001509 (SATT)tf P.O. BOX 1504 No. 001509
Building 78-105 CALLE ESTADO
Address 7,3"'275 HM—iZon Pa3= CirCle LA QUINTA, CALIFORNIA 92253
Owner
GMijiral Ha nawm !'t BUILDING: TYPE CONST.- Y N OCC: GRP. R 3
Mailing'
Address
_#It'll '� . 91� f3 A.P. Number
City Zi'p Tel.
s>e AIM %]-API l. -U -7 -AA -f Legal Description
Contractor Project Description Hmd2m uml",Om
..Address .. .
145 i= 'K% 1 « .
P.O. B= 3'73
City Zip Tela
1t�afir; r Q90514 id#i- 5is
State Lic. City DK 1247& Classif.. Lic. # Sq. Ft. No. No. Dw.
Arch., Engr:,
Size• . 433 - stories Units
Designer WC.. New,9 Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address ((�� CC�� $t��.� R' Tel. y �}Q«
...3435 -S. .ifii aU S4. .-323-!-7 7 _ r r ... - .. •.
City Zip State
r+ar=ter 2 _ Lic.-#
�W LICENSED CONTRACTOR'S DECLARATION .
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with'Section >!
7000) of Divisiooh`3 of the Business and Professions Code, and my license'is in full force and
effect.v�. - •,� } 1 ,�..
SIGNATURE— ! 'o DATE
OWNER -BUILDER DECLARATION t 77—
rEstimated Valuation ' A
I hereby affirm that I am exempt from the Contractor's License Law for the following 74a Q
reason: (Sec. 7031.5, Business. and, Professions Code: Any city or. county -which requires a. 1 •v
permit, to construct, atter, improve, demolish, or repair any, structure, prior to. its -issuance also AMOUNT
requires the applicant for,such permit to file•a signed statement that he is licensed pursuant to .. - PERMIT
the provisions of the Contractor's License.Law, Chapter 9 (commencing with Section 7000) of
Division 3 o1 the Business and Professions Code, or t1fat. tie is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5. by 'any applicant for a .permit. 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 theirsolecompensation, will Plan Chk. Bal:
do the work, and the structure is not intended or offered for sale. (Seca 7044; Buisness and COrtst
Professions Code: The Contractor's License Law does not apply to an owner of property who. . - 1447 tit.
builds. or improves thereon and who does such work himself or through his own employees, Mech.� - -
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 havethe burden . Electrical
or proving that he did not, build or improve -for the purpose of sale.) .-
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 85.00
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.1.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
0 I am exempt under Sec. .. B: & P.C. for this reason Grading
Driveway Enc.
Date Owner Infrastructure Mfemd Dav= it as ameetwnt
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
❑ 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 --:L_' 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
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 cartify -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.
Signature of applicant » f' Dated
-.
Mailing Address _ a : • �-
City, State, Zip • `
HAKU WFY
TOTAL 756.83
REMARKS
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. SO. FT. ® $
2ND FL. SO. FT. ®
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. S0. FT. (g?
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 properly tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRY TRAY
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.
SO. 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 ® 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 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
IN5FLU I UM"5 SRfNA 1 UNt,/INI1 MLS
GARDEN WALL FINAL
r '
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 o1 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 manner so as to become subject tothe Workers'Compensation Laws of
and effect. California.
License Class Lic. Number Date Applicant
Date Contractor
OWNER•81.1ILDER 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 of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars (5500.):
0 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. 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. II, however, the
building or improvemni is sold within one year of completion, the owner -builder will have the burden of proving that
he did not build or improve lot the purpose of sale.).
0 1, as owner of the property. am exculsively contracting with licensed contractors to construct the project (Sec.
7044. Business and Professions Code: The Contractor's License Law does rot apply to an owner o1 property who
buillis or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the
Contractor's License Law.).
0 1 am exempt under Sec. B. 8 P.C. (Attached Certificate).
Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell -insure, or a
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.).
Policy No. 'Company
0 Certified copy is hereby furnished.
O Certified copy is filed with the City Building Inspection Department or City Department.
Date Applicant
APPLICANT NAME (L, F. MI)
JL Construction
ADDRESS
P.O. Box 173
CITY/COMMUNITY/STATE/ZIP
Nestor, CA 92053
JOB SITE ADDRESS/SPACE
CITY/COMMl1NITY/STATE/ZI P
lia.Quinta, CA 92253
BOK
PAIS
PAC
C
TWN
I FIND
SE
S
TRACT
19903
I LOT
r1l
MOD
SB
lmbi= Fee 85.00
TRACT NAME HORIZON PALMS
OWNER NAME (L. F. MI) Cianeral Management Corp. '
CONTRACTOR -FIRM NAME
J.L. Construction
ADDRESS
above
CITY/COMM UNITY/STATE/ZI P
PHONE a
756.88
LICNC •
* aareentnt
ARC/ENG FIRM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CM/COMMUNITY/STATE/ZIP
PalmSprings, CA 92262
PHONE I UCNC
323-7877
TOTAL •
FEE •
USE OF PERMIT
Single Family Dwelling
BL
ZON,
FSB
SSB
SSB
RSB
OFC
ZONE ORD •
LOT SZ
END
SIDE
NOTICE TO APPLICANT: II, alter 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:
0 thereby 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, lalsework, or
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2 Art 2, Sec341, Title 8,
C.A.C.)
0 As owner -builder, I will not employ anyone to do work which would require a permit from the Division o1
Industrial Safety, as noted above, unless such person has a permit to do such work from that division.
0 Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
o1 the work for which this permit is issued (Sec. 3097, Civ. Q.
Lender's Name
Lender's Address
I certity 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 1 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 buldling
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 Date
Print Applicant/Agent Name
APPL/PRMT"- RolDATE
5-2-2=85
S.F.D.
Permit to construct 1247 sq. ft.
of
living area and 433 sq. ft. of gaage
as per approved plans.
Mech. Fee 37.00
Plan Check Fee 307.96
Const. Fee 367.00
Elect. Fee 60.18
EM Fee 5.46
lmbi= Fee 85.00
Tnfrastructure
862.60
105.72 DF,P. PAID
756.88
* aareentnt
with Grlminitaz t Department
TOTAL •
FEE •
2.60
h i L L 0 7 L } /5&88 CK
FINANCE VALUATION 77,948.00