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001506 (SATT)•:ding t 78-105 CA BOX E ESTADO Addressss 79-287 � Pa Ie LA QUINTA, CALIFORNIA 92253 Address GMXWal #.mag==t O=P.- Mailing =P,Mailing Address 1001 RiAbillm 'St. ad1a "04 City * Zip Tel.. .1 j �.-4 .,2091-367-501 Contractor Address p� . .. .4. P.O. 3A�y.+lipa 173 City . _ Zip Tel.. No. 001506 BUILDING: TYPE CONST. cif N OCC: GRP., R 3 A.P. Number Legal Description Project Description [' State Lic. & Classif." . �? !EA'i City Lic. #� I = 2247 Sq. Ft. Size. GAR- 433 No. No. Dw. Stories Units • Arch., Engr., Rear Setback from. Rear Prop. Line Designer Vii. ASSIX. New 2 Add'❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel FINAL DATE INSPECTOR g�^�1 g L • . .. 340 S. �J.� St. 9e��e�1�� .TGT / 8 7. Validated by: Validation: _. ...-.. City Zip State . 1 s ; 92262 LiC. # LICENSED CONTRACTOR'S DECLARATION. `a -u 1 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.. ��� J SIGNATURE + N ff. - DATE OWNER -BUILDER DECLARATION I hereby affirm that 1 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 thaC 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 rive 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 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 fs 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.) Estimated ValUatlOn P .f w I!A a .77.94R. 4R.(M - PERMIT AMOUNT Plan.Chk. Dep. e - j•{)�j�' 3 Plan Chk. Bal. .202.24 Const. OnS. F s� �,q - 36 A .NET Mech.37.00 _ Electrical ' O_ Plumbing RCS O 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.) ❑ I am exempt under Sec.. B. & P.C. for this reason ._ S.M.I. - Grading _ Driveway Enc. Date Owner Infrastructure aA Aarae 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 "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 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 inspe/cttiion• purposes. Signature of applicant/ + t y' } l f/ l Date Mailing Address i City, State, Zip HARD COPY TOTAL ar7 An AR 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. SQ. FT. POR. SQ. FT. ® GAR. SQ. FT. CAR P. SD. FT. WALL SO. FT. ® SO. 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 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. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1+/. c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ec HOUSE SEWER REMARKS: VENTILATION 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 INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL PERMIT APPLICATION City of La Duinta 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'COMPENSATIONINSURANCE: This section need not be completed if LICENSED CONTRACTORS 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 eflect. License Class Lic. Number Date Contractor OWNERAUILOER 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 Contra ctor'sLicense Law (Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) o r 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.): 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, 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 not apply to an owner of property who buil(fs or improves thereon, and who contracts for such projects with a contractor(s) 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 self -insure, or a certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. Q. 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 APPLICANT NAME (L. F. MI) JL Cnnstruc.-tion ADDRESS P.O. Box 173 CITY/COMMUN ITY/STATE/ZIP Nestor, CA 92053 JOB SITE ADDREC.JSPACE CITY/COWLMITY/STATE/ZIP La.Quinta, CA 92253 Bac PAG PRC I C Mech. Fee 37.00 TWN PING SE s 19903 LO%� RE Fee 5.46.' MoD 1 Se TRACT NAME HORIZON PALMS OWNER /MME IL. F. MI) General Management Corp - CONTRACTOR -FIRM NAME J.L. Construction ADDRESS ablove CITY/COMMUN ITY/STATE/ZI P PHONE a LICNC e with emmini-taz t Department ARC/ENG FIRM NAME Michael Buccino Assoc. ADDRESS 340 S. Farrell Dr. A212 CITY/COMMUNITY/STAnalP Palm Springs, CA 92262 PHONE a LICNC 9 ' 323-7877 1 USE OF PERMIT ' Single Family Dwelling BL ZON. FSB SSB SS8 RSB DEC ZONE ORD • LOT SZ END I SIDE the permit is for one hundred ($100) o, 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 Applicant 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. DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: 0 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 3.2, Grp Z Art 2, Sec341, Title 8, C.A.C.) 0 As owner -builder, 1 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. Q. 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 buidling 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 o b 1 APPL/PRMT _ DATE =ti` 5-2-2 '85_j S.F.D. Permit to construct 1247 sq. ft. of living area and .433 sq. ft. of gaage as ver appirtzged plans. Mech. Fee 37.00 Plan Check Fee 307.96 Const. Fee 367.00 Elect, Fee 60.18 RE Fee 5.46.' .Plimbing Fee 85.00 862.60 105.72 DEP. PAID 756.88 * agreenImt with emmini-taz t Department TOTAL °• FEE 862.60 H1LL� D LS 15&88 CK E VALUATION F77,948.00