001493 (SATT)P.O. BOX 1504 No.. 001493
Building79-310 B=izm P C�� LA Q 78 105 CALLE
AddressUINTA, CALIFORNIAORNIA 92253
Owner
Mailing
Gemrpll Maymmmmit own. BUILDING:,TYPE CONST. V N OCC. GRP. Ra 3
'
Address 1001 Bishorl, St. SlAte 27 0 A.P. Number
City Zip Tel. +
.1--800-367-5054 Legal Description
Contractor Project Description _4-61 palm
�'T �. _., 1, 46 Ueits i� DMI.
..Address.. ... ...... .. .. ..
RA 11= 173
City Zip Tel.
Nam= 92053 340 -SSU
State Lic. City -
& Classif.. - 44200
. Lia. # Sq. Ft.= 1287 No. No. Dw.
Arch., Erigr., - Size 4,,33. -Stories Units
Designer Mz� " New Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
340 S. rarrell Dr. . 3,23-78"-, .
City Zip State
-
pig"Seri ilp 92262Lic. #
_ i LICENSED CONTRACTOR'S DECLARATION
I hereby affirm lhat.l,am licensed under provisions of Chapter 9 (commencing with'Section
7000) of Division 3 oVtthe Business and Professions Code, and my license is in full force and
effect.
SIGNATURE "" r / DATE
OWNER -BUILDER DECLARATION Estimated 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 file a signed statement that he islicensed pursuanttoPERMIT - AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions 'Code, or thathe' 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 (S500):
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. 202.24
do the work; and the structure is not intended or offered for sale. (Sec. 7044; Buisness and COr1St. , y� nn
Professions Code: The Contractor's License Law does not apply to an' owner of property who .3t1 7 .L�i7
'builds or improves thereon and who does such workhimselfor through his own employees, -Mach.
provided that'such improvements -are not intended or offered for sale. If, however, the building
37-00
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 of sale.). -
❑ 1, 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
O I am exempt under Sec... - B. 8 P.C. for -this reason
Driveway Enc.
.Date owner Infrastructure an 'k3�'� r
-�
WORKERS' COMPENSATION DECLARATION
hereby affirm Ahat 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 31 i�. CA tie
CERTIFICATE OF EXEMPTION FROM REMARKS
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 Ihp 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 ZONE: BY: '
subject to the Workers' Compensation provisions of- the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked. - '
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
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.) . " 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 Inspelction3purposes. JJ^� Validated by:
Signature of applicant Ott* P �r t , - Date f+� ✓'=3
Mailing Address �'j " Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. SO. 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 APPJEOUIP.
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/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ic
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 APPJEOUIP.
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
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 o1 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 o1 Chapter 9
the permit is for one hundred ($100) o. less. I certify that in the performance of the work for which this permit is
(commencing with Section 7000) of Division 3ofthe Businessand Professions Code, and my license is in full force
..Issued. Ishall notemployany 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: If, after making this Certificate of Exemption, you should become subject to the Workers'
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License law for the
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
'-following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to
be deemed revoked.
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, scaffolding, falsework, 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 2, Art 2, Sec341, Title 8,
subjects the applicant to a civil penalty o1 not more than five hundred dollars (5500.):
C.A.C.)
❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
❑ 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
OWNER NAME (L. F. MI)
l�LL1C1 1JC111L1
gement Corp.CONTRACTOR-FIRM
through his own employees, provided that such improvements are not intended or offered for sale. If, however, the
O Division of Industrial Safety Permit No.
building orimprovemntissold within one year ofcompletion, the owner -builder will havethe burden of proving that
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
❑ 1, as owner of 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.).
7004. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
Lender's Name
builds or Improves thereon, and who contracts for such projects with a coniractor(s) licensed pursuant to the
PalmSDrincrs, CA 92262
Contractor's License Law.).
Lender's Address
O 1 am exempt under Sec. B. 6 P.C. (Attached Certificate).
I certify that I have read this application and state that the above information is correct. I 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: I hereby affirm that I have a certificate of consent to self -insure, or a
FSB
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3600. lab. C.).
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
❑ Certified copy is hereby furnished.
the information given is correct. l agree to comply with all state laws and county ordinances relating to buidling
❑ Certified copy is filed with the City Building Inspection Department or City Department.
construction, and authorize a' representative o1 the City of La Ouinta Department of Building and Safety to enter
LOT SZ
upon the property for which I have applied for this permit for the purpose of making inspections.
Date Applicant
END
SIDE
Signature of Applicant or Agent Date
APPLICANT NAME (L. F. MI) JL Construction
Wti
ADDRESS
P.O. Box 173
CITY/COMMUNITY/STATE/ZIP
Nestor; CA 92053
JOB SITE ADDRESS/SPACE
CITY/COM LINITYSTATE/ZIP -
La. to CA 92253
SOK
PAG
PRC
C
TWN
RNO
SE
.S
TRACT
l0T
Elect, Fee 60.18
MOD
Sit
—.21urrbim Fee 85.00
19903
Tnfrastructure
862.60
I
.756.88
TRACT NAME HORIZON PTT S
HORIZON tvM^M1
OWNER NAME (L. F. MI)
l�LL1C1 1JC111L1
gement Corp.CONTRACTOR-FIRM
NAME
J.L. Construction.
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
PHONE.
TOTAL .
'FEE
LICNC .
862.60
ARC/ENG FIRM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CITY/COMMUNITY/STATE/ZIP
PalmSDrincrs, CA 92262
PHONE . LICNC .
323-7877 1 1
USE OF PERMIT
Single Familv Dwelling
OL
ZON.
FSB
SSB
SSB
RSS
OFC
ZONE ORD .
LOT SZ
END
SIDE
Print Applicant/Agent Name
o) I 1/ 9
APPIJPRMT-----�-- X=
DATE 2�=85
S.T.D.
Permit to construct 1247 sq. ft.
of
livinq area and 433 sq. ft. of garage
as per approved plans.
mech. Fee 37.00
Plan Check Fee 307.96
Const. Fee 367.00
Elect, Fee 60.18
.CMT POP 5.46
—.21urrbim Fee 85.00
Tnfrastructure
862.60
105.72 DEP. PAID
.756.88
* agreernkint
t Department
TOTAL .
'FEE
862.60
H 1 L i l D L S ] 5& 8 8 CK
FINANCE VAL.UATIo1V 77,948.00