SFD (001008)77233 Calle Mazatlan
001008
APPLICANT NAME (L. F. MI)_
Corp.
ADDRESS I . I . .1. . I I
P.O. B= 780
PERMIT
APPLICATION
City of La Quinta
116,11 "s, Department of Building and Safety
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' COMPENSATION INSURANCE: This section neednot becompleted if
LICENSED CONTRACTORS DECLARATION: I hereby. affirm that. I am.licensed, under provisioni of Chapter. 9,
the permit -is for one hundred ($100) o. less. I,certify that in the performance of ffie work to( which this permit is
in
(commencing with -Section 7000) of Division 3of the Business and ProtessionsVili,'and my license is in full force,
and effect.
Jssued * I shall not employ any person any manner so as to becoftsubject to the Workers'Compensation Lawsof
California.
License Class G—CNu r
Date Applicant
•,, , Conir2rtnr. 417LJ I,j6:
'Date—:..
NOTICE TO APPLICANT: If, -after making this Certificaticif Exemption, you should become subject to the Workers .,.L
-`4
OWNER -BUILDER DECLARATION: I hereby affirm that am exempt from tK6 Contractor's License Law for the'
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
'be
following reason (Sec. 7031.5. Business.and Professions Code: Any city or county. which requires a permit to
deemed revoked.
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for
DIVISION OF INDUSTRIAL SAFETY PERMifCERTIFICATION:
such permit to file a signed statement that he.is licensed pursuant to the provisions of the Contractor's License La w
0 1 hereby certify that no excaiation five (5) or more feet in depth into which a person is required to descend, will be ;J
(Chapter 9(commencing with section 7000) of Division 3.of the,Busi.ness and Professions Code) or that he is exempt
'made im6onnection With work authorized by this permit, and that no building structure, scaffolding, falsework. or 7,74,
therefrom and the. basis for the alleged exemption. Any violation of Section 7,031.5 by any applicant for a permit
the five.
demolition or -dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3:2. Grp Z Art 2, Sec 341, Title 8, 1
subjecis hundred dollars (MO.):.
applicant to a'civil penalty of not more-th; n*,
t'C.A.C.) - It.
j
O. 1. as owner of. the property, or my employees with wages as their sole compensation, will do the work, and the
0 As'dwner-66ilder I%Willnot employ,anyone to do -work which would, require a permit from; the. Division, of.
structure is not intended or.ottered.ior sale (Sec. 7044, Business and Professions Code: The Contractor's License , -
- Industrial Safely,as noted above, unless such person has a permit,to do such work.from'that division:.'
Lawtdoes not apply to an owner of property who builds, or improves thereon. and who.does such work himself or- -
* . I . . ;. -Y .11
"
t through his own employees, provided that such improvements are not intended or, offered for sale. If, however, the
El Divisi6n of Industrial Safety Permit
y.F rmit 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 for the purpose of sale.).
•CONSTRUCTION
'
LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
O 1, as owner
owner ot:th'e 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.). I
7044, Business and Professions Code: Jhe Contractor's License Law does not apply to an. owner of property who
1_11
Lender's
builds wimproves thereon, and who contracts4or such projects with a contractor(s) licensed pursuant to the
Name .
Contractor's License Law.).
Lender's Address — -
0 1 am exempt under Sec. B. & P.C. (Altached.Certificate).i,.
I certify that lhave read this application and state that the above information is correct. I agree to comply with all
Date OWner
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county, to enter upon the above:mentioneIf property for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that) 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 or Agent" -Date
Policy No. Company
'CERTIFICATE OF COMPLIANCEAND AUTHORIZATION OF ENTRY: I certify I have read thisapplication and state that .
0 Certified,copy is hereby furnished.
the information given'(s I agree to comply with all state laws and county ordinances relating to buidling,
• O Certified copy is filed with the City Building Inspection Department or City DeparlmenC.:".
construct`on,pttio—riz—ea 'rep
d r I re;entative of the City of La Ouinta Department of Building and: Safety to enter :.A
Date Ap
Lao,
up rope o2pe JRE.w6cfi`l have applied for this permit for the. pufp6siof making inspections.
plicant
Signaturel6f Applicant or Agent f - Date
APPLICANT NAME (L. F. MI)_
Corp.
ADDRESS I . I . .1. . I I
P.O. B= 780
CITY/COMMUNITY/STATE/ZIP
Ia Quinta, CA 92253
JOB SITE.ADORESS/SPA
C17-.33
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
BOK
PAG:
PRC
C
TNM'
RNG
SE
S.
TRACT
14 496-11]
LOT
251.50
Elect. Fee
moo _.
G-1
I so
73.00
TRACT NAME.
Santa Rosa Ocive
OWNER NAME (L. F, MI) Ankm
CONTRACTOR -FIRM NAME
'Ien
ADDRESS
abwe
CITY/COMMUNITY/STATE/ZIP
above
PHONE I ' I
564-1315
I LICNC 0 376 T
V0—) A .1 11 11
ARC/ENG FIRM NAME
BarrV B&rli=
'ADDRESS
1531 Chapala Street
CITY/COMMUNITY/STATE/ZIP
Santa Bftbara. CA 93101
PHONE 0
FEE
LICNC 0
USE OF PERMIT
Single family dweim
ll
OL
ZONL
FSB
. SSB I
SS8. 1.i1RSB
I
OFC
'.ZONE ORD 0,1; r
LOT SZ
END
SIDE
Print Applicant/Agent Name
APPUPRMT "nl nnH, DATE
tj 10-22-8_ •_
Pendt to construct 2,758
scr. ft. of
sincrle family y dwelLincr with attadia
qaraqe.This pennit to replace
pennit #'0460 ECPnM.
Mech. Fee
13.00
Plan Check Fee
32.70
Const. Fee
251.50
Elect. Fee
21.08
Plumbing Fee
73.00
V0—) A .1 11 11
''TOTAL
FEE
r.
4
A *.BL DWDEPT.',,",'..
\LALUAT
ION
p
a
Ah
Ah
NO.
OPERATION TWTE INSPECTOR
NO.
OP TION DATE INSPECTUR'r
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab• Grade
o 3
35
Furnace Compart.
•3
Steel
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5'
Bond Beams
38
Compressor
6
Roof Deck
/[9
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.
❑
NPON
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall S
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 S i
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 PiI
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final