SFD (0456)77273 Calle Mazatlan
0456
APPI q IalCANT NAME
(. , 1
RM AP LIC _P RTIO
PE IT N
City of La Ouinta
,-. • ,,.. Department of Building and Safety
r -,
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-This permit becomes void it work not commenced within 180 days from date of issuance, OR, if work has been.suspended or abandoned for, a period of 180 days.
• I:• ' .,
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if? ' fi
-' LICENSED CONTRACTORS. DECLARATION: I hereby affirm thi l am.licensed under provisions, of Chapter 9:
the permit is for one. hundred- ($100) o, less. I certify that in the performance of the work for: which this permit is, +
- (commencing with Section.70D0) of Division 3 of the Business and Professions Code, and my license is in lull force. ' . ,
, .: issued, I shall not employ any person in any mannersoasto become:subject tgthe Workers'Compensation Laws of
and effect.
California. l
License Class. Lic. Number
_ Date Applicant - -
Date - - ` Contractor •-:- •• -- :_•
.. NOTICE.TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'. +
Compensation the Labor Code, forthwith
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's, License Law for the •,
following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a.permit to
proyisions.af you must comply with such provisions or this permit shall
be deemed revoked.
construct,alter, improve: demolish, or -repair any structure, prior to its issuance, also requires the applicant for
DIVISION OF:INDUSTRIAL SAFETY PERMIT, CERTIFICATION:
such permit to file a signed statement.that he is licensed pursuant to the provisions of the Contractor's License Law,.
0 hereby 6eftify that noexcavatioFn five (5) or more feet ih , dipth into which a person is required to descend, will be
(Chapter 9(commencing with section 7000) of Division 3 of the Business and Professions Code)or that he isexempt
made in connection with work authorized by this permit, and that no building structure, scaffolding; falsework; of e4.
therefrom'and the. basis for the alleged exemption. Any violation of Section 7031.5;by any applicant for a permit ,.z• .:
. demolition or dismantling thereof; will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2 An 2, Sec341, Title8.
subjects the applicant to a civil penalty of not more than five•hundred dollars,($%O.): -
... - -• .. .. ':
0 i, as owner of the property. or m employees with.wages es as their sole compensation, will do the work, and the
p p y 9
"• ❑ 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: 7044, Business and Professions Code: The Contractor's License .
Industrial Safety, as noted above, unless such personhas a permit -to do such work from that division.,
Law does not apply to en owner -of property who builds, or improves.thereon, and who does such work himself or.
'
' thiough his own employees, provided that such improvements are not intended or offered for sale. If, however, the •.
o0 Division of Industrial Safety Permit.No. '
?
building orimprovemntissold within one yearofcompletion. 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 hereby affirm that there is a construction lending agency for the performance
0 I, as owner,of the property, am.ezculsivelycontracting with licensed contractors to construct the project (Sec: - . :.
.of the work.for which thispermitis issued (Sec. 3097,.Civ. C.). - . • e .
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
Contractor's License. Law.).
Lender's Address r,
0 1 am exemprunder Sec. .-B. 8 P.C. (Attached Certificate).
1 certify that I have read;this application and state that the above information is correct.] agree to comply with all ,
DaleOwner
city and county ordinances and state laws relating to building construction.;and.hereby authorize representatives
SIDE" ,
of this county to enter upon the above-mentioned property. for inspection• purposes.
• WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, ora
certificate of Workers' Compensation. Insurance., or a'certified .copy thereof.(Sec. 3800: Lab. C.).
Signatuie'ot Applicant or Agent Date iI
Policy No. Company
❑ Certified copy ishereby furnished.
CERTIFICATEDF COMPLIANCE AND AUTHORIZATION OF ENTRY:. I certify I have read this application and state that '•• _
of _ •' x
the information given is correct.'1 agree to comply,with all state laws and county ordinances relating•to buidling.
76ertihed `copy is filed'withVthe City Building InspectiD partmentro7City1' Department
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construction, and authorize a'representative of the City of La Ouinta Department of Building and Safety to enter .
Date /% )l r1 / U
upon the property for which I have applied for this'permit for. the purpose of making inspections:
Applicant
rte_
'
Signature of Applicant or Agent Date
APPI q IalCANT NAME
(. , 1
Tr -7p
clTv/c ER IP
Y92253. .. - .
Quinj^I ^T
(Mazatlan
i i;-2 /3 REcL ,aillb
CITY/COMMUNITY/STATE/ZIP,'Ay9CA 2253 .
SOK
PAGPAG -•
PRC •
.0
291, 20
TWN
RNG
SE
S
4496.4
18 13
P1trrbing Fee
-73, 00
moo
.450;00
-
TRACT. NAME. .
Santa-Rosa XV«
OWNER NAME (L. F. MI)
CONTRACTOR-FIRNAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP .. .. ..
554-1315'
L1333762
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP , •- - - ,
PHONE M •
LICNC 0
'
USE OF PERMIT
S/F/D with Attached Garai
BL
ZON
FSB.
SSB
SSB
' RSB
.OFC
ZONE ORD M, ,
LOT SZ,
• END •
SIDE" ,
Print Applicant/Agent Name
APPL/PRMT 12-'A-•83
- S/F/D =•.
Pelt to c imstruct 2 f 326 Sq. Ft. Of S/F/D ,
with Attached 'Garage
tCr1dT11Ca7. Fee $-.""26900
Plan Check F ° :
291, 20
Gbmtructim r -W `
'448.00
Fole
36,t,96 '
DII Fee` . -,
7;39 ,.
P1trrbing Fee
-73, 00
Prcpecty Dave nt Fee
.450;00
1
E
E y :..(: ';+•.sad....
, n
c U TOF1$
1,332.49
BLDG. DEPT.''
VALUATION$105,867.60
a
Ah
NO.
OPERATION ATE
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.
❑
NPON
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall dr
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 ' / i •
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 Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
•31 Service.
32 Final