SFD (0461)77223 Calle Mazatlan
0461
' PERMIT APPLICATION x'
- City of La Ouinta
• Department of Building and Safety " ' •.
...
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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