001513 (SATT)44Q
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address %°" H'9xJ= PUJ= CJ=J9 LA.QUINTA, CALIFORNIA 92253
Owner
No. 001513
� �. %AAL' BUILDING: TYPE CONST. V 14 OCC. GRP. R3
Mallmg
Address 1401 t
City
Contractor
Address
-City
1�
State Lic.
& Classif.
p
zc x.73
Zip .. .
A.P. Number
Legal Description
Project Description -tea,
146— Ul isSAE st3" k3AiDevel.
Sq. Ft. GM 433 No.
Arch., Engr., '
Size Stories
Designer�New _ Add ❑ � Vic. -� _
Address Tel.
340 'S. - Farmill ft. - .323-7, 877 »
City Zip State
..Lic. # ...
9 $ "=
_ LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I•am licensed under provisions of Chapter 9 (commencing'with Section
7000) of.Di,i.io.3 of,t(h(e Business and Professions Code, and my license is in full force and
effect.t if / )f
N :.
SIGNATURE DATE _
'OWNER•BUILDER DECLARATION EStimatt d Valuation
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, or repair any structure, prior to its issuance'also
requires the applicant for such permit to rile a signed statement that he is .licensed pursuant to - PERMIT - the provisions or the Contractor's License Law, Chapter 9 (commencing with Section.7000). of
Division 3 or the Business and Professions Code, or that. he is exempt therefrom, and -the basis
r n ali d' Plan Chi, De
No. Dw.
Units -
Alter ❑ Repair ❑
or t e age exemption. Any —.—n o/.Section 7031.5 by any applicant for a permit p-
'subjects the applicant to a civil penalty of not more than live hundred dollars ($500)."' '- Plan Chk. Bal.
O• 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 Const...
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees, .Mach.
provided that such improvements are not Intended or offered for sale. If, however, 'the building.
or .improvement is sold within one year of completion, -the owner -builder will have the burden Electrical
of proving that he did not build or improve for the purpose or.sale.) -
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
struct the project. (Sec. 7044, Business. and Professions Code: The Contractor's License -Law
does. not apply to an owner of property who builds or improves thereon, and who contracts for S•M.I:
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
Date owner Infrastructure )`
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. IS c. 3800, Labor Code.)
Policy No. ' . .Company
❑ Copy is filed with the city. O 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 (S100) 'valuation
or less.)•
I certify that in the performance of lhg work for which this permit is issued, I shall not
employ any person in any manner so as to become subject'lo the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: It, after making this Certificate or 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
I hereby 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. f _ j
Signature of applicant ! /,! , ,►/ r +- —Date—i ` r
Mailing Address r 4.
City, State, Zip
HARD COPY
TOTAL
REMARKS.
Demolition ❑
ti
AMOUNT
105,7'
2€ 2.24
367.0 R
37.00
LIST . �R9
8S.0Q
«l•AEE
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 FF.FS
1ST FL. SQ. FT. ® $
2ND FL. Q. FT. ®
POR. SO. FT. ®
GAR. SQ. FT. @
CARP. SQ. FT.
WALL SQ. 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
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
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.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® V/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 APPJEQUIP.
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
INSYtU 1 UN.' wurM 1 UMblINI I IALS
GARDEN WALL FINAL
- ! `.�
PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
This permit becomes void It work not commenced within 180 days from date of Issuance. OR, if work has been suspended or abandoned for a period o1 180 days.
CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE: This sectionbeed not be completed if
LICENSED CONTRACTORS DECLARATION: I hereby affirm that 1 am licensed under provisions of Chapter 9
-(commencing with Section 7000) o1 Division 3 o1 the Business and Professions Code, and my license is in full force
and effect.
License Class Lic' Number
Date Contractor
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, or repair any structure, prior to its issuance, also requires the applicant for
such permit to file a signed statement that he is licensed pursuant to 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 o1 Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
O 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. 7004, Business and Professions Code: The Contractor's License
Law does not apply to an owner of property who builds, or improves thereon, and who does such work himself or
through his own employees, provided that such improvements are not intended or offered for sale. If, however, the
building or improvemnt 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.).
O I, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec.
7004, Business and Professions Code: The Contractor's License Law does riot apply to an owner of property who
builQs or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
O 1 am exempt under Sec. B. & P.C. (Attached Certificate).
Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
certificate o1 Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.).
Policy No. Company
o Certified copy is hereby furnished.
O Certified copy is filed with the City Building Inspection Department or City Department.
Date Applicant
APPIICMIT NAME (L. F. MI)
JL Cmstruction
ADDRESS
P.O. Box 173
CITY/COMMUNITY/STATE/ZI P
. Nestor, CA 92053
JOe SITE ADDRESS/SPACE
.living area and 433
CITY/COkMUNITY/STATE/ZIP
La. to CA 92253
SOK
PAG
PRC
I C -
Plan Check Fee
TWN
RNO
SE
S
60.18
L02
.
Plunbing Fee
Moo
Set
19CT
903
�!
105.72 DF.P. PAID
756.88
*
TRACT NAME
HO Z(W PALMS
OWNER IIAME (L. F. MI) t=ine al Management Co
CONTRACTOR -FIRM NAME
J.L. Construction
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
ahipme
PHONE a
TOTAL °•
FEE
LICK •
ARC/ENG FIRM NAME '
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CITY/COMMUNITY/STATE/ZIP
Palm rin s CA 92262
PHONE a LICHC •
323-7877 I
USE OF PERMIT
Single Familv Dwellin
el
ZON.
FSB
SSB
SSB
RSB
OFC
ZONE ORD 8
LOT SZ
1
1 END
SIDE
the permit Is for one hundred ($100) o. less. l certify that in the performance o1 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 Applicant
NOTICE TO APPLICANT: It, atter 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.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
O 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 32, Grp 2 An 2, Sec 341, Title 8,
C.A.C.)
O As owner -builder, I will not employ anyone to do work which would require a permit from the Division of
Industrial Safety, as noted above, unless such person has a permit to do such work from that division.
O Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
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 county to enter upon the above-mentioned property for inspection purposes.
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidlieg .
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.
Signature of Applicant or Agent
Print Applicant/Agent Name
Date
APPtJPRMT '
S 2-2=85 S.T.D.
Permit to construct
1247 sq. ft. of
.living area and 433
sq. ft. of age
as ner approved plans.
me -ch. Fee
37.00
Plan Check Fee
307.96
Const. Fee
367.00
60.18
SE
.
Plunbing Fee
p5.46
85.00
Tnfrastnicture
862.60
105.72 DF.P. PAID
756.88
*
ggreentnt
with C"mmity
t De t
TOTAL °•
FEE
862.60
H1L3� 7 LS 75688 CK
:E VALUATION F77, 948.00