SFD (0452)77313 Calle Mazatlan
0452
PERMIT APPLICATION
',,
CityofLa Ouinta r to f' ' r+ e n r N.
' t
Department of Building and Safety ,µ
- _ F.. 1, t
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 r i ,
::.;?'.+•': ' - CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE: This section need not be completedif L.
.LI C ENSED CONTRACTORS,DECLARATION: I hereby affirm that I amlicensed, 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 4
•(commencing With Section 70DD) ofDivision.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
and effect. California. f <°
License Class. ` Lic. Number Date _ •Applicant- 7 y e
"Date' - Contractor NOTICE -TO APPLICANT: If, after making this Certificate of Exemption, you should become subject. to.the•Workers
.r r •Compensationprovisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
OWNER -BUILDER DECLARATION' I. hereby affirm that I am exemptfrofn 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. ; be deemed revoked.
construct. alter, improve: demolish. or repair any.slructure, prior to its issuance, also requires the applicant for DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:' };
such permit to file a signed statement that he.islicensedpursuanttotheprovisionsofthe Contractor's License Law :, bIhdrebycertifythat noexcavationfive (5)ormore feet indepth into Which apersonisrequiredtodescend,willbe' '
(Chapter 9(commencingwith section 7000) of Division 301 the Business and,Prolessions Code)or thathe isexempt made in connection,with work authorized bgt%permit, and that no building structure, scaffolding, falsewoik: or
therefrom and the basis for the 'alleged exemption: Any violation of Section 7031.5 by any applicant fora permit. - -'demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2r Art 2, Sec 341;TitleV -y
subjects the applicant to a civil penalty ofnot more than five hundred'doltars C.A.C.) '
y O I. as owner of the,property,-or my:employees with wages as their cote compensation, will do the work, and the r O'Ag owner -builder, I wilLnoi 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 Indust' I Safety, as''noted,above\dnle s such person has a permit. to do such work from that division. i
Law does not apply to an owner of property.who builds, or improves thereon, and who does such.work himself or m y'
through his own employees, provided that such improvements are not intended or.offered for sale: If; however, the O Division.of Industrial Safety Permit No. n
building orimprovemntissoldwithinoneyearof.completion,the owner -builder will havethe burden of provingthat, Date Applicant -
he did. not build or,improve for the purpose of sale.).`
' x • • CONSTRUCTION LENDING AGENCyr'fhereby 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:. ofthe.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, - . ' , ' . .
Nam
builds or improves thereon, and who contracts for such projects with a contractorLender's Name,
licensed pursuant to'the 4.4
Contractor's License Law.). .. _. -Lender's Address
❑ 1 am. exempt undeoSec: B. 8 P.C:,(Attached Certificate): J certify that I have read this application and state that the above information is coirecLt agree to comply with all
" city and county ordinances and state laws relating to.building construction; and hereby authorize representatives . r
Date " «.' Owner 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, or a .
certificate.of:Workers' Compensation Insurance , or a certified copythereof-(Sec. 3800. Lab. C.).' Signature of Applicant or Agent Date '
Policy No. ,Company -
- - CERTIFICATEDFCOMPLIANCEANDAUTHORI7ATIONOFENTRY:Icertifylhave'readthisapplicationandstatethat .,4•
• • O Certified copy.is hereby furnished.. ?. ' l ' _ v the information given is correct. I agree to comply. with all state laws and county ordinances relating. to buidting..'
ertified,:copy is filed withthe.City Building inspe6ti6,Oepartment•arC1ty, •Department.':; construction, and authorize a.representative of the City of La Ouinta Department of Building. and Safety to enter
r / " upon the property for'which I have applied for this permit for the purpose of.makitig inspections'...- -:-
Date.'7 J Z7 ;X. 7i ADPlicant I ` / % rIY
y ^\ • Signature o6`Applicant or -Agent Date •^,
Print Applicant/Agent Name u
.APPLICANT NMlFM
Tieaticin
ADDRESS
P.780 ..., .. .. .: ..
ITV/COM__ MUNIta0TES .92253
;JOB SITE '
IZ313 ca.Lle Mazatlan
lcl Tr/C ri r/S TE/ ZiP 92253
BOK
PAG
PRtC,.Cf
C
_ -TNM
326695
RNG
SE j
S
1 4 ,,49,.6 -1
`184
" 8,93
..
00
G;a
SB' ••
..
►7Q11L iiMlZmaowe '• - -
OWNER NAME (L, F, MI)
•CO`s T_ACT,OvR IRM- .NAME - •-
ADDRESS
CITY/COMMUNITY/STATE/ZIP . .
PHONE U • • '
564--1315
•,LICNC'11
333762
Uni
ARC/ENG FIRM NAME ,
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE N -
$1 430-,w Q 4
. LICNC N
-
U5/ OF PERMIT-
j /iTJ Att Gi.4lled • Garage
BL
ZON
FSB •
SS.B
SSB.'
RSB
OFC. .
• ,t 'ZONE, ORD
LOT SZ -
END.
SIDE .
. APPL/PRMT DATE
AIR(. 12-28-•83
-
S/F/D
Permit to construct 2,758 Sq. Ft. of S/F/D
with Attached, Garage
MechaniJcal i'ee . :. $
26.00
Pian {heat Fee
326695
Fee
563,00
rlectrical.-Fme_. •: ..
42,16
SMI Fee
" 8,93
P7 umbintg Fee .
73,00,
kwerty Developotit'
450,00
Li
Uni
TOTAL•
FEE
$1 430-,w Q 4
< VALUATION $127,658.80'
BLDG, DEPT. — — _......_._,_._.._•_ — _
Ah
Adh
NO.
OPERATION I TKTE 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
p
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.
❑
NOO
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) 7
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 17