001507 (SATT)P.O. BOX, 1504 N o . .0'01507
Building
Address 79-2193 U=i=n Pal= CirCU LA QUINTA, CALIFORNIA 92253
Owner
BUILDING: TYPE CONST. V R -OCC: GRP.-
Mailing 3
Address 1001 Bisbcp st. 2700
A: P. Number
City Zip Tel.
�nlu 96813 i -3? -5454 Legal Description
Contractor .
.. _.. .. .. Project Description Nwi'&G'33 Pal=
J.L. 'l.... . 146 i tit6 awtial DML
Address- .... _ _
State Lic. I City
& Classif.. 442827 Lic. # 237
Arch:; Engr.; -'
Designer
f�E�t�k+a�t ���>r�n to •
Address Tel.
'oda'! 14:. 'a 'I.1' 391-71477
City Zip State
.Sm"iftlIn 92262 . .Lic. #
LICENSED CONTR&CTOR'S DECLARATION
I hereby affirm that I°am licensed under provisions of Chapter'9 (commencing with Section..
7000) of Division 3 of the Business and Professions Code, and'my license is in full force and
effect. . . If I
SIGNATURE .% r r Y - 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, 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 lhe'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 civilpenalty of not more than rive 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, Buisness and
Professions Code: The Contractor's License Law doesnotapplyto 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 improvement -is sold within one year or completion, • the owner -builder will have 'the burden -
.• . of proving that he did not build or improve for the purpose of sale.)
❑ 1, 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
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.)
❑ 1 am exempt -under Sec. B: & P.C. for this reason
Date Owner
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. , 0 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 tha 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 or 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.
Signature of applicant •1 f r DateA
Mailing Address % f
City, State, Zip
HARD COPY
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
". 1247 Sq. Ft.
.Size—, M 933. -
No.
Stories
No. Dw.
Units -
New Add ❑
Alter ❑• .
Repair ❑ Demolition ❑
FINAL DATE
INSPECTOR
Issued by:- .
Date Permit
Validated by:
Validation:
Estimated Valuation
S
77,94800
-• PERMIT
AMOUNT
Plan Chk. Dep.
Pri,c 72
Plan Chk. Bal.
34
.Const:
_.
167 _n0
Mech.
17 An
Electrical
9110%,10
Plumbing
1; AA
Grading
Driveway Enc.
Infrastructure
l-, Act an9"
.
TOTAL
, AM
_AQ
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
IST FL. SO. FT. ® $
2ND FL. SO. FT. ®
POR. SQ. 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
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRY TRAY
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.
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 TLUMB. 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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
APPLICANT NAME (L. F. MI)
JL Construction
ADDRESS
P.O. Box 173
CITY/COMMUNITY/STATE/ZI P
Nestor; CA 92053
JOB SITE ADDRESS/SPACE
CITY/COMMUNITY/STATE/ZIP
La. to CA 92253
• 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 o1 180 days.
T"
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 o1 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 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 to the Workers' Compensation Laws of
and effect.
California.
License Class Lic: Number
Date Applicant
Date Contractor
NOTICE TO APPLICANT: It, after making this Certificate of Exemption, you should become subject to the Workers'
OWNER -BUILDER DECLARATION: I hereby affirm that 1 am exempt from the Contractor's License Law for line
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
be deemed revoked.
' following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to
CITY/COMMUNITY/STATE/ZIP
abipm
construct. 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 file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
01 hereby certify that no excavation five (5) or more feet in depth into whicha person is required to descend. will be
(Chapter 9(commencing with section 7000) of Division 3 of the Business and Professions Code) or that he is exempt
made in connection with work authorized by this permit, and that no building structure, scaftolding, lalsework, 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 Z 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 I. as owner o1 the property, or my employees with wages as their sole compensation, will do the work, and the
O As owner -builder, I 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 property who builds, or improves thereon, and who does such work himself or
0 Division of Industrial Safety Permit No.
through his own employees. provided that such improvements are not intended or offered for safe. if, however, the
building orimprovemntissold within one year ofcompletion, theowner-builder will have the burden ofprovingthat
Date Applicant
he did not build or improve for the purpose of sale.).
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
0 1, as owner o1 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 o1 property who
Lender's Name
builQs or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
LOT SZ
Contractor's License law.).
Lender's Address
0 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. l agree to comply with all
Date Owner
'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.
WORKERS' COMPENSATION DECLARATION: thereby 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. Q.
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
0 Certified copy is hereby furnished.
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling .
0 Certified copy is filed with the City Building Inspection Department or City Department.
construction, and authorize a'represeniative 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
Signature of Applicant or Agent Date
APPLICANT NAME (L. F. MI)
JL Construction
ADDRESS
P.O. Box 173
CITY/COMMUNITY/STATE/ZI P
Nestor; CA 92053
JOB SITE ADDRESS/SPACE
CITY/COMMUNITY/STATE/ZIP
La. to CA 92253
BOK I
PAG
PRC
I C
37.00
T"
I FIND
SE
S
19903
LOT
SM Fee
5.46
Moo
se
Tnfrastructure
TRACT NAME HORIZON PAJ.I'L7
r Valli
wietel.
OWNER NAME (L. F. MI)
Management
1�11C/ nal agement C o rp-
CONTRACTOR-FIRM NAME
J. L. Construction
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
abipm
PNONE • 1LICNC
756.88
*nafe=ad p&ymmt
as = agreembnt
ARC/ENG FIRM NAME
Michael Buccir>o Assoc.
ADDRESS
340 S. Farrell Dr. A212
CITY/COMMUNITY/STATE/ZIP
Palm Sorinas. CA 92262
PHONE • LICNC •
862.60
323-7877
USE OF PERMIT
Single Family Dwelling
BL
ZOM.
'FSB
SSB
SSB
RSB
OFC .
ZONE ORD •
LOT SZ
ENo
SIDE
Print Applicant/Agent Name
(hit I -S nr�
APPL/PRMTDATE
- _ a.. F � , ".
5-2-2=85 SX. D.
Permit to construct
1247 sq. ft. of
living area and 433
sq. ft. of garage
as per approved plans.
Niech. Fee
37.00
Plan Check Fee
307.96
Const. Fee
367.00
Elect- Fee
60.18
SM Fee
5.46
.21urrbim Fee
85.00
Tnfrastructure
862.60
105:72 DEP. PAID
756.88
*nafe=ad p&ymmt
as = agreembnt
t Department
TOTAL •
'FEE
862.60
N 1.t. L 0 7 L / 5& 8 8 CK
FINONf_F VALUATION F77,948.00