BLCK (001196)77243 Calle Mazatlan
00196
PERMIT APPLICATION
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City of La Ouinta,
'( t Department.of Building•and Satefy
CITY/COMMUNITY/STATE/ZIiSi P Quint,CA L 9y'253 •'
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This permit becomes void if work not commenced within 180 days from date of
issuance. OR, it work has been suspended or abandoned for period of 180.days.
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if `
' LICENSEDCONTRACTORS. DECLARATION: I hereby affirm that,l 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 f, '•
(commencing with Sectiom7000).o1 Division 3 of the Business and.Professions.Code, and my Iicense,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
and effect.
California. y
License Clas > - Lio Nu lb e R z r
Date Applicant' 1
"re
Date Contractor X
NOTICE TO APPLICANT: If: after making this Certificate of Exemption,.you should become subject to the.Workers a
OWNER -BUILDER DECLARATION: I hereby affirm that] am exempt from the Contractor's License Law for the,
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or.this'permit shall r w
following reason (Sec. 7031.5. Business and.Professions Code: Any city'or'county which requires a permit to
be deenied7evoked: ;
• 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 file a signed statement that he is licensed pursuant to the provisions of the Contractovs License Law:_:
: _- ❑ I hereby'certify that no excavation five (5) or more feet in depth into which a person is required 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 in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or ,
.therefrom and.the basis for the alleged:eaemption. Any violation of Section 7031.5 by any applicanifor.a permit
demolition or dismantling thereof, will bemore than thirty-six (36) feet high..(Chap 3.2, Grp 2, Art 2, Sec341, Title8, r,.r`:'
subjects the applicant to a civil penalty.of not more than five hundred dollars ($500.):C.A.C.)
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O. I, as owner at the property; army employees with wages as their sole compensation, will do the work, and the ., • .
0 As.owner-builder, Twill not employ anyone to do work which would require a.permit.from the Division of '
structure is not intended or offered for sale(Sec. 7041, Business ariffrofessions Code: The Contractor'slicense'
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, and who does such work himself or. . z
through his own employees, provided that such improvements ar.e.not intended or offered for sale. If, however; the-
Djvision,of Industrial Safety Permit No..
building orimprovemntissold within one year ofcompletion, the owner -builder will have the burden ot,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
a 1 -.,as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec:, L• .
of the work for which this permit is issued (Sec. 3097, Civ: C.).
7044. Business and Professions Code: The Contractor's License Law does not apply to an owner ofpropertywho. .
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Lender's Name ?f
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the •,
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.Contractor's License Law.). ... ..
Lender's Address !
' 0'.I am exempt under: Sec'. B. 8 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 ' ' Owner
city and county ordinances and state.laws relating to building construction, and hereby authorize representatives
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate'of consent to self -insure; or a'
of this county to enter upon the above-mentioned property for inspection purposes.
certificate of Workers' Compensation Insurance , or.a certified°copy thereof -(Sec. 3800. Lab. C:)'- ": .
Signature of Applicant`or Agent Date
Policy No.`Company..
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r CERTIFICATEOFCOMPLIANCE AND'AUTHORIZATION OF'ENTRY: t certify, have read this application and state that ",
❑Certified; copy is hereby furnished. ; - , -
the information gi en is correct. I agree to comply with,all state laws and county ordinances relating to buidling ;
4
' ❑ Certitied.copy is tiled with the City Building Inspection Department.or City -' Department
,consGuotrn, and authorize a representative of the City of La Ouinta•Departmentol,Building and'Safety to enter. .
for have for
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t upon the.pro _ which I applied.for this permit the purpose.of ma)(mn inspections:
Date Applicant
/Sign tune of Applicant or Agent Date { i
u . -
Print Applicant/Agent Name Y
APPLICANT NAME (L, F. MI)Tn.1e /br . ..
ADDRESS P.O. 1= 780'-
80' - -
CITY/COMMUNITY/STATE/ZIP
CITY/COMMUNITY/STATE/Zlra Quint
. 'C 92253
JOB SITE ADDREss/SPACE
77-243 Calle Mazatalan.•
CITY/COMMUNITY/STATE/ZIiSi P Quint,CA L 9y'253 •'
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PAG
PRC
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TRACT NAME'- ^__y„•• Ab Cove
OWNER NAME (L. F. MI) Am1 1
CONTRACTOR -FIRM NAME - ..
ADDRESS ,y
above
CITY/COMMUNITY/STATE/ZIP.L...M
64- 315''JLJVG
PHONE a 564-1315'
LIC 33762'
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ARC/ENG FIRM NAME '• -
ADDRESS .. -
CITY/COMMUNITY/STATE/ZIP ••
PHONE ir
LICNC 0
USE OF PERMIT block retaining -wall. •
BL
ZON'
FSB
SSB
SSB
RSB'
R ZONE ORD.:. -
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END
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Pex&it to constxulct t 356 Lin. Ft..
of bi&k retakning, as per.
approved piens-
Phan Cheak' F( 6 ' 44.52
Const. Fee 68.50
9mi Fee .53
^TOTAL .13r:55
FEE •
VALUATION %/' ZU.00
. BLDG. DEPT. _ - - :
AL
NO.
OPERATION TATE
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
35
Furnace Compart.
3
Steel'
36
Inlets & Outlets
4
Grout Blocks
37
Combustiori 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.
❑
NPON
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/I
STREET NAME
26 Power Polb
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final