SFD (0455)77283 Calle Mazatlan
0455
APPLICANT NAME (L,F. MI) - -
Ancien Cbr orAtic
ADDRESS .r
P♦ 0, D 780
PERMIT APPLICATION t,
City of La Duinta
• ^
r • Department of Building and Safety y
a
' This permit becomes void if work not commenced within 180 days from date otissuance,
OR, if work has been suspended or.abandoned for a period,of,180 days:'
PRC •
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE:' This section neednet be completed if
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I arr licensed -Under provisions of. Chapter 9 ?
7000) Business Professions Code, my license is in full force
the'permit is for one hundred ($100) m less.1 certify that in the.performance of the'work for which this permit,is
'issued, I not employ any in any manner as to become subject to the Workers'. Compensation Laws of
(commencing with Section of Division 3 of the and and :
and effect. -
shall person -so
California.
.,
_
License.Class r Lic. Number
Date Applicant e,
Date - - ^'• ••Contractot •
.... NOTICE•TO APPLICANT: It, after making this Certificateof. Exemption, you should become subject to the Workers, _-
+Compensation
• OWNER=BUILDER DECLARATION' I hereby affirm that I am exempt.from the Contractor's License -Law for the -
provisions of the Labor Code, you must forthwith,comply with such provisions or this permit'shall' •'v+
$ 21
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•
-i DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ,. •'
such permit to file asignedstatement that heislicensed pursuantto. the provisions ofthe Contractor.'sLicense Law.
••Olherebytertilythatno'excavationfive(5)ormorefestrodepthintowhichapersonisrequiredtodescend,willbe.''
• (Chapter 9 (commencing with section.7000) of Division 3 of the Business and Professions Code) 9r that he is exempt
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, oI%
.therefrom and the basis'tor 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 (36) feet high. (Chap 3.2, Grp 2, Ari 2, Sec341, Tiflill '•
subjects the applicant to a civiLpenalty of not more than five hundred dollars* (S500;): •• -
' C.A.C.) ,^` - - . • - - - -• "` `•
D Las owner of. the 'Property. ;or my,employees with.wages as their sole compensation, willdo the work, and the, ..,
: -p• As "owner•builder, Pwill not employ anyone to'do. work .which would require a permit from the.. Division of"
'Industrial 'above, 44
structure is notintended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License
improves does himself
Safety, as notedunless such persomhis a permit to do such work'irom that division.
Law does not apply to an owner of property who builds, or thereon, avid who such work or
• through his own employees, provided that such improvements are not intended or offered.for sale. If, however, the -
+•;
, Division of Industrial Safety Permit No.
buildingorimprovemIII issoldwithinone yea rofcompietion, theowner- buiIder wilIhavethe burdenoIprov-ingIhat, .
. •
•'DateApplicant
. he did not build or improve for the purpose of sale.). .. . ' - ; . t.;.:. .. , ,
- - - w
CONSTRUCTION LENDING AGENCY: 1 hereby affirm that there Is a construction lending agency for the performance
. •" O I, as owner of the:property, am exculsively contracting with licensed contractors to construct the project (Sec: -
- of the work for -which this'permit isissued (Seo. 3097, Civ. C.). -
7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
LenCer's Name '
builds or'improves thereon, and who.contracts for such projects with a contractor(s) licensed pursuantt.to'the
Contractor's License Law.).
Lender's Address •'
' ❑ 1 am exempt under Sec. B. 8 P.C., (Attached Certificate).:.
I certify that 1 have read this application and state that the above information'is correct. I agree to comply with all
Date"—'Own er.
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
SIDE
,
t of this county to enter upon the above-mentioned property for inspection purposes.'
WORKERS' COMPENSATION DECLARATION: 1 h'ereby'affirm that'I haven certificate of consent to self -insure, or a
certificate of Workers' Compensation Insurance : ora certified copy thereof (Sec. 3800. Lab. C.). " w ; +•
Signature of Applicant or Agent Date "•
Policy No. Company
4
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTM I certify I have read thisapplication and state that
O Certified copy is hereby furnished: "'+ - 1:-!. ... •. . +.
' : -the information given is correct. I agree to comply with all state laws and county ordinances relating'to buidling.
C` 1
O:Certified copy is filed with City Building InspectionAepai(llment or/Clty.l Department.-
construction, and authorize a'representative ot.the City of La Ouinta Department of Building and Safety to enter
Y D.. 9 Y
"Date 1-^ r''iApplicant J f +)fU — •
- upon the property for which_I have applied for this permit for the purpose of making inspections. _; - J.
L
.r— ...
Signature of Applicant or Agent Date '
•
Print Applicant/Agent Name _
APPLICANT NAME (L,F. MI) - -
Ancien Cbr orAtic
ADDRESS .r
P♦ 0, D 780
CITY/COMMUNITY/STATE/ZIP • - -
La Quinta,•'CA 92253
JOB SITE ADDRESS/SPACE -
77-283 CAUe Mazatlan
CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
BOK
PAG
PRC •
C
- • - - -
TWN'
RNG
SE'.
S.
TRACT
14496-1
LOT
187
v
Smit Fee
v
MOD
G-1.
SB -
Property t `
TRACT NAME
Santa Rosa Cbve
OWNER NAME,(L. F. MI)
CONTRACTOR -FIRM NAME ...... .. ... .,
Same As Above
ADDRESS - ..•
CITY/COMMUNITY/STATE/ZIP .. ,
PHONE •' i '
564-13,15''
' '"
LICNC I - -
333762
ARC/ENG FIRM NAME , ••
ADDRESS
CITY/COMMUNITY/STATE/ZIP - ..
PHONE •
U•
LICNC •USE
.,
S%F/% rith Attached Garage
Bb
ZON.
FSB
SSB
SSB,
RSB
OFC
ZONE ORD N
7
LOT SZ '
r
-
•END -
SIDE
,
APPL/PRMTp E
(# 12DAT - 8-83
S lVb -
Permit to construct 2 758 Sq" F ,
of 'S/F/D
with Attached Garage
-
i antca1. Yee . $
" 261.00
Plan'+Check .Fee ,
326"95
Construction on Fee
503,00
Electr'ioal .Fee, `' '
42"16
v
Smit Fee
8993 -
993_Plumbing
Plumbing Flee
73,00
Property t `
450800
{Y' G !vim
i
U•
TOTAL
FEE
$ 10430"04.
y
I - ' } « r_ -•.rte R., j' .• - ♦ 1 i A - 'AY a tom•.+•. .: .. t - ' ., _ .. ,r. r
. • .r rV? AL.U..AT '` IO_ NZ7 y658,8
U
•5BLDG{DEPT_.•. .i
n
Alk
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
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.
❑
NADDITIONAL INFORMATION
NO.
O.
%
[eJ /
!!!
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 .Internal Lath
12A '• Drywall "
'
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12Ceiling (Batts)
12CC 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
4
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