SFD (0437)77484 Calle Mazatlan
0437
• PERMIT APPLICATION
City of La Og a
Department of Building and Safety
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 daysi
CyaCDM__ MUNITI'a,TEC 92253
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CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
LICENSED CONTRACTORS 'DECLARATION:.I hereby 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 70D0) of Division of the Business and Professions Code, and my license is in full force
issued, I shall not employ any person inany manner so asto become subject to the Workers'Compensation laws of '
and effect.
California.
License Class Lic.. Number
Date Applicant
Date Contractor •
NOTICE TO APPLICANT: If, after making this Certificate oL:Exemption, you should become subject,to the Workers'
OWNER -BUILDER DECLARATION: I'hereoy 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
"
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
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
such permit to file a signed statement thathe is licensed pursuant to the provisions of the Contractor's License Law
01 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be
(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 rib building structure, scaffolding, falsework, 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 moretban thirty-six (36) feet high. (Chap 3.2, Grp.2, Art 2, Sec 341, Title 8,
subjects the applicant to a'civil penalty of not more than five hundred dollars ($500Jr
C.A.C. ' .[:, '
0 I. as owner of the property, or my employees with wages as their. sole compensation, will do lhe.work, and the
0 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 License
Industrial Safety, as noted above, 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
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through his own employees, provided that such improvements ane not intended or offered for sale: If, however, the
❑.Division of Industrial Safety Permit No.
building orimprovemntissold within one-year ofcompletion, the owner -builder will have the burden of provingthat •'
Date 'Applicant _
he did not build or improve for the purpose.ol sale.).
%.i, CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
0 I, as owner of the property, am exculsively contracting, with licensed contractors to construct theproject(Sec:
of the 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
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 l.am exempt under Sec. B. 8 P.C. (Attached Certificate).
1 certify that I have read this application,and state that the above information is correct. I agree to comply with all
Date ' Owner Al
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
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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
Policy No. -Company
CERTIFICATEOF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certifylhave read this application and slatethat
0•:Certified copy is hereby furnished. :. . /)
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the' information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
Certified.copy is it withFAhe,Cny Building Inspection OeDartmEnt,6r City n Department. "
construction, and authorize a'representative of the City of La Ouinta Department of Building and Safety to enter .
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upon the property for which I have applied for this permit for the purpose of making inspections.
Applicant'
..
PPUCANT NAME(L, F, Ml al.i Il
ADDRESS
P. 0. Baas 780
CITY/COMMUNITY/STATE/ZIP
CTE
Quin92253 .
JOB SIT.E,ADDRESS/SP CE
ri - can% Mazatlan '7 7-
CyaCDM__ MUNITI'a,TEC 92253
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BOK
PAG
PRC
C
Plan Cbhak Fee
TWN
PING
SE
S
TRACTLOT
14496-1
157
7.39
-
MOD
P-3
se
'
TRACT NAME •p, .,..,
Santa . Cove
OWNER NAME (L. F. MI) ,
CONTRACTOR -FIRM NAME '
Same AS Abom
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE 0
564-1315
LICNC I
333762
`TFEE
ARC/ENG FIRM NAME
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PPHOONE 9
LyICNC 8
S/ • /D Mlwith AttachedGEkrage
BL I
I ZON
FSB
I SSB
SSB'.
RSB
OFC
ZONE ORD N
LOT SZ
. END
'SIDE
Signature of Applicant or Agent
Print Applicant/Agent Name
Date
APPVPRMT 0 4 ? F.
i}A,) 12-28-83
S/F/D .
Pennit to construct 2,326 Sq. Ft. of S/F/D
with Attached raracg
Mechanical. Fee
31.00
Plan Cbhak Fee
291.20
Construction Fee
448,00
Electrical Fee
31.25
SNI Fee
7.39
Plumbing Fee
52,50
Property DeveloWmt Fee
450,00
r
a•
y ® La 73 oKtl
`TFEE
$ 1,311„34
BLDG. DEPT.
VALUATION $105,699.40
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A&
NO.
OPERATION rATE
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.
❑
NPON ADDITIONAL INFORMATION
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y/ •
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lathi i' /
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 s
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