLICANT NAME IL: F. My q , 77.,,,,,, '
Cikn- Jy
LlLE m
ADDRESS ' Q
vrn sin
CITY/COMMUNITY/STATE/ZIPx .. - ' •'
Q22851
JOB SITE ADDRESS/SPACE --
77-203 Calle Mazatlant
CITY/COMMUNITY/STATE/LP ..
La CAunta. CA 92253
BOK•
•PAG •
PRC
C
Const. Fee
TWN
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MOD
SB
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14496--1
195
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TFEE
321.07 .
TRACT NAME
A Postal 0 -no
sart
OWNER NAME (L. F; MI) •
CONTRACTOR -FIRM NAMEArd- • .
P_
ADDRESS -
aixx
CITY/COMMUNITY/STATE/ZIP .. .,
PHONE •
LICNC •
SAA -114
333762
ARC/ENG FIRM NAME
w '
ADDRESS ` . --•
1531 Chapala Street
CITY/COMMUNITY/STATE/ZIP •"' ' - - - '
Santa Barbara, CA -'93101
PHONE •
LICNC •
- "
USE OF PERMIT
sUrle fan ily f3ml inq
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SSB .
SSB '
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ZONE ORD •
LOT SZ • l
END
••. SIDE
APPL/PRMT fl n l n l
DATE 4'
10S.F.A...
Pennit to construct 22.326y sa. fto of.
si ncrl a family' dwelLin
with atbached
garage. This ve dt to replace
#0463 N E XPnW.
Mechanical Fee
13.00
Plan Check Fee
29..12
Const. Fee
224.00
Erect. Flee
18.45
-Plumbing Fee
36.50
K
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G OOcl- AA
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19
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TFEE
321.07 .
VALUATION "O" `.1t
BLDG. DEPT. a _
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Ak
NO.
OPERATION ,ATE INSPECTOR
NO.
OP , 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.
❑
TPTNO.
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath a 0
12 Internal Lath
12A Drywall a
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
' 9l
20 Sewer /a gs /•t
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 PiI
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring .
29A Grounding Wire
298 Bonding
30 Fixtures
31 Service
32 Final