001503 (SATT)r14
14 C4J
P.O. BOX 1504
Building=` 78-105 CALLE ESTADO
Address 77-299 fl=LUM PaIM CLTCIS LA QUINTA, CALIFORNIA 92253
Owner
Address
City
Tel.
No. 001503
BUILDING: TYPE CONST., V N OCC. GRP. R 3
A.P..Number
Legal Description
Contractor Project Description .RWA7
omstrwtkn
Address _._ . . .. _ . "146 Mifts rRaid-mt1al ilk k_
jZip
State Lic.
& Classif. 442=
Arch., Engr., - - ..
Designer Michp^i
Tel. -
53 340--55U_
City
Lic. 23#� Sq. Ft. 1247'
Size,
Addressnn t� yyl �!,+yyy� Tel. 323-7877
City Zip State
P.*Avn Smirm ' 92262 Lic. # -
LICENSED CONTRACTOR'S DECLARATION
No. No. Dw.
Stories Units
New Add ❑ Alter ❑ Repair ❑ Den-olition ❑
I hereby affirm that.I am licensed under provisions of Chapter 9 (commencing with Section
70 OO) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
BY:
Minimum Setback Distances:
SIGNATURE i ,F d--• a +- i * f 'r f DATE
-
OWNER -BUILDER DECLARATION /
. ' I hereby affirm that I am exempt from the Contractor's License Law for the following
. reason: (Sec. 7031.5,Business and Professions'Code: -Any city or county which requires a
'permit to construct, alter, improve; demolish, orrepair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
Rear Setback from Rear Prop. Line
Estimated Valuation
PERMIT
• the provisions of the Contractor's License Law, Chapter 9 (commencing with Section. 7000) of
• Division 3 of the Business and Professions Code, or that. he is exempt ` therefrom, and the basis '
for the alleged exemption. Any violation of Section 7031.5 by 'any. applicant for a permit
Side Setback from Property Line
Plan Chk. Dep.
^' subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and,
. Professions Code: The Contractor's License Law does not apply to an owner of property who
-
Plan Chk. Bal.
Const.
'Meeh.
builds or improves thereon and who does such work himself or throughhis own employees,
provided that such improvements are not intended or,offered for sale. If, however, the building
Electrical
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose_ of sale.)
Plumbing
• ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct -the project: (Sec. 7044, Business and Professions Code: The Contractor's License Law -
S.M.I.
does not apply to an owner of property who builds or. improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I.am exempt under Sec. B.-8 P.C. for this reason
Grading
Driveway Enc.
Date Owner
Infrastructure C
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate'of consent to. self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
O Copy is filed with the city. - ❑ Certified copy is.hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE -
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
• or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers" Compensation
Laws of California.
Date' Owner
NOTICE TO APPLICANT., If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of `the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days:
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby• authorize representatives -of this city to enter the,* above-
mentioned property for inspection purposes. r f
Signature of applicant J 1 i Dae �I/
Mailing Address
City, State, Zip `
HARD COPY
p
TOTAL
REMARKS
AMOUNT
� n � •w,�nr�,nti- .
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CARP. SQ. FT.
WALL SO. FT. ®
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. @ c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1Ya c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPt(:I UX'S WUNA I UKE51INI I IALS
GARDEN WALL FINAL
PERMIT APPLICATION
City of La Ouinta
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 days.
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 7000) of Division 3 o the Business and Professions Code, and my license is in full force
• issued. Ishall not employ any person inanymanner soasto 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 of Exemption, you should become subject to the Workers'
OWNER• 3UILDER DECLARATION: I hereby 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, atter, 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 that he is licensed pursuantto the provisions of the Contractor's License Law
❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be
(Chapter 91commencing with section 7000) of Division 3 o the Business and Professions Code)or that he is exempt
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
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 more than thirty-six (36) feet high. (Chap 3.2. Grp 2, Art 2, Sec 341, Title B.
subjects the applicant to a civil penally of not more than five hundred dollars (5500.):
C.A.C.)
0 1. as owner of the properly, or my employees with wages as their sole compensation, will do the work, and the
p As owner -builder, 1 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 properly who builds, or improves thereon, and who does such work himself or
.PiJiE3bing Fee
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.
building orimprovemntissold within one year ofcompletion, the owner -builder will have the burden ofprovingthat
Date Applicant
he did not build or improve for the purpose of sale.).
CONSTRUCTION LENDING AGENCY: 1 hereby affirm that there is a construction lending agency for the performance
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
Lender's Name
builps or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
SS8
Contractor's License Law.).
Lender's Address
O 1 am exempt under Sec. B. 8 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 stale 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. Q.
Signature of Applicant or Agent Date
Policy No. Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify Ihave read this 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
O Certified copy is filed with the City Building Inspection Department or City Department.
construction, and authorize a'representative of the City of La Ouinta Department of Building and Safety to enter
upon the property for which I have applied for this permit for the purpose of making inspections.
Date Applicant
APPLICANT NAME (L. F. MO -
JL Clnnstruction
ADDRESS
P.O. Box 173
CITY/COMMMITY/STATE/ZI P
Nestor; CA 92053
JOB SITE ADDRESS/SPACE
Cm/COMMUNITY/STATUMP
La, to CA 92253
BOK
PAIS
PRC
I C
I
TNM
FIND
SE
S
19903
LOT�
Plan Check Fee
MOD
se
Const. Fee
TRACT NAME
HORIZON PALMS
OWNER NAME (L. F. M11 Ganeral Management Corp. '
CONTRACTOWFIRM NAME
J.L. Construction
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
PHONE a
5.46
LICNC .
.PiJiE3bing Fee
ARC/ENG FIRM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CITY/COMM UN ITY/STATE/Z I P
Palm Spir2mgs, CA 92262
PHONE . 1 LICNC •
323-7877
USE OF PERMIT
Single Fami1v Dwelling
BL
ZON,
I
FSB
SS8
SSB I
RSB
agreendmt
OFC
t Department
ZONE DAD •
LOT SZ
END
- SIDE
l
Signature of Applicant or Agent
Print Applicant/Agent Name
Date
APPLRRMTI -,� ' - -
5 TE -85
I.F.D.
Peznlit to construct
1247 sq. ft.
of
living area and 433
sq. ft. of garage
as per approved plans.
mech. Fee
37.00
Plan Check Fee
307.96
Const. Fee
367.00
Elect, Fee
60.18
cW Fee
5.46
.PiJiE3bing Fee
85.00
Trifrastructure
862.60
105.72 DEP. PAID
756.88
*
agreendmt
t Department
TOTAL •
FEE
862.60
MiLL1 D LJ /j&88 CK
'FINANCE
VALUATION F77,948.00
•