001490 (SATT)• ��
P.O. BOX 1504 No. 001490
Building CAddre9—�7H=i 0� LA QUINTACAL CALIFORNIAFORNIA 92253
-
Owner
BUILDING: TYPE CONST. V N -OCC: GRP.
Mailing
Address 3.001 Sisbw St. &dte 2700 A.P. Number
City Zip �j Tel.
,..._ 1'•800"'367""5054 Legal Description
Contractor Hwitl".Xi .PBS
Project Description
:Y T 146 "MAtS 3 t*jx-d- 1Jal
Address .
P.O. BOX 173
City ... ZipTel..
wntzw 92053 340-55 .1- }
State Lic. City DM, 1247
& Classif. 822 Lic. # ZiT Sq. Ft. No. No. Dw.
'� _ Size Stories -Units
Arch., Engr:,
Designer mi,t.1a4a11ptvninn
A New Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
344) e. 323-7877„
CityZip State _
.s .. 9226Lic. #
fit
e" 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 licenseJis in full force and
- .effect. ti Ile d0,f ? { J / •� aj
SIGNATURE'- DATE
OWNER -BUILDER DECLARATION '
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation cc «� n�
reason: (Sec. 7031,,5,Business and, Professions Code: Any city or 'County, which requires a it . f7_s94Cltl .00
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 isilicensed pursuant to PERMIT AMOUNT
the provisions of the Contractor's License Law, Chapter9 (commencing .with Section 7000) of
Division 3'of the Business and Professions Code, orahat. he is exempt theiefrom, and the basis. -
for •the •aIle ed exemption. An violation of Section 7031.5 b any applicant- for. a - -
9 P Y Y Y apP permit Plan Chk. Dep.:
subjects "the applicant to a civil penalty of not more than five hundred dollars ($500). -
O, I, as owner of the. property, or ;
my employees with wages as their sole compensation, willPlan Chk. Bal.+'
do the work, and the structure is not intended or offered for sale. (Sec.. 7044, Buisness and ' Const. 362 24
Professions Code: The Contractor's License Law does not apply to an.owner of 'property who s
builds' or improves thereon and who does such work- himself or through his own employees, .. McCh.'�
,. provided that such improvements are not intended or offered for sale. If, however, the building - •
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.) 60.18
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 85.00
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. •` 5.ft 46
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
Grading
❑ lam exempt under Sec. .. B. & P.C. for this reason - •
Driveway Enc.
Date owner Infrastructure De£emid ramit as 8meemeft
WORKERS' COMPENSATION DECLARATION
hereby affirm'that I have a certificate of consent toself-insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) •
Policy No. ' ' Company
q 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 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.
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
Ihereby affirm that tfieie 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 theyabove-.
mentioned property for inspection purposes.
Signature of applicant Datej j
Mailing Address
City, State, Zip
HARD COPY
I
vilt-hCj=n. -al. t33XeG== '
TOTAL�� 75.
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. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. p
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT. ®
OTHER APP./EQUIP.
DRINKING FOUNTAIN
SQ FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/a c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
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./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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL 4
INSPECTOR'S SIGNATURESIINITIALS_
GARDEN WALL FINAL
PERMIT APPLICATION
City o1 La Duinta
Department of Building and Safety
This permit becomes void if work not commenced within 180 days from date o1 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 it
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 effect.
License Class Lic. Number
Date Contractor
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 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
subjects the applicant to a civil penalty of not more than five hundred dollars
0 I, as owner o1 the property, or my employees with wages as Meir 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. II, 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 sale.).
0 I, as owner of the properly, am exculsively contracting with licensed contractors to construct 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 coniractor(s) licensed pursuant to the
Contractor's License Law.).
0 1 am exempt under Sec. B. & 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. C.).
Policy No. 'Company
0 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 Ctnnstruction '
ADDRESS
P.O. Box 173
CIT VrCOMMUNITY/STAITAI P
Nestor, CA 92053
JOB SITE ADDRESSrSPACE
CITY/COMMWNITV/STATE/ZI P
La. to CA 92253
BOK
PAD
PRC
C
TNN
FIND
SE
S
19903
LDTjy
i
Elect. Fee 60.18
Moo
ser
.Plurrbing Fee 85.00
TRACT NAME
HORIZON PAIMS
OWNER NAME (l, F. MI) (aneral Management Corp. '
CONTRACTOR -FIRM NAME
J. L. Construction
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
PHONE a
756.88
LICNC a
* agreentint
ARC/END FIRM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212'
CIT Y/COMMUN ITY/STATEM P
Palm Springs, CA "92262
PHONE • LICNC 11
323-7877
TOTAL •.
T
USE OF PERMIT
Single Fc -mil Dwelling
BL
ZONA
FSB
Sse
Sse
RSB
OFC .
ZONE ORD •
LOT SZ
END
- 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: 11. 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 2 Art 2. Sec341, Title B.
C.A.C.)
0 As owner -builder, I will not employ anyone to do work which would require a permit from the Division o1
Industrial Safety, as noted above, unless such person has a permit to do such work from that division.
0 Division o1 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. C.).
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 statethat
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 01 :OO
APPLNRMT 2 r DATE
f 5-2-2=85
S.F.D.
Pexmit to construct 1247 sq. ft.
of
livincr 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
SMI Fee 5.46.
.Plurrbing Fee 85.00
Trifra-gtructure
862.60
105.72 DFP. PAID
756.88
* agreentint
with rimmmitzZ t Department
TOTAL •.
T
2 60
A i L U 0 7 L
VALUATION 77,948.00
F