SFD (001009)77223 Calle Mazatlan
001009
APPLICANT NAME (L, -F, MI)
MEM Arxn Coro.
PERMIT
APPLICATION
City of La Ouinta.,
Department of Building and Safeity
La Q%=ta,'CA 92253
JOB SITE ADDRESS/SPACE
77-223 Calle Mazatlan
CITY/COMMUNITY/STATE/ZIP -
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.",."
PAG
CERTIFICATE OF EXEMPTION FROM WORKERS' OMPENSATION INSURANCE: This section neednot be completed if
LICENSED CONTRACTORS. DECLARATION:, I hereby affirm ;that~I am licensed under provisions of Chapter .9
the permit isJor 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 not employ any person in any manner so as to become subject to the Workers' Compensation Laws of
and effect.
California.
License Class mhpr
Date Applicant
"Date `,6, == --3 Contractor, . ..... :r-4 NOTICE TO APPLICANT: If. after making thit,Certificatiof Exemption, you should become subject to the Workers
n,:
OWNEA-BUILDER DE&ARATION: 1 h6riby'affirm thW1 am exempt- from Ifie Contractor's Lictinse1aw for the 'A
i Compensation provisions of the,Labor Code, yqumust forthwith comply.with such provisions or this permit shall
, - . - -. - - - - . . . ; - I .. a.
following reason* (Sec. 7031.5, Business -and Professions. Code: Any city or county which, requires a permit to
ede'imed'ri oked.' - . \F ,\ - , .
,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 filea signed statement that he is licensed pursuantto theprovisions of the Contractor's License Law '1
011 hereby ceitify that no excavation five (5) or inori feet iri'deplh into which a perion is requirid 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 irii 'connection with work a6thorized by this fiermit,-aind thatno building structure, scaffolding', falsework. or e4
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for, a,permit
.
'>dernolition ordismiIntlifig thereof, will be . more than thirty-six (36) feet high (Chap 3.2, Grp 2, Art 2. Sec341. Title 8.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500:): i l
- '
C.A.C.).
0 I. as owner of the property. or. my employees with wages as their sole compensation, will do the work, and the -
0 As owner -builder, I- will not employ anyone to do work which Would -requite 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, asnoted ibdve, unless such person has a permit to do such Work from that division. %4
Law does not apply to an owner of property who builds, or. improves thereon, and who does such work himself or
•
it - No.
0 Di . vis . ion . of Industrial . Safe . ty Permii
through his own employees, provided that such improvements are not'intended or offered for sale. If,. however. the
building or improventnt is sold within oneyear of completion, theowner-builddr will have the.burden of provingthat
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.10 construct the project (Sec:
of the work for.which this permit is issued (Sec. 3097, Civ. Q-
7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
Lender's Nam.e
builds *or improves thereon, and who contracts for such projects with a contractor(s). licensed pursuant to the
CITY/COMMUNITY/STATE/ZIP
Contractor's License Law.).
?—Lender's Address
• 0 1 am exempt under Sec. .-B. & P.C. (Attached Certificate).
I certify that thave read this application and state that the above information.is correct. I agree to comply with all
Date dOwner
city and county ordinances and state laws relating to building construction, and hereby authorize zepresentatives
7L
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
certificate of Workers' 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: I certify I have read this application and state that
0 Certified copy is hereby furnished.
the information given is-corr—ect. I agree to comply with all stale laws and county ordinances relating to buidling
0 Certified copy is filed with the City Building Insp6clitin'Department -or City Depaitment
c
constr tion an -at rtii—one a'repre'sentative of the.City of La Ouinta Department of Building and Safety to enter
`upon the rope. for whic.hrha4 applied for'this permit for the purpose of making inspections.
Date
oat Applicant
Y.
Signature,6i'Apolicant or Agent Date
APPLICANT NAME (L, -F, MI)
MEM Arxn Coro.
ADDRESS,
P.O. Box 780
CITY/COMMUNITY/STATE/ZIP
La Q%=ta,'CA 92253
JOB SITE ADDRESS/SPACE
77-223 Calle Mazatlan
CITY/COMMUNITY/STATE/ZIP -
LaQuinta. CA 92253
SOK
PAG
PRC'
C -TWN
FIND
SE
S
TRACTOT
J
321.07
MOO
14496-1 11.
.11.
193 1
G-31
TRACT NAME
Santa Rona Cain
OWNER NAME (L. F MI) V,
Anden
CONTRACTOR -FIRM NAME
Anden
ADDRESS
AbAMIR
CITY/COMMUNITY/STATE/ZIP
PHONE
'7r
564-1-11.5
I
I.L'CNC
3.113 %2
• ARC/ENG FIRM NAME
Parry r4k-1C*viq
ADDRESS -
15 rlinr
,Ala
CITY/COMMUNITY/STATE/ZIP
qamta Parham CM CRI Q1
PHONE 0
LI CNC It
USE OF PERMIT.
smgle family dipell=g
7L
ZON
FSB,' `SSB
_SSB
RSB
OFC
-ZONE ORD 0Z
LOT S
END
SID
Print Applicant/Agent Name
APPL/PRMT D
10Q2-84' S .-F,D..
Permit to cbn4truct 2,326 sq. ft,'of
swigle family dwmilng with attached
garage, 7us 1pejmdt to rqVlam-
permit 0461 EXPIRED,'
Keech, Fee 13.60
Plan Qieck'Fee 29.12
Cmat. Fee 224,00 -
Elect, Fee 18.45
Pin dAng Fee -36.50
LN
10;w 4
in" CnA
TOTAL'
FEE
J
321.07
A,#
`VAI
F BLDG. DE
& LUATION
a
F-1
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
//62
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.
❑
OP'N
NO.
ADDITIONAL INFORMATION'
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath p2 Q
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick 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
P/L P/I
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding,
30 Fixtures
31 Service
32 Final l