SFD (0435)77504 Calle Mazatlan
0435
APPLICANT NE'(L, F. MLi 4
AMM
'ADDRESS'
P.- O: E= 780
' PERMIT APPLICATION r
City of La
Department of Building
Ouinta
and Safety
BOK I
PAG
This permit becomes void if work not commenced within 180 days from date of issuance, OR}if work has been suspended orabandoned for a'period of 180 days.-
ays:CERTIFICATE
C
CERTIFICATEOF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE:* This section need not be completed if {
LICENSED' CONTRACTORS DECLARATIONr.1'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 7000) 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 mannersoaslo 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 Certilicate of Exemption; you should become subject to the Workers' Z ,,
OWNER -BUILDER DECLARATION: I hereby'aflirm tba(I am exempt from II a Contractor s License Law for the ,•
i Compensation,provisions of the Labor Code, you must forthwith comply with suchprovisions or this permit shall
'
following' reason (Sec. 7031.5,. Business and Professions Code: Any city or county. which requires a permit to
be Ceemed revoked.
-
construcL 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 life a signed statement that he is licensed pursuanttothe provisions oflheContractor's License Law
0 1 hereby certify thai no exia4atioiifivij5) or r6e f6et in depth into which ipeison is riquired to descend, will be
' (Chapter,9(commend ng.with section 7000) of Division 3 of the Business and'Professions;Code)orthat he is exempt:
made made in connection with work authorized by this permit, and that no building structure, scaffolding, lalsework, or
,therefrom and the basis for the alleged,exemption: Any violation of Section 703,1.5 by any applicant for a permit: S ' '
demolition or dismantling thereof, will be more than thirty-six (36).feet high. (Chap'3.2;Grp 2, Art 2, Sec 341, Title 8. 8`4u;l
subjects the applicant to a civil penally of not more than five hundred dollars+'($500.): -
C.A.C.)
• O 1. as owner of the property;.or my em ployees-with-wages as their sole compensation, will do the work, and the • ,,,
`
O As owner -builder, 1 will not employ anyone to do work4vhich 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
` Law does town builds, improves thereon, and does himseltor
Industrial'SafeiyE as noted above, unless such'person has a permit,to do such work from that division.
not apply owner of property who or who such work
-.-through his own employees. provided that such improvements are not intended or offered for sale.lf,however, the:..
;
O Division -of Industrial Safety: Permit No
••buildingorimprovemntis'soldwithin one year ofcompletion. the owner -builder will have the burden of, proving that
Date Applicant'
he did not build or improve.tor the purpose of sale.). .
'
CONSTRUCTION'LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance : fi. •'
O 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.).
7044. Business and Professions Code: The Contractor's License.Law does not apply to an owner of property who
Gender'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 ?
O 1 am exempt under Sec. B..B P.C. .(Attached Certificate). • .
I certify that'I have read this application and state 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' ;
4
of this county to enter upon the above=mentioned properly for inspection purposes.
WORKERS' COMPENSATION DECLARATION: •I hereby affirm that) have a certificate of consent to self-insure,.or a
s' -
^ certificate of Workers"Compensation Insurance Tor a certified•copy thereof'(Sec. 3800. Lab. C.).'
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. a , .
O'C rtifled copy Is her y fu nished. - ! : • •r -
'
the information given is correct. I agree to comply with all state laws and county.ordinances relating to buidling
and authorize a representative the City of La Ouinta Department Building Safety;to,enter i
❑ CertlheId co Is'iled wnry the Ci . Buildin Ins eciiolifDe ariment' De 8rtment
Ly" ! •"'V 9 y(/ — --- p
.construction, of of and *"
the, for I have for this for.lhe inspections
-` . __•
Date 1 Apphcanl
upon property which applied permit purpose of making -
1
+.
Signature of Applicant or Agent Date i
APPLICANT NE'(L, F. MLi 4
AMM
'ADDRESS'
P.- O: E= 780
CITY/COMMUNITY/STATE/ZIP
La Quinta,-CA 92253
77-504 REcI;e Matatlan
CITY/COMMUNITY/STATE/ZIP
La QWzta, CA 92253
BOK I
PAG
PRC
C
TWN '
PING
SE
S
TRACT
14496 -1
- LOT+MOD
155
]E -1
SB
-
TRACT NAME
Simta Rosa Cove
OWNER NAME (L. F. MI) •- -•
CONTRACTOR -FIRM _NAME
a . P
.am
ADDRESS
CITY/COMMUNITY/STATE/ZIP ..
PHONE N `-
564=1315
- .-
LICNC If
X33762
,
ARC/ENG FIRM NAME .+ .
ADDRESS -
CITY/COMMUNITY/STATE/ZIP .•- • • ' - -
PHONE •yy.
.
GarageLLICNC•
PVE RMI
..0 OF PERMIT
71FFiiitlS Attached '
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SSB
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Print Applicant/Agent Name
APPVPRMT_ fl 4'7' 12A28s 83^ S/F/D
ffJJ
Permit to construct 1,903 Sq. Ft: of S/F/D
with Attach Gazagsr
Mechanical Fee $: 31:00
Plan'Check Fee. 250925
Construction Fee 385;00
Electricaa. Fee f ' .31,25'
&MI Fee 5.185
Plumbing Fee 48.50
Property Develogneit Fee 450.00
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V 1E
OWN
., 9.19
P.n• ' r ? `7 Asn' ,S
FEE
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+4 Z 4, -"• ! 5,7 r/ l+ 1 r' -..I L i y sr f -.-.rex ti
i.-+ 1 tl*"`;;4k`t" yy 'a'i'Y'ki .' jF'"..-..J `".. 1>r'" G...1y,—.:syr,,,,;.• - t
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VALUATION 83,889.8 t „• 111*1
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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
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)!! Llzpv Z/4
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 A Vff
25' Final •
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
PIL P)
STREET NAME
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final