SFD (0453)77303 Calle Mazatlan
0453
_4101 9 _
PERMIT APPLICATION'
City of La Ouinta "
• Department of Building and Safety •'
This permit becomes void if work not commenced within 180 days irom'date of issuance. OR, if work has been suspended or abandoned for a period of 180 days. •
AATP PPL,,II C AAN TT NAME (L. ,,F ., MI) y '
ATu3e 1 Vdi F ration
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed it :.
" LICENSED CONTRACTORS DECLARATION: I hereby alfirm.that 1 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 7000)'ol Division Sof the Business and Professions Code, and my license is in lull force •
issued, I shall not employ any. person in any manner so asto become subject to the Workers'Compensation Laws of w,
and effect.
California.
License Class Lic: Number
Date Applicant
Date Contractor
NOTICE TOAP.PLICANT:,11, after making this Certificateof Exemption, you should become subject to the Workers'
DWNER-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
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185
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 Contra ctor'sLicense Law
0.1hereby certify thatno excavmionfive'(5) or more feet in depth into which apersonis required to descend, will 6e
(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 oti'dismantling thereof, will be more'ihan thirty-sik (36j feet high. (Chap 3.2, Grp 2. Art 2, Sec341, Title B, =
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
C.A.C.)
O 1. as owner of• the property, or my employees with wages as their sole compensation, will do themork, and the
• ❑ 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.Cicense
Industrial Safety, as noted aoo've; 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 or
ADDRESS - -
through his own employeesrprovided that such improvements are not intended or offered for sale. If. however, the
❑ Division of Industrial Safety Permit No.
building or improvemnt is sold within one year of completion. 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 agencyfor the performance ,
❑ 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 Contractors 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 coniractor(s) licensed pursuant to the
SSB
Contractor's License Law.).
Lender's Address
❑ 1 am exempt under Seca B. 8 P.C. (Attached Certificate).
I certify that l have read this application and slate 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 h
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.).
•
•
'Signature of Applicant or Agent ' Date ;w
Policy No. Company. -
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
0Certified copy is hereby furnished. -
F6ertilied
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
construction, and authorize a'representative of the City of La Ouinta Department Building Safety to
copy is filed with the City Building Inspection Department; or{Cit Department.'-
,
, I= ' ` `
of and enter
upon the property for which I have applied for this permit. for the purpose of making. inspections.' ;
Date n Applicant Y
i+
AATP PPL,,II C AAN TT NAME (L. ,,F ., MI) y '
ATu3e 1 Vdi F ration
ADDRESS
P. O. Box 780
CITY/COMMUNITY/STATE/ZIP
La Qui.nhl, CA 92253
JOB SITE ADDRESS/SPACE -
77-•303 Calle AYazatlan
CITY/COMM UNITY/STATE/ZIP
Ila Quinta,F CA 92253
BON
PAG •
PRC
C
-
TWN
RING
SE
S
TRACT
14496-1
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185
7..39
Plumbing Fee
MDo
Cr3
SB
450.00
T rRR,A,..,,C TT yyNA ME
Pima C&4e
OWNER NAME (L. F. MI)
CONTRACTORFIRM NAME
Same &9 T, ,.. '
ADDRESS
CITY/COMMUNITY/STATE/ZIP -
PHONE 1
564•-1315
LICNC •
333762
ARC/ENG FIRM NAME '
ADDRESS - -
CITY/COMMUNITY/STATE/ZIP
PHONE •
LICNC
$ 1„332.49
SE.Of ERM IT ,
/D kth : Attached' Garage
BL
ZON
FSB
SSB
SSB
RSB
OFC
'ZONE ORD_$•
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END
SIDE
4.
. Signaturerof:Applicant or Agent
Print Applicant/Agent Name
Date
APPL/PRMT l A 4 L 1z.. .Q 83 J
S/F/D
Permit to crostruct 2#326 Sri. Ft. of S/F/D
with Attached Gavage
Mechanical Fee $
26.00
Plan Check Fee '
291.20
Ctinstructi,oa'i Fee
448.00
F.l l.Fee
36.90
SNa Fee
7..39
Plumbing Fee
73.00
Tmper y Dewelgr;lent Fee"
450.00
PO
Itp
DEG 9 1933
TOTAL' .
r FEE
$ 1„332.49
BLDG. DEPT.
VALUATION $105,867.60
a
r-1
NO.
OPERATION MTE 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 Blacks
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.
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 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
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 ,