001488 (SATT)P.O. BOX 1504 No. 403488
Building 78-105 CALLE ESTADO
Address -»ma y 14brirm Pnlrm Cirrlo LA QUINTA, CALIFORNIA 92253
Owner
mal Pwa;mlmt Owp..
Mailing - BUILDING: TYPE CONST. V NOCC: GRP. -• .R J
Address 1001 AL&W ft. Shit* 2700 _ A.P..Number
City Zip? TI—M-367—W54
el.
n3�t7t Legal Description
Contractor Project Description nori= •palm
Address
P.Q. BMC 173
City Zip Tela '
r 92063 340--551'x .
State Lic. .City ^ 224' •
& Classif. Lic. # .. Sq. Ft. No. No. Dw.
dA r Size • Stories Units
Arch., Engr.,- .. . . . . .. . : .
- ZONE:
BY:
Designer WAChW1 EMCiMA
New. X_ Add ❑ Alter ❑ Repair ❑
Demolition ❑
Address
Tel.
340 S. PbXM%- . St. •
1"2_77877..
Side Street Setback from Center Line
City
Zip
State
work for which this permit is issued. (Sec. 3097, Civil Code.)
Side Setback from Property Line
9226
Lic..#
Lender's Address
_LICENSED CONTRACTOR'S DECLARATION A '
INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to
I hereby affirm that I amilicensed under provisions of Chapter 9 (commencing with°Section
7000) of Division 3 of the Business and Professions'Code, and my license is in IU),force
expiration if work thereunder is suspended for 180 days.
9and
-effect. �k,j` /1l s", ,,
I certify that I have read this application and state that the above information is correct.
SIGNATURE Z- DATE
Date Permit
_
OWNER -BUILDER DECLARATION
Estimated Valuation
construction, and hereby authorize representatives of this city to enter. the/above '
' I hereby affirm that I am exempt from the Contractor's License Law for the following
7031..5,Business Code: Any
'
mentioned property for inspection Purposes.
-
4
reason: (Sec. and Professions city or county which requires - a"T.948.00
permit to construct, alter, improve, demolish, or repair any structure, prior -to its issuance also
-'
Signature of applicant/ / �>?fir t Date
requires the applicant for such permit to file a signed. statement that he is licensed pursuant to
PERMIT •. -
AMOUNT
the provisions or the Contractor's License Law, Chapter 9 (commencing with Section 7000) of-
City, State, Zip
' ' Division 3 of the Business and Professions Code, or that, he is exempt therefrom, and the basis
for the Any Section 7031.5 for
Plan Chk. Dep.
4n
alleged exemption. violation of by any applicant a permit
subjects the applicant to a'civil penalty of not more than five hundred dollars ($500).
1�i5.7
_
202.24
Plan Chk. Bal.
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, Buisness'and •
Const.
'� 00
,. 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,
Mech.
•
yq
provided that such improvements are,.not intended or offered. for sale: If, however, the building
3! •00
or improvement is. sold within one year of completion,, the .owner -builder will have the burden
Electrical -
A
60
or proving that he did not build or improve for the purpose of sale.) -
.10
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing`
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? • -
5.46 "
• such projects with a contractor(s) licensed pursuant to the. Contractor's License Law.)
Grading
. ❑ I am exempt under -Sec.- B. 8 P.C. for this reason
Driveway Enc.
Date owner
WORKERS' COMPENSATION DECLARATION
A 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 thg work for which this permit is issued, I shall not
• • employ any persowin any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
Infrastructure DeferMid as
With 0=96 Deva. Dirwtw.
TOTAL 862.60 756.58
REMARKS
NOTICE TO APPLICANT: It, after making this Certificate of Exemption you should become
- ZONE:
BY:
subject 'to the Workers' Compensation, provisions of 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
colusTRucnoN 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
f 1NAL,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 relaling.to building
r
construction, and hereby authorize representatives of this city to enter. the/above '
mentioned property for inspection Purposes.
-
4
Validated by:
Signature of applicant/ / �>?fir t Date
_
Mailing Addres''s ` `
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING KES
IST FL. SQ. FT. ® $
2ND FL. SO. FT. ®
POR. SQ. FT. @
GAR. SQ, FT, @
CARP. 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.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
SO. FT. c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/ac
HOUSE SEWER
REMARKS:
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEEELECT. 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
I bvru1vm,b JIVnA 1 uKrbi iIIALJ
GARDEN WALL FINAL
V
- '(. „- - - - -. . - --
LICENSED CONTRACTORS DECLARATI
(commencing with Section 7DOO) o1 Divi
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 totheprovisions of the Contractor's License Law
(Chapter 9 (commencing with section 7000) o1 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 (5500.):
❑ 1, 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 properly. am exculsively contracting with licensed contractors to construct the project (Sec.
7074. Business and Professions Code: The Contractor's License Law does rat 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.).
❑ 1 am exempt under Sec. B. d 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
❑ Certified copy is hereby furnished.
l7 Certified copy is filed with the City Building Inspection Department or City Department.
Date Applicant
1
PERMIT APPLICATION
City of La Duinta
Department of Building and Safety
r!\ F
'` y�
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'COMPENSATIONINSURANCE: This section need not be completed if
ON: 1 hereby affirm that I am licensed under provisions of Chapter 9 the permit is for one hundred (5100) o, less. I certify that in the performance of the work for which this permit is
s
ion 3ofthe Business and Professions Code, and mylicense isinfull force issued. I shall not employ any person inany manner so as to become subject to the Workers'Compensation Laws of
California.
APPLICANT NAME (L. F. MI) JL Cmstruction
Wli
ADDRESS
P.O. Box 173
CITYI'COMMUNITY/STATE/ZI P
Nestor; CA 92053
JOB SITE ADDRESSISPACE
CITY/COk�7l1NITY/STATE/ZfP
La• to CA 92253
BOIL
PAZ
PAC
C
TNN
RNO
SE
S
19903
LOT,y0
Eftect. Fee 60.18
MO.
sa
TRACT NAME HORIZON PTTMS
OWNER NAME (L, F. MI) Gmeral Management Corp. '
CONTRACTOR -FIRM NAME -
J.L. Construction
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
abipm
PHONE .
105.72 DEP. PAID
LICNC /
ARC/ENG FIRM NAME '
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CITY/COMMUNITY/STATE/ZIP
Palm rin s CA 92262
PHONE . LICNC •
323-7877
USE OF PERMIT .
Sin le.Famil Dwelling
BL
2 60
ZON.
-
FSO
SSG
SSG
'RSB
OFC
ZONE ORD .
LOT SZ
END
SIDE
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate o1 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:
❑ 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, Sec 341, Title8,
C.A.C.)
❑ 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.
❑ 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 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 1 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 Safely to enter
upon the property for which 1 have applied for this permit for the purpose of making inspections.
Signature of Applicant or Agent
Print Applicant/Agent Name f 1 t
'Date
APPINRMT _= 5 22=85
S.T.D.
Permit to construct 1247 sq. ft.
of
livingarea and 433 . ft. of
age
as a roved laps.
mech. Fee 37.00
Plan Check Fee 307.96
Const. Fee 367.00
Eftect. Fee 60.18
WT Fee 5.46
Plurrbing Flee 85.00
Trifrastructure
862.60
105.72 DEP. PAID
756.88
* a e�zt
t Department
TOTAL
FEE
2 60
A i L U 0 D L } 75688 CK
VALUATION 77,948.00,
.E