SFD (0462)77213 Calle Mazatlan
0462
PERMIT APPLICATION
City of La Quinta
afety
Department of Building and Safety
ADDRESS
P. O. BOX 780
CITY/COMMUNITY/STATEIZIP -
La92253
. (/MZ
This permit becomes void if work not commenced within 180 days from date
of -issuance, OR, ii,,work has been suspended'ar abandoned for a period ofv,180 days:
BOK.
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE,.' This section need not be completed if
LICENSED CONTRACTORS -DECLARATION: .1 hereby affirm that I am licensed under provisions of, Chapter 9
-
the permit is for one hundred ($100) o. less. I certify that in the performance ofthe work for which this permit is5.
(commencing with Section 7000) of Division 3 of the Business and Professions Code; and my license is in full force
issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of
and effect.
California.
License Class Lic. Number*
Date Applicant
Date Contractor
NOTICE TO APPLICANT: If; after making thi&Certificaleof:Exemption, you should become subject to the Workers'
iexerfipt from ffhi 'Contractor's License
OWNER-BUILDER DECLARATION: I hereby affirm that I a - Law -for the
Compensation provisions 01,11he L* permit shall
. _ ,of Code, you must forthwith comply with such provisions or this.
'revoked.
n (Sec. 7631.5. Business and Professions Code: Any city dr,county which requires a permit to
following reason
be aeemed t
*
construct. alter, improve, demolish, orrepair any structure, prior to its issuance, also requires the applicant for
DIVISION OF INDUSTRIAL. SAFETY PERMIT CERTIFICATION:
such permit to-fileasigned statement that he is licensed pursuant,to the provisions of the Contractor's License Law,.Y
O'Iherebycertif that no excaJalion live (5) of more feet in depth into which a person is required to descend; will be -
(Chapter 9 (commencing with section 7000) of.Division Sof the,Business and Professions Code) or that heis exempt
made in connection With work authorized by this permil,:bhd that no building structure, scaffolding. falsework, or
p. therefrom and the baiis for the alleged exemption. Any.-violation,of Section 7031.5 by any applicant for a'permit
demolition or dismantling thereof, will be m -ore t 6an thirty-six (36) feet high -:(Chap 3.2, Grp 2, Art 2, Sdc 341.,Title 8,
subjects the applicant to a civil penalty of not more than five hundred -dollars ($500.):r,:;
C.A.C.)
-0 1: as owner of the property, or my employees with,wages as their sole cor.ppensation, will do the work, and the
0,As owner -builder, I- will not employ -anyone to do Work which would require a permit from the Division of
structure is not intended or offered.
tiered. for sale (Sec. 7044,.Business and Professions Code: The Contractor's License
Industrial Safity,, 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
through his own employees, provided that such improvements are not intencleclor offered for iale. If, however, the.
0 Division of, Industrial Safety Permit No.
building or improverrint 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 I . or the purpose o . t sale,).
-CONSTRUCTION LENDING AGENCY: I hereby affirm that'there is a construction lending agencyfor the performance
0 1, as owner of the property, am exculsively.contracting with licensed contractors to construct the project (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 of property who
Lender's Name"
builds or improves thereon. and who contracts*for such projects with a contractor(s). licensed pursuant to the
Contractor's License Law.).
Lender's Address
0 1 am exempt under Sec. B. &,P.C. (Attached,Certificate).-.
ea' this
.1 certilj thaf I have read is application and, state that the above i-nformation.is correct I agree to comply with all
Date -V Owner.
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this countioto enter upon the above4mentioned property for inspection purposes.
-,WORKERS"COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a .
'cerllificate,of, Workers' Compensation Insurance , or a certitied.copy thereof: (Sec ,3800. Lab.IC.)., :.. : ...,
"SignatureofA7ppli'iant'6rAgenI Date
Foli cY. N Company,
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have'read this application and'state that
-.0 Certified copy is hereby -furnished. the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
0 - Certified 'copy isililed with the City Building Inspection depar , tmentoeCityl*? Department.
construction, and authorize a 'representative of the City of La Ouinta Department of Building and Safety to enter I
- -\6 .
f ' V
P4
upon the property for which I have applied for this permit for the uroose of making inspections.
-Date' Applicant
•
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPLICANT NAME (L F, MI)
kidert Cox1pratim
ADDRESS
P. O. BOX 780
CITY/COMMUNITY/STATEIZIP -
La92253
. (/MZ
SCQITOEuUAMiDUnNIttSaa#S
77DREMS.eMazatlm
a- IP
LCTYIQuinTY/ST#ATECA 92253 '
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PAG
PRC
C
Plan -iCt'jeck Fee
TVM .
RNG
SE
S
TRACT -
144961
LOT
19
8,93.,
Plum. m Bee
moo
G-1
SB
TRACT NAME
Santa Rosa. 0mve
OWNER NAME (L. F, MI)
COC NTRACTIOaRFIRE
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE 4
5641-1315
LICNC
333762
N 6W
Lrna U
ARC/ENG FIRM NAME
.ADDRESS
.CITY,C OMMUNITY/STATE/ZIP
PHONE 0
LICNC 0
USE OF PERMIT
S/F/D with Attached- Garage -
BL'
ZONFS8
SSW -
SSB
RSB
OFC -
ZONE ORD 0
771'.
LOT SZ
END -
APPIJPRMT 0 A -S 7
DATE
12-28-83 S/F/D,
Pewit to construct: 2,758.Sq. Ft. -of S/F/D
with Attached Garacte
Mechanical Tee
26,00
Plan -iCt'jeck Fee
326*95,
Construction Fee
503,00
Electrical Fee
42.16,
SM Fee
8,93.,
Plum. m Bee
-73,00
Property Development Fee 550,00.
R E C E H 1V M
E
nrl AI"Nibi,
N 6W
Lrna U
Rw
TF
FEE
1 -43004'
Si
T 4 VALUATION 1$127,658.80:.,g
'T.
41
Alk Ah
NO.
OPERATION I., TE INSPECTOR
NO.
OP TION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVAL'S
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
f=ireplace T.O.
❑
NPON
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 P/I
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 :. Wiring
29A Grounding Are
29B Bonding
30 Fixtures
31 Service
32 Final
n