SFD (0436)77494 Calle Mazatlan
0436
ADDRESS
' Y .
PERMIT APPLICATION
City
Department of
of La Ouinta
Building and Safety •
Yi i•.
PAG
PRC
C
• This permit becomes void it work not commenced within. 180 days from date
of issuance, OR, if work -has been suspended or.abandoned dor'a period of 180 days.
"
' ' ' ?• c.
-under
:. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE:: This section need not be completed it
TRACT
LICENSED CONTRACTORS DECLARATION: 1 hereby affirm, that d am licensed provisions of Chapter 9 '+.
the permit is for one hundred ($100) o. less: l certify that in the performance of the work for,which this permit Is
,-
(commencing with Section 7000) of Division 3 of the Businessland 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.
License Class Lic. Number
Date Applicant,
• Date'Contractor
.:NOTICEJO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'..'•'"
f
'
-BUILDER DECLARATION: • 1 hereby' affirmahat I am exempt from the. Contractor's License Lawthe ; :
`' Compensation provisions of the Labor Code, you must forthwith comply.witb such'provisiobs or this permit shall
s
.'OWNER .for
- followingreason Sec, 7031.5. -Business and Professions Cade: An cit or count which requires a - permit to
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tie deemed revoked? -
i•
• construct, alter,rimprove, demolish..br.repair any structure, prior to its issuance, also requires -the applicant for
DIVISION OF,INOUSTRIAL SAFETY PERMIT CERTIFICATION:
such permit lo.file,asigned statement that heislicensedpursuanttothe provisions ofthe Contractor'sLicense Law
0 hereby certifythat'noexcavatibnfive(5)ormorefeelindepthintowhichapersonis equiredtodescend,wilFbe
t:
(Chapter 9(c9mmencing with section 7000) of.Division 3 of the Business and.ProfessionsCode) or thathe isexempt
.made in connection with work authorizid by this permit, and that no building structure, scaffolding, falsework,.or
ADDRESS ..
therefrom add1he basis for the alleged exemption. Any violation of Section 7031:5 by any applicant for a permit
; demolition'or dismantling thereof, will be'more than thirty-six (36) feet high: (Chap,3.2, Grp 2, An 2, Sec341,Title8;
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subjects0e applicant to a civil penalty of not more than five hundred dollars (S50O.):
;•' C:AtC.) 'S
- 0.1. as owner of the property, or,my employees with wages as their sofe,compensation, will do the work, and the
0 As owner -"builder, I viill'not• employ anyone to do work which would require a.perinit from the Division%of
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structure isnot 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. - [
t• -
Law does not apply to an owner of property who builds, or improves thereon, and who does such work -himself or
,.
❑Division of Industrial Safety' Permit No.
through his own employees, provided that such,improvements are not intended or offered for sale: If, however, the
y
'building orimprovemnfissoldwithinone yearofcompletion. the owner -builder will havetheburdenof.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 constructiomlendingagency fortheperformance
i
.
z0 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.). •_ ' -
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7044, Business and Professions Code: The Contractor's License Law does not apply to an owner.of property who
Lenders Name "
ZO
builds or improves thereon: and who contracts for such projects with a contractors) licensed pursuant to the , ..
Contractor's License.law.).
Lender's Address
EFC,.
' :::0;1 am exempt under Sec. B. & P.C.•(Attached Certificate):. ,
1 certify that.l have read this application and slate that.the above information is correct. l agree to comply with all.
,
'
Date Owner
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
'of
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to'self-insure; or.a
this county to enter upon the above-mentioned property for inspection purposes.
certificate,of Workers' Compensation Insurance Lor'a,certified-copy.thereof (Sec: 3800: Lab. C.). ..: " :. '.<
"; •'.. - . ., -: ,S .. x - -
ignat&e of Applicant or Agent Date
`
PolicyNo.. Company.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRi: I certify I have. read'fliis application and state that
❑ Certified copy is. hereby furnished
the information given is;correct. I agree to comply with all state laws and county ordinances relating to.buidling
the City.of Ca Ouinta
0 partlment or'Clty Department.
Y/!certified copy i0liled'with the CCdy Building InspectiliIt )•
construction, and authorize a'representative of Department of Building and Safety to enter'
which I have applied.for this for the inspections.'
'vIDate L Applicant
upon.the property -for permit purpose:of making
'Signature of Applicant or Agent Date ,
Print Applicant/Agent Name
APPLICANT NAME'(L, F.
MI)
And +n zatilon
ADDRESS
P. 0. Bax 780
CITY/COMMUNITY/STATE/ZIP,
La. Quanta, CA 92253
JOB SITE ADDRESS/SPACE
7i•-494 Calle Mazatlm
.CITY/COMMUNITY/STATE/ZIP
La Quinta, CA 92253
.BOK
PAG
PRC
C
TNM
RNG
SE
.S
TRACT
- LOT
MOD
..SB
14496-1
156.
P-2
TRACT NAME '
Santa Rasa Cove
OWNER NAME 1L: F, MI) . +
CONTRACTOR -FIRM
p NAME-'SaMe. As
bom
ADDRESS .,
CITY/COMMUNITY/STATE/ZIP .. ,
PHONES
.'
LICNC
564-1:315
333762
ARC/ENG FIRM NAME '
ADDRESS ..
CITY/COMMUNITY/STATE/ZIP - .. ..
PHONE N •
LICNC M
-
US OF PERMIT
S F/D with Attached Garage
BL
ZON
'FSB'
SSB
SSB ' -.'.RSB
ZO
EFC,.
NEORD MEND ••, ;'• riti _
Jf' lr'.{ , 'r' *P c'Jlwj - , auk f , A • td• l f ...1.i"r 1 u t ' 171 ."f ; Y'b Y f I ^ • -' , ♦ 1 v
.% 3 J► h _Ff % %r. ` '9jiL r,7 i77 Y n "`fg+ a (+ . VALUATION ' j{ • ;.g ( }
`+k+ ";» v►• ->' w,' „'+r.' '"".,i a. r :".i"-1` BLDG`w.Y • . r ti., M..`- - IY _ , y a•17,J 0.322 "A}
r ti'AA
APPL/PRMT DATE -
5
Pexdt to construct 1,812 Sq. Ft. of S/F/D
with Attached Garage
Alechaiical F
. Pian. -Oieck -Flee 242,45
Constxuctien Fee - 3' ON—
Electxil.t... . 31.25
S Fee 5.57 -
Phu ing Fee 48.50,
. y.
Property Develot Fee
300.00
La
9
ULC z
TOTAL'':- f -
'-FEE •• 1,031.17
-F
NEORD MEND ••, ;'• riti _
Jf' lr'.{ , 'r' *P c'Jlwj - , auk f , A • td• l f ...1.i"r 1 u t ' 171 ."f ; Y'b Y f I ^ • -' , ♦ 1 v
.% 3 J► h _Ff % %r. ` '9jiL r,7 i77 Y n "`fg+ a (+ . VALUATION ' j{ • ;.g ( }
`+k+ ";» v►• ->' w,' „'+r.' '"".,i a. r :".i"-1` BLDG`w.Y • . r ti., M..`- - IY _ , y a•17,J 0.322 "A}
r ti'AA
APPL/PRMT DATE -
5
Pexdt to construct 1,812 Sq. Ft. of S/F/D
with Attached Garage
Alechaiical F
. Pian. -Oieck -Flee 242,45
Constxuctien Fee - 3' ON—
Electxil.t... . 31.25
S Fee 5.57 -
Phu ing Fee 48.50,
. y.
Property Develot Fee
300.00
La
9
ULC z
TOTAL'':- f -
'-FEE •• 1,031.17
AN
Ak
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 111-7 IN
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'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
PSL P/I
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring 7
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service `-
32 Final