SFD (0457)77263 Calle Mazatlan
0457
PERMIT APPLICATION
. City of La Duinta •
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. •'
s . _ _ . .
- CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
LICENSED CONTRACTORS DECLARATION:' I hereby affirm that T am licensed under provisions of Chapter 9
the permit is for one hundred (5100) 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 Professions Code, and my license 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., 4
and effect.
California.
License Class Lic. Number
Date Applicant'
Date ' Contractor
NOTICE TO.APPLICANT: IL after making this Certificate of. Exemption, you should become subject to the Workers' -
OWNER -BUILDER DECLARATION: I hereby affirm that I 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
be deemed revoked.
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which'requires a permit to
.
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 Contractor's License Law
01 hereby certify that no excdvittion 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 exemption. Any violation of. Section 7031.5 by any applicant for a permit
demolition or dismantling thereof; will be more than thirty-six (38) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341, Title 8,
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
C.A.C.)
0 I. as owner of the property, or my,employees with wages as theirsole 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' '
• structure is not intended or offered for sale (Sec. 7044. Business and Professions Code: The Contractor's License ' '
Industrial' Safety, as noted above, uriless 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
ADDRESS
through his own employees, provided that such improvements are not intended or offered for sale. If, however, the
0 Division of 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 ^g
he did not build or improve for the purpose of sale.).t:l
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
0:.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 thereon, and who.contracts for such projects with a contractor(s) licensed pursuant to the
SSB
Contractor's License Law.).
Lender's Address
- 0 1 am -exempt under Sec. -- B. &• 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
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 -insure, or a
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 COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify l ha4e read this application and state that
0 Certified copy is hereby furnished. )
tne•City onC
the information given is-correctl agree to -comply with all state laws and county,ordinances relating to buidling
construction, and authorize a,'representative of the City of La Duinta Department of Building and Safety to enter.
DO'Certifiedl{copy is filed with Building Inspection' Department c. Department.
for have for for of inspections.
1 L ( . 1 / ( V -_-- _
Date Applicant
upon •the property which I applied this permit the purpose making
1
I
Signature of Applicant or"Agent Date
PPLICANT
ADDRESS
P. 0, Box 780
CITY/COMMUNITY/STATE/ZIP
La Quinta,.CA 92253
,JOB SITE AQDRESS/SPACE
c:aile Mazatlan
`•u,
lac/I:OMMUNITY/ CA 92253
f]K
BOK
PAG
PRC
C
'•
TNM
FIND
SE
S
X4CT 496-1
L189
8,93
Plumbing Fee
(5 °1
SB
450,00
6,.CT NAME
lbsa: Owe
OWNERi NAME (L. F. MI) r
COQ NR CTA^FIRM--,NAME
am L]r7 Iciiiie
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE* '
564-1315
i l y.
LICNC 8
333762
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP '
PHONE t
LICNC 8
USE OF PERMIT
S/F/D with Attached Garage
BL
ZON
FSB
SSB
SSB
RSB
OFC
ZONE ORD
LOT SZ
END
SIDE,
Print Applicant/Agent Name
APPL/PRMT 04ST 1ZAo2— 83 J S/F/D
U
Pe=rt to construct 2,758
Sq. Ft, of S/F/D
with Attached Garage
Mechanical Fee
$ 26,00
Plan Click Fee
326.95
Constructicn Fee
503,00
F1 r rat FFee ,
42,16
SMI Fee
8,93
Plumbing Fee
73,00
Property DwelcgTmt Fee
450,00
A+ +/ 1
i l y.
(S r Z0 3 3
City 0."f 'CA15h-gta
TOTAL
FEE
$ 1,430.04 1
BLDG. DEPT.
VALUATION $127,658.80
.
a
NO.
OPERATION DATE
INSPECTOR
NO.
OPE KTION 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.
❑
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)
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/I
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final i