RPL (001187)77283 Calle Mazatlan
001187
PERMIT APPLICATION
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Department of Building and Safety
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CITY/COMMUNITY/STATE/ZIP I&
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88:31
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PU47,
r This permit becomes void it work not commenced within 180 days from date of issuance, OR, if work. has been suspended or abandoned for period'of 180 days:' ' • - ,
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CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed it
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 f
• (commencing. with Section 7000) of Division 3 of the Business'and Professions Code, and my license isin full force '•-
issued, I shall not employ any person inany manner so as to become subject to the Workers'Compensation Laws of
and effect =
California. s 3•t
License Class Lic.,(Number .-- - V rt
NIA
Date Applicant ;
,411_1.
• Date - Contractor '
NOTICE TO.APPLICANT: If, after making this Certificate of Exemption, you should become subjecLto the Workers r .
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,orthis permit shall- •
'following reason (Sec: 7031,5. Business and Professions Code: Any city or county which requires a permit to
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 •.
• .O Ihereby certify that noexcavation five (5)ormore feetindepthinto wnichapersonisrequired todescend, will be -i`
' .(Chapter 9 (commencing with section 7000) of. Division 3 of the.Business•and Professions Code)or that he is exempt
made in connectionwith work authoriied by this permit, and that no building structure, scaffolding, falsework, or
' therefro,m:and :the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
demolition or dismantling thereof; willbe more thanthirty-six (36)'feet.high. (Chap 3.2+'Grp 2, Art 2,.Sec341,Title8, 1• '
-
subjects the applicant to a civil penalty of not more than five hundred dollars ($500:):
C.A:C.) -.la's. 7?
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. O I, as owner of the property, or. y,eployees with wages as their sole compensation, will do the work, and the •
❑ As owner-builder,'I will not employ anyone to do work which would require a permit from the Division of
f' 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 person has a perm it do such work from that division.. "d
-'
••Law does not apply to an owner of property 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 intended or offered for sale. If; however, the
q Division of Industrial Safety Permit No.-
' building or improverrint is sold within one year of completion, the owner-buildel,%A(ill have the burden of proving that e-
Date •" ' Applicant
he did not build or improve, for the purpose of sale.). •;
CONSTRUCTION LENDING AGENCY:'l hereby affirm that there is a construction lending agency for theperformance
0 I, as owner of the property: am.exculsively contracting with.licensed contractorsto 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 't
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 Ter(
- O 1 am exempt under Sec. A. B,P.C. (Attached Certificate). • ..
• I certify that I have read this application.and state that the above information is correct. ) agree to comply with all
Date Owner`
city and county ordinances and state laws relating to•building.construction, and hereby authorize representatives . sfj
'of this county to enter, upon the above-mentioned property for inspection purposes.
' WORKERS' COMPENSATION DECLARATION: I hereby affirm that 1 have a certificate of consent tdself-insure, ora '
certificate of Workers' Compensation Insurance', or a'certitied copy thereof (Sec. 3800. Lab. C.). ' -
Signature of'Applicant or Agent Date
Policy NO. Company,
X.
OF.COMPLIANCE AND AUTHORIZATION OF ENTRY: 'I certif y I have read this application and state that y
• O Certified copy is.hereby furnished:.• ..
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling m
O Certified copy is tiled with the'Cily Building' Inspection Department or City Department.
Construction, and authorize a'representative of the City of La Ouinta Department of Building and Safety lo.enter
upon the property for which I have applied for this permit for the purpose of making inspections:
Date Applicant.
_ .... _
•
/..4;_SignaturetotlAp'plicanl Agent;+ Date
I
Print Applicant/Agent Name
APPLICANT NAME (L, F. MI) 11LraUt os - -
ADDRESS"' P.O. • -Box ,1593 -
CITY/COMMUNITY/STATE/ZIP .Pa]M iJC.•'7GiL b, CX 92260 '
JOB SITE ADDRESS/SPACE 77-283 Calle Mazatlan'
Luinta.
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CITY/COMMUNITY/STATE/ZIP I&
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TRACT NAME to Fbsa, Com
OWNER NAME (L. F. MI) - .. - ...
CONTRACTOR -FIRM NAMEc6t
ADDRESSQJe. r' . •.
CITY/COMMUNITY/STATE/ZIP J7 L )V
'Gii.7VVC ,
PHONE .346"4804':
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6445
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ARC/ENG FIRM NAME y
ADDRESS -- '
CITY/COMMUNITY/STATE/ZIP
PHONE N.
LICNC 0
USE OF PERMIT
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FSB,
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ZONE ORD • . •..;';
- LOT SZ
_-END
.' SIDE
.•APPL/PRMTY% • 1.0 7, .85
Pe T t to' install a 6" ft by, 31 in
spa,as l?r . agprat pans:. • -
Plan ( Fee 41.,52' 25.02
"ODSst. Fee ' " - 68.59. 38.50
lacal Free' Y5.00
nl. L.2... T. r ;r., tti GA
BLDG. DEPT.
• r
e 7 '$5
TOTAL QW 60W .-02
FEE •
VALUATION F
2,900.00 t
NO.
OPERATION ,,TE
INSPECTOR
NO.
OPL-...ATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVAL'S
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.
❑
OP'N
NO.
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
1 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)
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final