SFD (0451)77323 Calle Mazatlan
0451
N14- -
APPLICANT NAME (L F MI) .. - 1, : .. . I . . . . I
Aricien
ADDRESS
P. 0. B= 780
PERMIT APPLICATION
City
of La Quinta'
Depa;tment of
Building and Safety
This permit becomes void if work not commenced within 190 days from date
of issuance, OR, -if work has been suspended'or abandoned for a period of 180 clays.—
Plan. Check Fee
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This'section needhot belcomplited if'.
LICENSED -CONTRACTORS DECLARATION: I-shereby 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
(commencing with Section 7000) of Division 3 of the Business and Professions'Code, and my license is infull force
issued, I shall not employ any person inanymannerso as to become subject to the Workers'Compensation Laws of
and effect.
California.
License Class' • Lic. Number
Date Applicant
Date Contractor,. -
NOTICE TO APPLICANT: If; atter making this Certificati of Exemption, you should'become subject to the Workers',
'
OWNER -BUILDER DECLARATION: I hereby affirm I iW exempt' from the Contractor's Licensi Law*for the
Compensation provisions of the Labor Code, you.r qst forthwith comply with such provisions or this permit shall
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to
., 1:be deemd.revoked. .,e
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 asigned statement that he is licensed pursuaqt to the provisionsof the Contractor;s License Law
0 1 hereby diirtify that ndexcavationfive (5) or.more feet in depth into which a peirson is required to desceAd. will be
(Chapter 9(cpmmencing with section 7000) of Division 3 o the Business and Professions Code) or that he is exempt
made idcdnneciion with work authorized
ized by this perm . it, and that no building structure, scaffolding, falsework, of
therefrom and the basis. for the. alleged exemption. Any violation of Section.7031.5 by any applicant for a permit
demolition or dismantling thereof, will be'morelhin thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec341, Title B;
subjects the applicant to a civil penalty o1not more than five hundred dollars ($500.):
'C.A.C.)
0 Las owner of the property. or'my employees.with wages as their sole compensation, will.do the work, and the
d Ai owner-buildef', I employ anyone to do work which would require a permit from the Division of
structure is.not-intended or offered for sale (Sec; 7044 Bu-siness..and,Protessions-Code: The Contractor.'s License
Industrial Safety: as notg.aijo kUiess suchpergon-ha a permit to dosUch work from that division.
Lawdoes not apply to an owner of property who builds; or improves thereon, and who does such work himself or
through his own employees, provided that such improviaments are not intended or offeied for sale. If. however. the
0 Di.viAion of Industrial Safety.,Fermit No.
A, building or impr ovemnt is sold within one year of.completion, the owner -builder will have the burden of proving ttk@!-
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 performarvie
.0 1, as'owner of the property.. am exculs ively contracting with licensed contractorsito construct the project (Sec.*, I,,
of the Work for which thispermit 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
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
'.0 I am exempt under Sec. B; & P.C. (Attached Certificate).:;-
I certify that I have read this application and state 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::'
of this county to enter upon the"5bove-: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 copy thereof (Sec. 3800. Lab: C.).--'.
Applicant or W'A
Signature of App gent Date
Policy No. Company
TERTIFICATE OF COMPLIANCE AND AUTHORIZATION'OF ENTRY: I certify I have read thigapplicatiorl and state that
• Cb&rtified copy is hereby furnished.
the information given is correct. I agree to comply with all state laws and county ordinances relating'to buidling -
151'6rtified copy is filed with the City Building Inspection Departmint"Or City "Department.
construction, and authorize a 'representative of the City of La Ouinta Department of Building and Safety to enter
'_1
I
upon the` pr6perly or which I. have applied for this permit for the purpose of making inspections.
Date rApplicant
7-
Signature ol,'ApOcant or Agent Date
Print Applicant/Agent Name
N14- -
APPLICANT NAME (L F MI) .. - 1, : .. . I . . . . I
Aricien
ADDRESS
P. 0. B= 780
CITY/CUNITY/STATE/ZIP
La junta, CA 92253
JOB SITEJOTRESS/SPACE
17 Ca If 1 e Mazatlan
CI1ATY/COMMUNITYt/STATE/ZIPC9225.. 3. . . I .. . . . I . I ..
WihApA •
BOK
PAG 4
PRC'
C
Plan. Check Fee
TNM
RNIG
SE
S
JAC
4 496-1
LOT
183-
7939
Plumbing Fee
MOD
0-3
SO
4500'00
TRACT NAME
Santa Pbsa Qwe
OWNER NAME (L. F. MI)
CONTRACTOR -FIRM NAME
bam AS ku3cve
ADDRESS
CITY/COMMUNITY/STATE/ZIP
564PHONE-1315
3331-LICNC 0
7627
7
1.332.49
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE 0
LICNC 0
USE 0 E
S ]Ff
, with witli Attached G=age
OL
ZON
FSB
SSB''SSB
RSB
t-
OFC
• -ZONE ORO
LOT SZ
END
SIDE
APPUPRMT DATE
.12-28783
S/P/D_
Pennit to oluct. 2,,326 Sq. Ft. of S/F/D
with Attached Garage
Mechbinical Fee..:
26.00
Plan. Check Fee
291.20
Wnst3mction Fee
448,00
ElecrirI Pan
MOO'
81-11 Fee
7939
Plumbing Fee
.73000
Developnea:t Fee-
4500'00
-prWerty
R 2 C: F__ o if F_ n
f.
PL2'i 46TAL.,
FEE
7
1.332.49
VALUATION $1105,,867.601
T. BLDG. DEPT: ,
..
Ah
Ah
NO.
OPERATION I U TE INSPECTOR
NO. OP EWTION 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
Av39
, Appl. Clearance
7
Framing
hy
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.
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
t2A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts) s
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/1
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final