BLCK (001171)77243 Calle Mazatlan
001171
P.O.
CITY/COMMUNITV/STATE/ZIPra .Quintal ' ltd nn 92253
PERMIT APPLICATION
City of La Ouinta'.
Department of Building and Safe .-. .... sr
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PAG
This permit'becomes void if work not commencedwithin 180 days from date of issuance: OR; if work has-been suspended or abandoned. for a period of 180 days:
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CERTIFICATE OF EXEMPTION FROM -WORKERS' COMPENSATION INSURANCE: This section need not be- completed ifr,
LICENSED- CONTRACTORS' DECLARATION: I 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 of the work for which this permit is 'a1. ,
"• (commencing with Section 7000)-of.Division Sof the Business and Professions Code, and my license is in ful orce'' . .. -
issued, I shall:not employ any person in any manner so as to become subject to the Workers`Compensation Laws of
and effect. «,--•--•• •--rte 'xj ) '
PLic,4tlu5ber;_'- U
California. w,
LicenseCs
Date, Applicant
Date-- ' Contractor, ,• .: -• - •- -
• _ NOTICE TO APPLICANT: It, after making dhis Cerlilicate oLExemption; you should become subject to the Workers ,
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the'Contractor's'License Law.forthe - >
Compensation provisions of the Labor Code, you -must forthwith comply with such provisions or this permit shall • i;:
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to
be deemed revoked: ,• '
construct: alter, improve, demolish, or•repairany structure, prior to its issuance, also requires the.applicant.for =
DIVISION OF.INDUSTRIAL SAFETY PERMIT CERTIFICATION::
-such permit to file a signed statement -that he is licensed pursuant to the provisions of the Contractor's License Law
01 hereby certify that no excavation five (5).or more fedt in depth into whi . ch a person is reqi6ired to d6scend.'will tt '.
(Chapter 9 (commencing with'section 7000) of Division.3 of the Business and Professions Code)or that he is exempt
made in connection with'work authorized'bythis permit, and that no building structuie,acaftolding, falsework-or • `
.therefrom and the basis for the alleged exemptions Any violation of -Section 7031.5 by.any applicant for a permit.. '
demolition or dismantling thereof, will be more thin thirty-six (36) feet high. (Chap 3.2, Grp 2. Art 2, Seo341, Title B,' • w;,
subjects the applicant to'a civil penallyof not.more than five hundred dollars ($500.):
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0.1:as owner of the properly, or my employees with wages as their sole compensation. -mill do the work, and the -
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' O'As oviner•builder,'I wilt not employanyone to do work which would require a permit from the Division of- .w
structure isnot 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. ,
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Law does not apply to an owner of property who builds, or improves'thereon, and who does such work himself or
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through his own employees. -provided that such improvements are not intended or offered for sale. If, however, the .'.
❑ Division of.lndustrial Safety Permit No..
• building orimprovemntissold within one year ofcompletion,theowner-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 iso construction lending agency for the performance
O Lias 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:)..c - .. • i
7044. Business and Professions' Code: The Contractor's License Law does.nol apply to an owner of property who
Lender's Name '
builds or improves thereon, and who contracts for such projectswith a contractor(s) licensed pursuant to the
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Contractor's License Law.). _.
Lender's Address 1
0.1 am'exempt under Sec. B.'8 P.C. (Attached Certificate).
I certify-thatI have read this application and state that the above informationJs correct, I agree to comply with all,n e
gate ` ' Owner .' ' r`
city and county ordinances and state laws relating to building construction, and hereby authorize representatives 7
of this'county to'enter upon the abo've-mentioned property for inspectiori purposes. ,
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of -consent to self insure. or a
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certificate of Workers' Compensation Insurance' -or a certified copy thereof (Sec. 3800. Lab. C.):
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Signaturofe Applicant or Agent Date p
Policy No. Company ,
CERTIFICATE OF'COMPL'IANCE AND AUTHORIZATION OF ENTRY :'l certify I have read this a pplication and state that '
❑ Certified copy is hereby- furnished. -
the information iven iiscorrect. I agree to'complywith all state laws and county ordinances relating to buidling
0 Certified' copy is filed with the City Building Inspection Oepartmeni or City' °• Department:
consiructionF and authorize a,'representative of the City of La Ouinta Department of Building and Safety to enter ;.
r upo_ n the 9prop ykforwhich I have applied for this permit for the purpose of daking:inspeetions.
Date 4pficant.
fir.. Signature of Applicant or. Agent, : Date
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Print Applicant/Agent Name
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APPLICANT NAME (C, F. MI) <JLJrp.
APPUPRMT }may
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ADDRESS .. P • O • Box 780 .. .. • '
CITY/COMMUNITV/STATE/ZIPra .Quintal ' ltd nn 92253
JOB SITE ADDRESS/SPACE
' CITY/COMMUNITY/STATE/ZIPLa Quint, CA 922.531-
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TRACT NAME Santa Rosa .Cove
OWNER NAME (L. F. MI) AWllcant
CONTRACTOR -FIRM NAME App]_1•.c nt '
ADDRESS - above •, , ..
'CITY/COMMUNITWSTATE/ZIP - -. .-
PHONE -1564-1315'.LI
,09762
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ARC/ENG FIRM NAME •- • ....
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE .
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USE OF PERMIT retaining hall - ,• '. ,
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END - •
SIDE:
Permit to construct 160 lin. ft. --of
41 high retaining waU as- per ap,=OVed
plans• '. ,. .
Plan Steck `' 48.
Const. 74.50
SMI Fee .60,.-
V,
60'. R
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'.. TOTAL
FEE
`9,U U.0U ;
•, "•; VALUATION '
BLDG. DEPT. k;
Ak
NO.
OPERATION TE
INSPECTOR
NO. OP ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
/ ,1 5
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.
❑
NPN
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 T
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18Vents
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 PyI
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final