001484 (SATT)4
P.O. BOX 1504 No. 001484
Building 78-105 CALLE ESTADO
Address Iri t^r pyo p LA OUINTA, CALIFORNIA 92253
Owner
Gavial • -
BUILDING: TYPE CON$T.VW OCC. GRP:
Mailing
Address 1001 Bt#= $t. ; Edta 2700A,P. Number
City Zip PAo ,;3�3 Tel. - -
Win... .. 3--800-367-54 Legal Description
Contractor H=iZM Paifis
Project Description
Address... ... . - _ -.
123
City Zip Tel.
32453 340-55U.
State Lic. X2$22 23'7.City
43
& Classif. Lic. # Sq. Ft, No. No. Dw.
....., .
' Arch., Engr., _ Size -GM, - 433 - - "Stories Units
Designer ' New Add ❑ Alter ❑• Repair ❑ Demolition ❑
Address Tel.
_ - 37-3-7977,, ,.� .. . r . ... ... .
CityZip State
3 S`PYitns 92262 Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensedunder provisions of Chapter 9 (commencing with Section W
7000) of Division 3 of the Business
and Professions Code, and my license is in full force and'
effect:
SIGNATURE t t DATE
OWNER -BUILDER DECLARATION t
. I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation w -
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which.requiras a w+ - ..%�
'permit to construct, after, improve, demolish, or repair any structure, prior to its lssuance-also
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 •�'+ +�
. Division 3 of the Buslness and Professions Code, or that. he is exempt therefrom; and the basis, C
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep. - 3y 2 »
- subjects the applicant to a civil penalty of not more than five hundred dollars.($500): --
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.' 02.1A
do (fie work,and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const 367. 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,- •+•moi
provided that, such improvements are not intended or offered for sale. If, however, the building • Mech. 37.010/
or Improvement is sold within one year of completion, the owner -builder will 'have the: burden Electrical - - 0
,, A
of proving that he did not build or improve for the purpose of sale.) - - 61.18
❑ I, 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 __
00
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
-
.O.Lam exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
Date ' owner Infrastructure
Daferivid amm,it 8s
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.
TOTAL 62. 756.08
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COM P.ENSATION 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
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 certify that 1 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 inspeecliiomp/uyar-poses.
Signature of applicant /+'t# I Jr� ) �.'/ 1 -• Date /�f
Mailing Address
City, State, Zip
HARD COPY
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 FEIS
1ST FL. SO. FT. ® $
2ND FL.SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CARP. SQ. FT.
WALL SQ. 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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRY TRAY
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 ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ec
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 APPJEQUIP.
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 UX'S WUNA 1 UKEWINI I IALS
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 of 180 days.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 o the Business and Professions Code, and my license is in full force
and effect.
License Class Lic. Number
Date Contractor
OWNER$UILDER 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, after, 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 (5500.):
O I, as owner o1 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 Contractors 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 sale. If, however, the
building or improvemnf 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.).
❑ L 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 not apply to an owner o1 property who
builds or Improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's license Law.).
O 1 am exempt under Sec. B. & 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 o1 Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.).
Policy No. Company
O Certified copy is hereby furnished.
❑ Certified copy is filed with the City Building Inspection Department or City
Date Applicant
Department.
APPLICANT NAME (L, F. MI)
JL Construction
ADDRESS
P.O. Box 173
CITY/COMMUNITY/STATE/ZIP
Nestor, CA 92053
JOB SITE ADDRESS/SPACE
CITYICOMMUNITY/STATE/ZIP '
La. to CA 92253
DOK I
PAG
PRC
C
Pluffbi= Fee 85.00
T"
RNG
SE
S
* a een-lint
LOT
TOTAL •
FEE
M00
SS
19903
W
I
TRACT NAME
HORIZC N PALMS
OWNER NAME (L. F. MI) General Management Corp.
'
CONTRACTOR -FIRM NAME
J.L. Construction
ADDRESS
above
CITY/COMMLOWY/STATE/ZIP
PHONE .
LICHC •
ARC/ENG FIRM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CITYPCOMMUNITY/STATE/ZIP
Palm Scirinas, CA 92262
PHONE • LICNC •
323-7877
USE OF PERMIT '
Single Family Dwelling
Bl
ZON,
FSB
SSB
SSB
RSB
I
OFC
ZONE ORO /
LOT SZ
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE: This section need not be completed if
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: II, 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:
❑ 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 32, Grp 2 Art 2. Sec 341, Title 8.
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.
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
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. l 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 n j Off
APPI/PRMT`s f ` DATE
TE S.F.D.
Permit to construct 1247 sq. ft. of
living area and 433 sq. ft. of arage
as per appricivred plans.
Mech. Fee 37.00
Plan Check Fee 307.96
Const. Fee 367.00
Elect, Fee 60.18
SM Fee 5.46
Pluffbi= Fee 85.00
862.60
105.72 DEP. PAID
756.88
* a een-lint
with rciminit2Z t Department
TOTAL •
FEE
862.60
756,88 CK
1:4n4e1►Irc
VALUATION F77,948.00