SFD (0463)77203 Calle Mazatlan
0463
PERMIT APPLICATION
City of
Department of
La Ouinla
Building and Safety -
JOB SITE ADDRESS/SPACE.
77-203 Calle Mazatlan
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
'ThiS'permit becomes void'if work not commenced within 180 days from date.of issuance, OR; if work has bee n suspended or abandoned for a period o1.180 days:
PAG'
CERTIFICATE OREXEMPTION FROM WORKERS t COMPENSATION INSURANCE: This section n I edd not be completed _ ,i
LICENSED CONTRACTORS DECLARATION:•I hereby affirm that 1 -am licensed under provisions of Chapter 9.,
the permit is forone hundred ($100) o, less..I,certify. that in the. performance of,the'work for which this permit is XV
(commenting -Aiith-Section 7000) of Division Sof the*Business and Professions Code, and my license is in full force
issued, I shallnot employ any person in any:manner so as to become,subject to the Workers'Compensation Laws of"."
and effect.
California. I . . I . . i
-License Class Lic. Number
'Date Applicant . . r'17
Date: Contractor
NOTICE TO APPLICANT, If, after making this Cerlificate*of Exemption, you should become subject to.theWtirkers'
OWNER hat" I am exempt from the Contractor's License Law for. the -BUIC(StA DECLARATION: - I hereby aifirm:t
Compens5tionprovisioni•of the Labor Code::you must forthwith comply with such provisions or 11hispermit shall
following reason (Sec. 7031.5.' Business and Professions'Code: Any city or county which*i6quires a permit to
,deemed f'
bed evoked,
construct.. alter, improve, demolish, or repair any structure, prioir to its issuance, also requires the applicant for
DIVISION OFANDUSTRIAL SAFETY PERMIT CERTIFICATION:
such permit to file,a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law- f.6"
I hereby certify that no excavation five (5) or more feet in depth int which a perton is required to descend, will be'
(Chapter 9 (commenping.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.!Pe basis for the alleged exemption. Any, violation of Section 9(91.5 by any applicant for a permit
demolition or dismantling thereof, will- 6e more than thirty-six (36) feel high. (Chap 3.2. Grp 2,'Arl 2* Sec 34 1. Title 8. J
subjects the applicant to a civil penalty of not more than five hundred dollars (5500.):
C. . A.0•
.0 -1, as own ' er of the property, or my employees with wages as their sole compensation, will do the work,.and.the
b As ownelr-builder '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 persdn'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
; . — ' * ' ... . . ; - . I . . I
through his own employees. provided that such improi6ments are not intended or offered for sale. If, however. the -
Division of Industrial Safety No.
building or 'improvemnt is sold within one year of completion, the owner -builder will 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 1. as owner of the property, am exculsively contracting:with licensed contractors to construct the project (Sec:,.
'7044.
of the work for which this permit is issued.(Sec. 3097,'Civ.-C:):-
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*..
JONE ORD #.,
Contractor's License Law.).
Lender's Address
0 Tann exempt'under 'Sec.- - _A!,&.P.C. (Attached,Certificate).,_
A certify that I.have read this application and state that the above information is correct. I agree to comply with all e',
Dat Owner
city and county. ordinances and state laws relating to building construction,and hereby authorize representatives
, . .
of thiCcounty to enter upon the above:mentioned property for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I her eby' affirm that I have a certificate'of'consen t to self -insure, o ra
Workers' Compensation Insurance , ora certified copy thereof (Sec: 3800. Lab.,.).*. , I I. -. : _
cerlificale'of C
.1 . . I . . I I :
Signature of Applicant'or Agent Date
Policy No Company
CERTIFICATE'OF COMPLIANCE AND AUTHORIZATION.OF ENTRY: I certify I have read this application ind.state that
0 &rlified"copy. is, h ereby.f6rnished; ,
the information given is correct. I -agree to comply with all state laws and county ordinances relating,to buidling
,
.0,Certified copy'is'liled with -the Cit Budding Inspection Department or City- Department:
construction, and authorize a 'representative of the City*of La Ouinta Department of Building and Safety to enter
upon the property for which I have applied for this permit for the purpose of making inspections—, I'
•e
Dat plicant
Signature of Applicant or Agent Date Ir
Print Applicant/Agent Name
APPLICANT
Ankn Im
,ADDRESS
P. O. B= 780
CITY/COMMUNITY/STATE/ZIP
La QW'nta,.CA 92253-
JOB SITE ADDRESS/SPACE.
77-203 Calle Mazatlan
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
SOK
PAG'
PRC
C
Fee
448.00
RNG
SE'
S
TRACT
1449 6-1
LOT
19.5
73,00-
Prioperty Develorruetit Fee
MOD
so
TRACT NAME
Santa Pbm Owe
OWNER NAME (L' F. MI)
CONTRACTOR -FIRM NAME
'As Abme
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE
564-3-33-5
TF1
LICNC #
33-3762
Is 1#132.4911 'v
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE 0
LICNC
USE OF PERMITS
iwith Attached Garage
BL
ZON
FSB
SSB
SSB
RSB
JONE ORD #.,
L.T_S1.
JND'SIDE
APPUPRUT - DATE
n4l. r% 3 14/28-8
Permit to construct 21326 Sq.
Ft. of S/F/D
with Attached Garage
Mechapical Fee-
;26..00
Plan Cher -k- Fed'.
2qi'2'0-
Fee
448.00
Electrical Fell,.
-36,90
SimFed,
_:-179,39
Plumbing Fee
73,00-
Prioperty Develorruetit Fee
450,0W
U tu
111 7
&zd
U) atj 0 'R..@ Q'i-ArAQ
TF1
Is 1#132.4911 'v
44 ' : - 4 ., .. `VALUATION F$IQ5,867*6011
OBLDG`b
.. : ?1
If All .0.r41rr7`N `
NO.
OPERATION , TE, •.
INSPECTOR
NO.
OP , ..r+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. ❑
NPON
ADDITIONAL INFORMATION
"K
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 i
22 Water Softener
23 Water Service
24 Gas Test
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
PL- P/I
STREET NAME
26 Power Pole
27 Conduit,',
28 Servicethirance
29 Wiring.:
29A Grounding Wire _
29B Bonding.
30 Fixtures
31 Service
32 Final