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001479 (SATT)P.O. BOX 1504 Building 78-105 CALLE ESTADO Address 79-421S=J2= P&JIfiS Citrla LA QUINTA,,CALIFORNIA 92253 Owner Mailing Address ��Z •fit City Z'ip Tel. Contractor Address No. 003479 BUILDING: TYPE CONST. V 14 •' OCC. GRP. R3 A.P. Number Legal Description Project Description WWII U!W1'Me P.O. B= 17►3 City . Zia . Tel.. _ State Lic. & Classif. 442922Size City Lic. # ,, 1247 Sq. Ft. Glll�: - 433 • •• No. No. Dw. -Stories Units - Arch., Engr., ' Rear Setback from Rear Prop. Line Designer New fl Add ❑ Alter ❑ Repair ❑ _ . Demolition ❑ AddressTel. FINAL DATE INSPECTOR • 34 ��aa eta aimpQ S 323-77 Validated by: CityZip State - Asn . Lic. # _ _% LICENSED CO NTRACTOR'S•DECLARATION 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 irr full force and effect. SIGNATURE !.f r A t-- r t' s r f ,}' / A % DATE OWNER -BUILDER DECLARATION yr 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 provisionslof the Contractor's License Law, Chapter.9 (commencing with Section 7000) of ' Division 3 ofdhe 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 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 Code: The Contractor's License Law does not apply to an owner of property, who Estimated Valuation 77.94846 • _ PERMIT . -'AMOUNT - -z: - Plan Chk. Dep. Plan Chk. Bal. 4 �� Const. Mech. 3gg•7� qq�� .0 , 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 Electrical G/� Tig3 - 60.19 or improvement is sold within one year of completion, the owner -builder will have the burden - • . ol•proving that he did not build or improve.for the purpose of sale,) Plumbing OO ❑ I, as owner of the property, am exclusively contracting'with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code::The Contractors License Law does not 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.)- O 1 am exempt under. Sec. B. & P.C. for this reason S.M.I..•� Grading Driveway Enc. Date Owner Infrastructurei we 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 ❑ 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 tha work for which this permit is issued, 1 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. 3997, 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 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 sof this city to enter the above- mentioned property for inspection purposes. Signature of applicant , /%�` %� Date— Af Mailing Address —��� V City, State, Zip HARD COPY TOTAL �„GQ 756.88 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 1ST FL. SQ. FT. ® $ 2ND FL. SQ. FT. POR. SQ. FT. ® GAR. SO. FT. ® CARP. SQ. FT. WALL SQ. FT. ® SQ FT ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK I 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 WASH ER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APP./EQUIP. LAUNDRYTRAY 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. SO. FT. RESID ® 11/4 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. 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 INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL AIV 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, It 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 of Chapter 9 (commencing with Section 7000) of Division 3of 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 70(10) of 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 o1 not more than five hundred dollars (9DO.): 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, 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 o1 sale.). O 1, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec. 7064. Business and Professions Code: The Contractor's License Law does riot apply to an owner of property who builps 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: 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 O Certified copy is hereby furnished. O Certified copy is filed with the City Building Inspection Department or City Department. Date Applicant APPLICANT NAME (L, F. MO JL Construction ADDRESS P.O. Box 173 CITY/COMMUN ITY/STATE/ZI P Nestor; CA 92053 JOB SITE ADDRECS/SPACE CITY/CO M LINITY/STATE/ZIP La. to CA 92253 BOK I PAG I PRC I C TNM I RNO SE S TRACT 19903 LOT Elect- Fee 60.18 MOD I SB TRACT NAME HORIZON PALMS OWNER NAME (L. F. MI) Gwieral Management Corp. CONTRACTOR -FIRM NAME J.L. Construction . ADDRESS above CITY/COL W UNITYSTATE/ZIP PHONE tr 105.72 DEP. PAID LICHC 9 ARC/ENG FIRM NAME Michael Buccino Assoc. ADDRESS 340 S. Farrell Dr. A212 CITY/COMMUN ITYSTATE/ZI P Palm SpriMs, CA 92262 PHONE I LICNC F 323-7877 USE OF PERMIT Single Familv Dwellin BL 862.60 ZON, FSB SSB SSB RSB DEC ZONE ORD LOT SZ 1.END I SIDE 9 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: If, alter 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: O 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, Title 8, C.A.C.) O 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: 1 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 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 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 ) c r ? APPIMRMT - 5 2J2=85 S:F.D. Permit to construct 1247 sq. ft. of living 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 cM Fee 5.46 .Plimbing Fee 85.00 Tnfrastructure 862.60 105.72 DEP. PAID 756.88 * a ee tint with cbmmity t Department TOTAL • FEE 862.60 H 1 1 7/ J L / � & 8 8 CK )6 VALUATION F77,948.00