SFD (0450)77333 Calle Mazatlan
0450
La Ouinta-
and Safety .
PAG -
PRC
•Jhis 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 980 days. '
TWN
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section neednot be completed if
LICENSED 'CONTRACTORS' DECLARATION:' hhereby. affirm -that I am' licensed under provisions, of-Chapten9 :
the permit is for one hundred ($100) o. less: I certify that in the performance of the work for.which this permit is :. •` a
. (commencing with Section 70DO) of Division 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:CompensationLaws of* .-
and effect. • -
California. '
License Class Lic. Number —
Date Applicant
.a .Date --' •' — Contractor
NOTICE TO APPLICANT: If, after making this Certificate of Exemption,youu should become subject to the Workers'
OWNER -BUILDER DECLARATION: I hereby affirm -that I am exempt from the Contractor's License Law for'the ,
Compensation provisions of the LaborCade, you most forthwith comply with such provisions or this permit shall
followingreason (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
.su ch permit to file a sighed statement that he is licensed pursuant to the provisions of the Contractor's License Law
-O 1 hereby certify:t'
hat no excavation five (5),or more feet in depth into which a person i&required to descend. will be
,(Chapter 9(commencing with section 7000) of Division 3 of the Businesi and Professions Code) or that he is exempt :.
made in connectfonwitfi work alithoriied'by this permit, and that no building structure, scaftalding,.falsework, or
therefrom and the basis for,)he alleged exemption. Any violation oI Section 7031.5.byany applicant for a permit ..
: 'demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341;rTitle8,
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.): -
C.A.C:)-
- 0.1; as owner of the property, or my employees with wages as their sole compensation, will do.the world and the
p A's- owner -builder, I will not employ anyone to do work, which would require a permit tram the -Division of
„• structure,is. no6.imended or offered for sale (Sec:.7044, Business and.Protessions Code: The Contractor's License
:. Industrial Safety, as noted above, unless such person has a perrhil 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,.
v
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. ti
building or improvemnt is sold within one year of completion. theqwner-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 agency for the performance
• ❑ 1• as.owner o6 the property, am exculsivety contracting with licensed contractors to construct the project (Sec: - ..
• of the work -for which this permit, is issued (Sec. X3097, 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
-END
Contractor's License Law.). ..
Lender's Address
❑ 1 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 v.
.... city.and county ordinances and state laws relating to building construction, and hereby authorize. representatives'
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 copy thereof (Sec: 3800. Lab. Ci).
Signature of Applicant or Agent* Date -
Policy No. Company -
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
Certified copyis hereby furnished. `. 5
the information given is correct. I agree to comply with all state laws and county ordinances,,relating to buidling
l..
,f kCeitifled copy if'filed with the City Building Inspection Department -or City Depactment.
construction, and authorize a;representative of the City of La Ouinta Department of Building and Safety to enter .
i /`
upon the property for which I have applied for this permit for the purpose of making inspectiods. -
Date L Applicant
+ - Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPLICANT
j
PjMrNJrN1E_tl _F MI) • .. .
' O?REQ . Bmc 780 ... s .:. .. ..
ITr/COVMT l U N,I J iC;TE,t 92253 .. .
7-1-aLJC33 JOB SITE RE all [Y36L1;tt tan
CITY/COMMUNITY/STATE/ZIP
92253 .. .
BOK
PAG -
PRC
C
-..
TWN
RNG
SE-
S
TRACT
14496-1
LOT
182
7:39 ,..
..
MOD
C>r3
SB
450.00
TRACT NAME -
Santa Rosa Cie
OWNER NAME 1L. F. MI) r• -
CONTRACTOR -FIRM NAME .. '
ADDAs
RESS
CITY/COMMUNITY/STATE/ZIP
PHONE N
564-1315
'•
'LICNC N
333762'
ARC/ENG FIRM NAME, -
ADDRESS
CITY/COMMUNITY/STATE/ZIP r
PHONE N
'LICNC •
- ,- .
USE OF PERMIT ..
S/F/D with Attac3 ed C amge
BL
ZON
FSB 'SSB
SSB'
RSB
OFC
1`
ZONE ORD N'-,'
LOT SZ
-END
„ SIDEc
' APPL/PRMT
I w 9 DATE —o
ldAT 8 3
-
S/F/D
Pennit to cmistnic-t 2,326 Sq. Ft. of S/F/D
with Attached Garage
vbchanical Fee $
-2,6,00,
-Plan 'C heck Fee , '
291.20
C onstnructioa'a Fee
•448.00
F ] ectrical -Fee
36.96'
SNff Fee
7:39 ,..
Plumbing Fee
73.00
Property Davelopaent Fee
450.00
..
• y r F
y,
• F .n '-a' In
jucu CJ
?rain6a "'TEFF`
"$ '1,332:49-
VALUATION $105,867.60
N - BLDG. DEPT.
Alk
AdL
NO.
OPERATION TE
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.
❑
OP•N ADDITIONAL INFORMATION
NO.
—0,18
12
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall %
13 Finish Grade
INSULATION Thick
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 2 j
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
A