001505 (SATT)44
P.O. BOX 1504 No. 001505
Building
Address 7920,1Pal= Ci=lt? LA QUINTA, CALIFORNIA 92253
Owner w
GMWMI
Mailing.
Z'a1'mmme%t i�. BUILDING: TYPE CONST. V tip OCC GRP.
Address 1001 Bishm St. ftite 2700 A.P. Number
CityZip Tel.
96913 1-800—�67= M� Legal Description
Contractor Project Description ,r_ —m an -J,>
?. fa4rntu'fia+rn
...Address
_tA a
City ` Zip -. Tel..
State Lia City -.�
& Classif. Add Lic. # Sq. Ft. No. No. Dw.
2-17 Size. • OM,433 Stories Units
Arch., Engr.;. _si
Designer:B=iM �.a New Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
BY: -
' subject to the Workers' Compensation provisions or the Labor Code,. you must forthwith
comply with such provisions or this permit shall be deemed revoked.
,. 340 S. Wil- St.
32.3--7977
Front Setback from Center Line
_
City
Zip
State
Side Street Setback from Center Line'•
hereby affirm that there is a construction lending agency for the performance of the
i7arlrraalrx39;
Lic.#
^
• _ d LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter (commencing with Section
70 OO) of Division 3
'+
_
of the Business and Professions Code, and my license is in full force and '
effect. . . .. . . .
expiration if work thereunder is suspended for 180 days.
SIGNATURE - 1r•i t / k • ''f ✓ , - DATE
Issued by:
-
- OWNER -BUILDER DECLARATION
'
Estimated Valuation
—
I hereby affirm that I am exempt from the Contractor's License Law for the following
.� , �y,T ��,
77448.00
reason: (Sec. 7031;5,Busfness and Professions Code: .Any city or county which requires a
permli to construct, • alter, -improve, demolish, or repair any' structure, prior to its issuance also
Validated by:
! 1 3M .. V
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
PERMIT
- <. AMOUNT'
the provisions of the Contractor's License . Law, Chapter 9 (commencing with Section 7000) of
Validation:
r
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
Pldn,Chk:. Dep.
-
105.72
. a..permit
subjects. the applicant to a civil penalty'ofnot more than five hundred dollars ($500). - "• ...
Plan Chk: Bal.
01, as owner of the property, or my employees with wages as their sole compensation, will
202.2
• do the work, and the structure is not intended or offered for sale. (Sec. 7044; Buisness and
Professions Code: The Contractor's License •does
COf1St.
367 '
Law not apply to an owner of�property who
builds or improves thereon and who does such work himself or through his own employees,
Mech-
.
'fit,
,.provided that such improvements. are not Intended or offered for sale. If, however, the building-
Lt r
or improvement is sold. within one year of completion, the owner -builder will have the burden
Electrical '�'
A
• of proving that he did not build or improve for the purpose of sale.)
S: R
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
P.5. An
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
lJ I am exempt under Sec. B. 8•P.C. for this reason
Driveway Enc.
Date Owner
Infrastructures
da
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. ,: O Certified copy is hereby furnished.
TOTAL*_
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 thg 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.
REMARKS
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
ZONE:
BY: -
' subject to the Workers' Compensation provisions or the Labor Code,. you must forthwith
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop..Line
CONSTRUCTION LENDING AGENCY. -
Side Street Setback from Center Line'•
hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civilcode.)
Side Setback from Property Line
Lender's Name
Lender's Address
FINAL DATE
INSPECTOR
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.
Issued by:
Date —Permit
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. •
Validated by:
f j
Signature of applicant f (r Date
Mailing Address 1
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT. @
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. SQ. 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 APP./EOUIP.
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3Ac
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 APP./EOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
0
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 SIGNATURESANITIALS
GARDEN WALL FINAL
7
PERMIT APPLICATION
City of la Ouinta
Department of Building and Safety
This permit becomes void if work not commenced within 180 days from date o1 issuance. OR, i1 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
(commencing with Section 7000) of Division 3 o1 the Business and Professions Code, and my license is in full force
and effect.
License Class tic. Number
Date Contractor
OWNER-BUILOER 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 (SM.):
O I, as owner of the properly. 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 o1 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 sate. If, 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 for the purpose of safe.).
0 I, 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 riot apply to an owner o1 property who
buil(1s 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: 1 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. C.).
Policy No. 'Company
D Certified copy Is hereby furnished.
0 Certified copy is filed with the City Building Inspection Department or City Department.
Date Applicant
APPLICANT NAME (L. F. MI) JL (� w LL s UctiOn
ADDRESS
P.O. Box 173
CITY/COMMUNITY/STATE/ZIP
Nestor; CA 92053
JOB SITE ADDRECSISPACE
CITY/COMMUNITY/STATE/ZIP
La. to CA 92253
BOK
PAG
PRC
11
C
TWN
RNG
SE
S
TRACT
LOY
cM Fee 5.46.
MOD
S8
19903
4
1
I
756.88
TRACT NAME
HORIZON PALMS
OWNER NAME (L. F. MI) General Management Corp. '
CONTRACTOWFIRM NAME
J. L. Construction
ADDRESS
above
CI V/COAMUNITY/STATE/ZIP
PHONE I
TOTAL
'FEE'
LICNC
2.60
ARC/ENG FIRM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CITY/COMMUNITY/STATE/ZIP
'Palm Sminas, CA 92262
PHONE . LICNC I
323-7877 I
USE OF PERMIT
Single Family Dwelling
BL
ZON,
FSB
SS8
SSB
RSB
OFC
ZONE ORD I
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 I hereby certify that no excavation live (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 2 Art 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
o1 the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
I cenity 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 arepresentative of the City of La Ouinta Department of Building and Safety to enter
upon the property for which 1 have applied for this permit for the purpose of making inspections.
Signature of Applicant or Agent Date
Print Applicant/Agent Name li 1 C;n4
APPL/PRMT DATE
5-2-2-85
S.F.D.
Permit to construct 1247 sq. ft.
of
living area and 433 sq. ft. of garage
as mr approved plans.
Mech. Fee 37.00
Plan Check Fee 307.96
Const. Fee 367.00
Elect. Fee 60.18
cM Fee 5.46.
.21urrbing Fee 85.00
Infrastructure
862.60
105.72 DEP. PAID
756.88
* agreemitint
with rimmmity t Department
TOTAL
'FEE'
2.60
N 1 L L 3 L / 7 Q 8 8 CK
FINONCF VALUATION 77,948.00