SFD (0458)77253 Calle Mazatlan
0458
This permit becomes void if work not commenced within 180 days from date of issuance,
OR; if .work hasbeen suspended or -abandoned lora period of 180 days. _ "• r r
TWN .
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need completed if.;
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- ,•' j
•(commencing with Section 7000) -of Division 3 of the Business and Professions Code,,3nd my license is in.full force ...
.,issued. I shall not employ any. person in any manner so as to become subject to lhe,Workers' Compensation Laws of - JP '
and effect.
California.
License Class Lic..Number
Date Applicant,
•' r
Date - Contractor -
NOTICE TO APPLICANT: df,.after making this Certifioate:of,Exemption: you should become subject to the Workers',' '4'
OWNER= BUILDER DECLARATION: - I hereby affirm That I am exempt Irdm the Contractor's license Lawlor the: •
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•permit to
be deemed revoked:: 9+
construct;.alter, improve, demolish, br.repair any structure. prior to.its issuance; also requires the applicant for •' -
DIVISION,OF INDUSTRIAL' SAFETY PERMIT CERTIFICATION-- ,
• .such•permit.totilea signed statement that-heislicensedpursuanttotheprovisionsoftheContractor'sLicense Law
(Chapter 9 (commencing with section 7000) o1 Division 3 of the Business and. Professions Code) or that heisexempt,
O Iherebycertifythatndexcavationfive(5)or.moreteelin depth into which a person is required to descend,willbe • '
°,
; . _'
,.therefrom and the-basis.for. the alleged exemption. Any violation of Section 7031.5 by any applicant.for a permit; :
made id'connection with work authorized bythis permit, and that no building structure: scaffolding, falsework, or.: +
demolition'or,dismantling thereof, will -be more than thirty-six (36) feet high. (Chap 3.2; Grp 2, Art 2, Sec 3411, Title 8,.'
subjects the applicant to a civil penalty of not more than five, hundred dollars ($500.):,--.
"CAC.)
0 .1, as.owner of the. property, or my employees with wages as,their sole compensation, will do the work; and the
. ,. 0 As owner -builder, I will not employ anyone to do work which would require a permit from the Division of 2' t
- structure is not intended.oc 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, and who does such work•himself orv
Industrial Safety.. t No.
through.his own employees. provided that such improvements are not intended or offered for sale. If, however, the
-Division of , ;6p
building orimprovemntissold within one yearo(completion. the owner -builder will havetheburdenofproving that, '.
Date -
he did not build or improve for the purpose oi. sale) . - ,
, , CONSTRUCTION LENDING AGENCY: I hereby affirm that is a canstructionlending agency for the performance
0 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.)... ,
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. thereon,'and who contracts for such projects with a contractor(s), licensed pursuant to the
LOT SZ
_. .Contractor's License.Law.).
Lender's Address
0 1'am, exempt under Sett -' B. 8 P.C. (Attached,Certificate).
s I certify that I have read this application and state that the above information is correct. I agree to comply with all
' Date Owner 4-
.-T 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 than have.a certificate o1 consent to self insure, ora
" certificate'.o1 Workers' Compensation Insurance ; or a certified copy thereof .(Sec.. 3800: Lab. C.) a.; •
-
Signature of Applicant or Agent Date
. 'r/Policy No. Company;
'
_
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have'read,thisapplication and state that `
;•. ❑ Certifiedt copy is hereby furnished. -
the information given is correct. I agree to comply with all state laws andcounty-ordinances relating to buidfing . 1
• o Certitied copy is Ided'with the/City Building InspectiodDep tment.or City Department
construction, and authorize. a're.presentative of the City of: La Ouinta Department of Building and Safety to enter.
upon the propeity for which:) have applied.for this permit forthe purpose of making inspections. ...
"Signature of Applicant or Agent Date
J
Print Applicant/Agent Name
AaaPgqPLI C, A N T NAME (
DATE
L, F. MI)
Cotpotatim
ADDRESS'
P. O. B= 780
CITY/COMMUNITY/STATE/ZIPLa Q,,C- 92253 .. .
JOB SITE AODA PACE
CTla T^Y/CQuin;/', CA 92253 - - - .
BOK .
PAG • :
PRC
C .
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TWN .
ONG
SE
.S
TRACT -
14496.1
LOT •
` 190
-
MOD
G-3
SB
450,:00
TRACT NAME ,
Santa Rosa Owe
OWNER NAME 1L. F. MI) - -
COC NT ACTOTR^IRM_ NAME .
bOM
ADDRESS .. .
CITY/COMMUNITY/STATE/ZIP ,..
PHONE • . ('
564-1315
,LICNC •
3,33762
+ -
ARC/ENG FIRM NAME' - -
ADDRESS ..
CITY/COMMUNITY/STATE/ZIP
PHONE •
L•ICNC •
• ,
USE OF PERMIT .•-
SIF/D with Attached Garaq
8L
ZON
FSB,
' SSB,.'',
'SSB .'
-.RSB.
OFC.
... ZONE ORD •,
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',END •
SIDE.
APPL/PRMT '. 12-•2843 S/F`D -• .
Peau t to calstrvc°t 2#326
Sq. Ft. ° of S/F/D _
with Attached Garage
Aechanica]_ Fee .. _
S 26.00 .
-Plm- Check Fee .
291020• .
F'ee
448,00
F1ec_ tr Fbe. ,V
36,190,
SMI Fee
Plying Fee
.73,00
Prioper-ty Development Fee
450,:00
fg' 3,f.7.` ti
TOTAL ..
FEE
c
51.332.49
_ VALUATION 1 $105,867.60
BLDG. DEPT.
talc
a.t
Ah
Ak
NO.
OPERATION GATE
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
'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.
❑
N
NO.
O.
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 APP OVALS
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 ,