SFD (0459)77243 Calle Mazatlan
0459
PERMIT
IiPPLICATION r
. 1 4-
Citi o La 6uin1_a-:"' 4
Department of Building and Safety
JOB SITE ADDRESS/S CE
77-; 24J We Yezatlan
CITY/CQMMYNIT STATEIZIP
C_
U J, CA 92253
Qux
BOK
'of -days.:
This permit becomes void iftw6rk not commenced within 180 days fromdate
of issuance, OR, if work hasbeen suspended or abandoned*for,a period 180
Plan Check Fee
CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE: T his,section need not be completed it' iz
LICENSED -CONTRACTORS DECLARATION: I hereby: affirm that I am,libensed under provisions of Chapter 9 -
'.the permit is for one hundred..(SIOO) o. less. I certify that in the performance of the work for which this permit is
(commencing with Section 7000) of Division 3 of the Business and ProfessionsCode: and my license is in full force
--'issuecLA shall not employ any person in any manner so as to become subject to the WorkersToIbpensation Laws of
and effect.
California.
• License Class - Lic: Number
Date Applicant
Date" -'-::Contractor
NOTICE TOAPPLICANT: If. after making this Certificatiof Exemption, you should become subject to thefflorkerss•,,-,,,
•OWNER -BU . L'D 'by 'a irm'that I am exempt from . the Contra . ctor's License 66*.for, the'.
I ER' DiCLARATIO"N: , I here' if I`
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit'shall
following reason (Sec. 7031.5. Business and.,Professions Code:, Any city or county which requires a perm*il to
a a
d6ein. d rev,o.ked.,
'DIVISION
'construcf, alter, improve, demolish' or repair any structure, prior to its issuance, also requires the applicant for'.
OF INDUSTRIAL SAFETY PERMIT CERTIFICATION::':
such,permit to file, a signed statement that he is licenserfpursuantto the provisions of the Contractor's License Law
b I heiiby certify that rioeicavation live (5) or more feet indepth intb whi ch a person is*req6ired to descend;w ill be
(Chapter91cornmenci ng.w ilhsection 7000) of Division 3 of the Business and Pr of essions Code) or that he is exempt
itiacle in n7 connection with'work:authorized by this permit, and that no building structure, scaffolding, falsework; or
therefrom and.the,basisljpr the alleged exemption. Any,,violation of Section 7031.5 by any applicant for a permit.
demolition or dismantling will be more than thirty-six (16) feet high. (Chap 3.2, Grp 2. Art 2, Se6,34f Title8.
9
subjects the applicant to,a,civil penalty of not more than -live hundred dollars ($500.): :.. ... . . . I
CA.C.) '. ! , — - . .
-O 1, as owner. of the properly, or my employees with wages as their -sole compensation, will do the 'work, and the
*0 As'dwner-builder, I will -not employ'anyoni to do work Which would require re a permit from the Division of
-structure is not intended or.offered for sale (Sec. 7044,'Businessand Professions.Code: The Contractor's License
industrial Safetyas noted* above;°unles§ such person has a permit to do such work fromthatdivision.
Law does not apply to an owner of prop erty-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 inte . nded or offered for sale. If;however, the
O•Oivision,o I Industrial Safety Permit No.
building or improvemni 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 herebjalfi6m that theie is a6ristruction lending agency for the pdrformance.
,.,D 1, 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.)."
7044, Business and Professions Code: The Contractor's License Law does,not apply to an owner of property who.
.
Lender's.Name
builds or 'improves Ahereon, and who contracts for'such projects with contractor(s) licensed pursuant -to the
Contractor's License Law.).- -
Lender's Address
0 1 am exernpl,under Sec. 6. & P.C,,(Attached -Certificate).-
I certify thaLl have.read this application and state -that the above information iscorrect. I agree to comply with all
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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) have a certificate of consent to self-insbre, or -a:
'certificate of Workers' Compensation, Insurance , or a certified copy thereof (Sec: 3800. Lab:.C.):
Sidnaturii of Applicant or Agent Date
Policy Company
7. No.
0 Certified copy is hereby furnished.
-CERTIFICATEOF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify lhave read this apolicationand state tKat:
the information given is correct. I,agree to comply with all state laws and county ordinances relating to bWdling
the. City Ouinta Department
G/Certified copy, is filed with the,,City guilding'ffiipection Depaftmeni:;I-C i2v- Department
construction. -and authorize a representative of of -La of Building and .Safety to enter
;Voa't—e':1-)'.7q ','d I
upon the property for which I have,applied for this permit for the purpose of making inspections..
Applicant
Signature of Applicant or Agent Date
Print Applicant/Agent Name
JGWNA
ADDRESS
P. 01 B= 780
CITY/COMMUNITY/STATE/ZIP
La Qiintafl, CA 92253
JOB SITE ADDRESS/S CE
77-; 24J We Yezatlan
CITY/CQMMYNIT STATEIZIP
C_
U J, CA 92253
Qux
BOK
PAG
PAC
C.
Plan Check Fee
TWN'
FING.
SE
S,
.TRACT 6-1'
1449 '
LOT'
3-9
i
P1t7.rtq Fee
MO 0
G-3
Se
450.00
TRACT NAME
Santa PDm Cbve
OWNER NAME (L. F. MI)
CONTRACTOWFIRM NAME
SEE= As, Above
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONELICNC
5 4—*1
6 315
'
333 62
A%
ARC/ENG FIRM NAME
l f1
ADDRESS
CITY/POMMUNITY/STATE/ZIP.
PHONE 0 r
`TLICNC
4
USE OF PERMIT
S/F/D with Attached Gu-cme
81.
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FSB
'. SSB
SSB
ASS
OFC, -
ZONE ORD 0. :
LOT SZ
NO
_7
"SIDE
APPL/PRMT 'q0. DATE
12-28-83
ti
7
Permt to comtruct 2,326
Sq. Ft. of SIFID
with Attached Garage
I-blobanical Fee
$ 26'900
Plan Check Fee
291,20
.CMIStruCtiM Fee
448,00
.36,90
SMI Fee
7,39
P1t7.rtq Fee
73,00
Propertv Development Fee
450.00
A%
C;
TOTAL
FEE
VALUATION 1$105,86
BLDG. DEPT.
111111ilil1O
r
rI
NO.
OPERATION DATE
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
4&s-"
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.
❑
OPEN
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)
12CT 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
P/L P/1
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
.29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final J1 5