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001475 (SATT)44 P.O. BOX 1504 No, 001475 Building 78-105 CALLE ESTADO Address .79-439 � ?Lo? LA QUINTA, CALIFORNIA 92253 Owner _ Mailing n=..BUILDING:-TYPE CONST. V 1I OCC. GRP. A .3 Address 1001 BiSbIOP Se SUite 2700 A.P. Number . City :,', Zip G �^, i>�✓ Tel. _ _ ... .. . - 37miuln 9103I—wo-zW!-50Legal Description ContractorProject Description iIAIM Palm J_I.,, c. 'ot ... 34f t ai Address.. P.O.. B= 173 „. ' City Zip - Tel.' State Lic. & Classif.. 442822 City Lic. # 237...-. DW 1247 Sq. Ft. No. No. Dw. Size M • 433 - Stories Units Arch:, Engr.; - Designer XiChWl BU=4W .iii. New Q Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. 348 S. :1 St.. - 23-7877 City Zip State Pal >K3 i 92262 ' Lic. # ,LICENSED CONTRACTOR'S DECLARATION, _ I hereby affirm that I, am licensed under provisions of Chapter 9 (commencingiwith Section 7000) of Division 3 Iof�,the Business and Professions Code, and my license is in' full force and effect. .J !ff� T./- %i r �) C •-1 � _SIGNATURE DATE OWNER -BUILDER DECLARATION f 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 fs licensed 'pursuant to. the piovisions 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 penally of not'more than five hundred dollars (3500)' ❑ 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, Buisness 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 improvement 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.) Estimated Valuation 77,948.00 r • AMOUNT PERMIT Plan Chk. Dep. 1105.72 a .. Plan Chk. Bal. .702.24 Const. y�yf ffA 1T7<A.wf Mech.- - Electrical - - Plumbing- - MAIN ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- 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 such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - ❑ I am exempt under Sec. B.,B P.C. for this reason S.M.I. Grading Driveway Enc. Date Owner. Infrastructure 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. 0. Certified copy is hereby furnished. TOTAL RF, Cm3. REMARKS CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit isfor 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. - ZONE: BY: - Minimum Setback Distances: Front Setback from Center.Line Rear.Setback from Rear Prop. Line 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. 3 09 7, Civil Code.) Side Street Setback from Center Line Side Setback from Property Line 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. FINAL DATE INSPECTOR 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/the above- mentioned property for inspection purposes. / Signature of applicant �,+f%' /, ��� ' ~ )Date Mailing Address Issued by: Date Permit Validated by: Validation: City, State, Zip HARD COPY u CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FtES IST FL. SQ. FT. ® $ 2ND FL. SQ. FT. ® POR. SO. FT. ® GAR. SO. FT. p CAR P. SQ. FT. WALL SQ. 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.000L HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEQUIP. 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 ® 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 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. I FENCE FINAL I IYJrCIi 1 V A J Alli ISM I V IlCJ1119111NLJ, r GARDEN WALL FINAL PERMIT APPLICATION City of La Ouinta Department of Building and Safety This permit becomes void it 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 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 lot a permit subjects the applicant to a civil penally of not more than five hundred dollars (5500.): 0 I, as owner of the properly. 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. It, however, the building or improvemnt is sold within oneyear 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 o1 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 of property who buil(1s or improves thereon, and who contracts for such projects with a contractor(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: 1 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 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 CITY/COMMLONITY/STATE/ZIP - La. to CA 92253 BOK PAG PRC C mech. Fee 37.00 TNM RNG SE s TRACT 19903 LOT n C*1 SMI Fee 5.46 MOD SS TRACT NAME HOPJZC N PALMS OWNER NAME (L. F. MI) Qaneral Management Corp. ' CONTRACTOR -FIRM NAME J.L. Construction ADDRESS above CITY/COMMUNITY/STATE/ZIP PHONE a LICNC a . ARC/ENG FIRM NAME Michael Buccino Assoc. ADDRESS 340 S. Farrell Dr. A212 CITY/COMMUNITY/STATE/ZIP Palm Springs, CA 92262 PHONE a LICNC F 323-7877 USE OF PERMIT Single Family Dwellin Bl ZON, FSB SSB SSB RSB OFC ZONE ORD • LOT SZ END SIDE CERTIFICATE OF EXEMPTION FROM WORKERSTOMPENSATION INSURANCE: This section need not be completed if the permit is for one hundred ($100) o. less. I certify that In the pertormance o1 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: IL 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: 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. Sec341. 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. 0 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 cerlify 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: 1 certify I have read this application and state that the information given is correct.) 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 66)141-7,5 APPL/PRMT DATE 5-2-2-85 S.F.D. Permit to construct 1247 sq. ft. of living area and 433 sq. ft. of gaage 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 Plumbing Fee 85.00 Tnfrastructure 862.60 105.72 DEP. PAID 756.88 * agreendrit t Department TOTAL 'FEE 862.60 AiIYS Z 75&88 CK FINANCE VALUATION 77, 948.00