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SFD (0461)77223 Calle Mazatlan 0461 ' PERMIT APPLICATION x' - City of La Ouinta • Department of Building and Safety " ' •. ... '1 +e wal • 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. ' " - • N BOK CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be co'mpteted if, k `• LICENSED CONTRACTORS, DECLARATION: 'F hereby affirm that •1 am licensed under provisions of Chapter 9 the permitis for one hundred (5100) o; less. I certify that in the performance of the work for which this permit is r, (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. f" and effect. California. License Class. Lic. Number .Date Applicant. r Date c Contractor -NOTICE.TO•APPLICANT: If after making this Certificate of Exemption, you should become subject to the Workers' OWNER -BUILDER DECLARATION: Thereby affirm that I'am exempt from the Contractor's License Lavi for the r' Comp nsation;provisions.o('the Labor Code, you must forthwdh,comply.with such provisions or this permit shall be deemed following'reason (Sec. 7031.5, Business and Professions Code: Any city. or'county which requires a permit to revoked +u construct, alter, improve, demolish, or repair any structure, prior to its issuance. -also requires the applicant for ' • —DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION J `- ' such permit tofile-asigned statementthatheislicensedpursuanttotheprovisionsoftheContractor'sLicenseLaw.•; ,' ❑` thereby certity.ihatnoezcavationfivej5)ormorefeetinoepthinto;whichaperson'isrequireGjodescenA,"will be (Chapter 9 (commencing with.section7000) of Division 3 of the,Business and,Protessions Code) or that he is exempt... made in connection with work auttioriied by this permit, and tliat no building structure, scaffolding, falsework, or , T+l therefrom and the basis for the alleged exemption:Any.violation of Section 7031.5 by any.applicantfor a.permit zx: 'demolition or dismantling {hereof, will be more than thirty=six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec341, Title8 • f;l subjects the applicant to.a.civil penalty of not more than five hundred dollars ($500.): , .a,tvt C'.A.C.) ❑ I, as owner of the. property, or my employees with wages as their sole compensation, will do the work; and the ❑ As owner -builder, I will not employ anyone to do'work which would require"a permit from'the Dioision 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 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, avid who does such.work himself or. " T. through his own employees, provided that such improvements are not intended or offered for sale. If, however, the 0 Division of Industrial Safety Permit No. •building;orimprovemntis sold within one year of completion, the owner -builder 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, en agency for the performance • ' • . O I,.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.). - -' • . - ' w ,,, 7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who gender's Name ' '. 'builds 'or improves thereon; and who contracts for such projects with a contractor(s) licensed pursuant to the. Contractor's License Law.). f Lender's Address • .I am exempt under Sec.' - B. B.P.C.'(Attached Certificate). ' . I'certify that I have read this application and state that the above information is correct. I agree to comply with all , Date „q•' Owner" r"e city and county ordinances and state laws relating to'building construction, and hereby authorize representatives.;. 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 certificate of Workers Compensation Insurance . or a certified copy thereof (Sec. 3800..Lab. C.-). • ' •. Signature of Applicant orAgent Date + Policy No. Company CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that O Certified copy is hereby furnished.. =j the information:given is'correct. I agree.to comply with all state,laws and county ordinances relating to buidling t9,,Certified copy is filed witl!h-the City Building Inspection Depalrtment•oriC it- *+ __2 — Department.' '771 y 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: ✓Date F f Y' Applicant y// G r.. `t U / v..0 Signature of Applicant or Agent Date APPLICANT CANT NAM(~ E (- L, F. MI) mwm jy;lyM' m tillcm ADDRESS P. 0. Box 780 CITY/COMMUNITY/STATE/ZIP' Ia Quin4, CA 92253 JOB SITE ADDRESS/SPACE -' 7.7-223 Calle Mazatlan CITY/COMMUNITY/STATE/ZIP Ia Quinta„ CA 92253' BOK PAG PRC ''•C 26.00 . .. TWN- RNG SE - S TRACT, . 14496--1 LOT - 193 ' .. 'MOO m-3.- SB' 1100 • .' ' TRACT NAME Santa Rom Cam OWNER NAME -(L. F. MI). _ -. • . - . . CONTRACTOR -FIRM NAME • - Same As Above ADDRESS - CITY/COMMUNITY/STATE/ZIP. PHONE* 564_13{5 I , LICNC •- 333762 ' ARC/ENG FIRM NAME ADDRESS CITY/COMMUNITY/STATE/ZIP - .• PHONE • LICNC • •• USE OF PERMIT S F/D with Attacbed Garage ` BL' ZON FSB SSB SSB RSB- - •OFC,: • ZONE•ORD • iq ; ':, 'LOTSZ. END SIDE Print Applicant/Agent Name APPVPRMTDATE n4 12-28-83 S/1'/D' Peinit to construct 2,326 Sq, Ft, O€ S/F/D with Attached Garage Mechanical Fee., 26.00 . Plan- Check. Fee 291;/2 0 _ .. . Oonst ruction F'ee' 4`$8.00 . Elrectrical. -Fee 36,00 SMI Fee 7,39'.` Property Developmiant Fee 450,00' Plumbing Fee 1100 • .' ' • RE C E r, VN E'ED , g4:. vGW. v!I, E'_.cJ• a°Ito"a I AY -9 .. - ., r d TOTAL ;. FEE $3 , 332.49' + • •h, i-. - L n c ry ?.1rr ' r 'vj '* K+t+w' w s1' r +-. ;i• "(. y.}- •:.,u u a '' {i!• . ' ' :VALUATION 1. iLS j8v7.6\i . i " ._.'`.sc '' . "*%'' i tt4'\ f'i .. s fL3' u r`! ` •,?e, , _BLDGDEPrT:X: .,'.'' :tF' '`. +• .`'.. ` . r_. .. •`+' - .> n Ah NO. OPERATION WTE INSPECTOR NO. OPE KTION 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. ❑ NO. 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 P/1 STREET. NAME 26 Power Pole 27 Conduit 28 Service Entrance' 29 Wir.yng 29A Grounding Wipe 29B Bonding 30 Fixtiires ' :r 31 Service 32 Final