001492 (SATT)P.O. BOX 1504 No. 001492
Building78-105 CALLE ESTADO
�.� )(
Address LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address
City
.Contractor
_ Address
GMIMMI ftragamo COW. , BUILDING: TYPE CONST. • y N OCC. GRP. -LZ 3
p
2700 A.P. Number
Tel.
,00_367,6 Legal Description
Project Description HOMIZOn PC%I=
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...❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COM PENSATI ON 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 - r
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 it 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,pu}rposes.
Signature of applicant/ ` �/ " r' ,r Da e., "I f
Mailing Address /
City, State, Zip
HARD COPY
TOTAL i3> . Eii 756.a8
REMARKS
ZO N E: 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:
City .. _
zip-•-
Tela
92 333
340n-554 .
State Lic.
City
Mks 12A7
& Classif.Lic.
�
#
237
Sq. Ft.
�� 41
No. No. Dw.
Size
Stories Units
Arch., Engr., -
Designer Higbmil BWCiM AMC-
New:X Add ❑
Alter ❑, Repair ❑ Demdition ❑
Address
Tel.
.340-S. � 1.ft.
323--78r, .. .
City
Zip
State
alt ��
92
Lic. #
w
. LICENSED CONTRACTOR'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 ism full force and
•�
effect..
SIGNATURE DATE
'
OWNER -BUILDER DECLARATION '
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation
Estimated
-
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 Isalso
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
PERMIT
- •..i '
AMOUNT
. the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
'c .
•'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
Plan Chk. Dep.
-V.
'subjects the applicant to a civil penalty of not more than five hundred dollars ($500). " '•. •'�'
I,
Plan Chk• Bal.
��f}�j
2o2.24
❑ 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
.
C011St.
' Q
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,
-
Mech. '
e��}
37.00
provided that such. improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, theowner-builder will have the burden '
of proving that he did not build or improve for the purpose of sale.) • -
Electrical
.�:►8�
-❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbingi�.
- 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..w
.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) •-
Grading
0 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner
Infrastructure
Deffwivid mvix as a=eem`
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...❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COM PENSATI ON 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 - r
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 it 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,pu}rposes.
Signature of applicant/ ` �/ " r' ,r Da e., "I f
Mailing Address /
City, State, Zip
HARD COPY
TOTAL i3> . Eii 756.a8
REMARKS
ZO N E: 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. SO. FT. ®
CARP. SQ. FT.
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 property 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 APP.IEQUIP.
LAUNDRYTRAY
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 @ 1114 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
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.IEQUIP.
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
s fr
PERMIT APPLICATION
City o1 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' COMPENSATION INSURANCE: This section need not be completed it
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 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 inany manner so asto become subject lothe Workers'Compensation Laws of
and effect.
California.
License Class Lic. Number
Date Applicant
Date Contractor
NOTICE TO APPLICANT: If, after making this Certifirate 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
be deemed revoked.
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to
19903
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 Contra ctor'sLicense Law
01 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be
(Chapter 9(commencing with section 7000) of Division 3 o1 the Business and Professions Code) orthat he is exempt
made in connection with work authorized by this permit, and that no building structure, scaffolding, 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 2. Art 2, Sec341, Title 8.
subjects the applicant to a civil penalty of not more than five hundred dollars ($50(k):
C.A.C.)
O I, as owner of 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 o1
structure is not intended or offered for safe (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
ARC/ENO FIRM NAME '
Michael Buccino Assoc.
through his own employees, provided that such improvements are not intended or offered for sale. It, however, the
O Division of Industrial Safety Permit No.
building orimprovemntissold within oneyearofcompletion. theowner-builder will have the burden of proving that
Date Applicant
he did not build or improve for the purpose of sale.).
CONSTRUCTION LENDING AGENCY: 1 hereby affirm that there is a construction lending agency for the performance
O 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.).
7044. Business and Professions Code: The Contractor's License Law does riot apply to an owner of property who
Lender's Name
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
SSB
Contractor's License Law.).
Lender's Address
O 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. I agree to comply with all
Date Owner
°city and county ordinances and state laws relating to building construction, and hereby authorize representatives
LOT SZ
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
END
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.).
Signature of Applicant or Agent Date
Policy No. Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify l have read this application and state that
O Certified copy is hereby furnished.
the information given is correct. l agree to comply with all state laws and county ordinances relating to buidling .
O Certified copy is filed with the City Building Inspection Department or City Department.
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.
Date Applicant
APPLICANT NAME (L. F. MI)
JL Gnnstruction
ADDRESS
P.O. Box 173
CITYICOMMLNIITY/STATE/ZIP
Nestor; CA 92053
JOB SITE ADDRESS/SPACE
CITY/COM/LINITY/STATERIP
La. to CA 92253
BOK I
PAG
PRC I
C
TWN
RNG
SE
s
19903
LD�
60.18
MDD
CM F01P 5.46.
TRACT NAME
HORIZON PAINTS
OWNER NAME (L. F. MI) Ganeral Managenent Corp. '
CONTRACTOR -FIRM NAME .
J.L. Construction
ADDRESS
above
CITY/COMMLIN ITY/STATE/ZI P
PHONE .
105.72 DEP. PAID
LICNC .
ARC/ENO FIRM NAME '
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CITYICOMM LIN I TY/STATE/ZI P
Palmrin s CA 92262
PHONE I I LICNC
323-7877
USE OF PERMIT '
Single Familv Dwelling
BL
862 60
ZONA
FSB
SSB
SSB
RSB
OFC
ZONE ORD •
LOT SZ
END
SIDE
Signature of Applicant or Agent
Print Applicant/Agent Name 6
0
I-11,251
Date
APP MT +; DATE
S.-F.D.
Permit to construct 1247 sq. ft.
of
livinct area and 433 sq. ft. of gaage
as pgK approved plans.
Mech. Fee 37.00
Plan Check Fee 307.96
Const. Fee 367.00
60.18
CM F01P 5.46.
.P11 Fee 85.00
Tnfrastructure
862.60
105.72 DEP. PAID
.756.88
* ggreemignt
t Deparftnent
TOTAL •
FEE
862 60
H 1 L l U 7 L 7 / j Q 6 8 CK
CINAN[ F VALUATION 77,948.00.