SFD (001010)77213 Calle Mazatlan
001010
PERMIT APPLICATION - .• i •
City of La Ouinta
'y - • Department of Building and Safety: °
N
P.Q. B= 780
This permit becomes void if work not 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' COMPENSATION INSURANCE: This section need not be completed if .,.Jo,
''LICENSED CONTRACTORS DECLARATIONi 1 hereby affirm that I am licensed_under'provisions-of Chapter 9
the permit• is for one hundred ($100) o, less. I certifylhat in the performance•of the work for which this permit is , -3
' (commencing with Section 7000) of Division 3 of the Business and Prof "Sio ss Code, an!d my license is in lull force
issued, I shall not employany,person in any manner so as to become subject to the Workers'Compensation Laws of
and effect. / e
/
California.
License.Class Li N1m[ber.J-
) - y
Date -Applicant w <
Date • Contractor— / '- '' /vim
, . ,• NOTICE TO APPLICANT:. If, alter. making this Certilicate.of Exemption; you should become subject to the Workers
•- -
exempt from for
.•Compwnsationprovislons olthe Labor Code; -you must forthwith comply with such provisions or this permit shall
OWNER -BUILDER DECLARATION: I hereby affirm that I am the Contractor's License Law the .
r' be deemed revoked.' a,
following reason'(Sec. 7031.5, Business and Professions Code: Any cily.or county which requires a.permit to .
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construct, alter, improve, demolish, or repair any structure prior to.its issuance, -also requires the applicant for. ,
such permit to file a signed statement that he is licensed pursuant to the provisions of the Contra ctor''sLicense Law •
DIVISION OF. INDUSTRIAL SAFETY PERMIT CERTIFICATION: "• ' •
0.1 hereby certify that no excavationfive(5)ormorefeetindepthintowhichapersonisrequiredtodescend,willbe
(Chapter 9(commencing with section 700) of Division 39f 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;4alsework, or
therefrom and the basis for the alleged.exemption. Any violation of Section 7031.5 by any applicant for a permit
demolition or dismantling,tnereof, will be more than thirty-six (36) feet high. (Chap 3.2. Grp 2, Art 2, Sec 341,.Title8 '-
subjects the applicant to a civil penalty of not more than five.hundred dollars ($500.):
C.A.C.)' " •a `' - "
O.1, as owner of the property: or my employees with wages,as their sole compensation, will dothe work, and the
'•p'As owner -builder. I will not employ anyone•to do work which would require a permit fromthe Division of. _ -d
' structure isnot;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,O
ADDRESS
through his own employees, provided that improvements are not intended oroffered for sale. If, however, the
Division of Industrial Safe Permit No.
Safety
building orimprovemntissoldwithinone year ofcompletion, 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
❑ I, as owner of the property: am ezculsively contracting with licensed contractors to construct the'project.(Sec. ,'.
r 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'
builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the
-
Contractor's License Law.).
Lender's Address
O 1 am exempt under Sec:., ^. B. 8 P.C. (Attached, Certificate).
I certifylhat I have read this application and state that the.above information is correct. I agree to comply with all - -
Date Owner t''
city and county ordinances and state laws relatingfo 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, ora
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' "certificate of Workers' Compensation Insurance • or.a certified copy thereota(Sec. 3800: Lab.•C.).-'
Signature of Applicant or Agent Date
Policy No. Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify 1 have read this application and state that
.O•Certified copy is, hereby tarnished. <
the information given -is -correct. I agree to comply.:with a0 state.laws and county ordinances relating to buidling
constr. ction,an authorize a;representative of the City of La Ouinta Department of Building and Safety4o.enter
O'Certified co is filed with' (he Cit Building Inspection Department or Cit Department.-, .'
PY Y B P Y` P
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upon the pro erty_lor which•t have applied for this pecmit•lor the purpose of making inspections.
Date .... APPlicant
- t --,:
Signature ff Applicant or Agent Date
APPLICANT NAME (L, F. MIAq )ndian _
ADDRESS
P.Q. B= 780
CITY/COMMUNITY/STATE/ZIP , I '' : , ..
la Quints CA 92253
JOB SITE ADDRESS/SPACE
77-213 Cane l aatlan
CITY/COMMUNITY/STATE/LIP - .' •' .. .
La Ouinta.CA 92253
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TRACT NAME - ..
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OWNER NAME•(L: F. MI) .. • '
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CONTRACTOR -FIRM NAME _. . + •.. . .
Arxien
ADDRESS
Ahcua
CITY/COMMUNITY/STATE/ZIP .
PHONE • ♦ `
LICNC 11
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rSfC-131.5
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ARC/ENG FIRM NAME
ADDRESS - 1531 Chapala SdLeT.i. .
CITY/COMMUNITY/STATE/ZIP
Santa Barbara, M 93101
PHONE •
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USE OF PERMIT ,
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Print Applicant/Agent Name
APPUPRMT. B ■i 1V' AL . 'v4 .F. D.
-nal.
Permit to construct -2,758 sq, ft, of
single family diftlliing with attached
garagei. This t to replace
$ 0462 Wt=*
Asch, Fee 13.00
Plan Cehrk Fee 32.70
Oonst. Fee 251.50
Fl e- t•, foe 23.08
Plumbing Fee. 36.50
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<'OCT 2'
BUCITY
-rVAi! F :NW @. RT MFNT ;
` F'TOTAL'•
FEE
- 35.4.78
VALUATION
Alk
Agh
NO.
OPERATION TE
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
1 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
1 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)
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
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
29B Bonding
30 Fixtures
31 Service
32 Final