001474 (SFD)1
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 79443 110riZop rQIMS Cele LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address lea Bishw st. atite z/oo
City Zipf �a�; Tel.
Honolulu 92M 1-800-367=505
Contractor
Address .. yah+..
city 3" Zip _
State Lic.
& Classif. 44%822
' Arch.; Engr., '
..-Designer
Tela
I Lic. # 237
No.. 0014` 4'
BUILDING:- TYPE CONST. V N OCC: GRP.• -R3
A.P. Number • .
r Legal Description
Project Description ft=i=n P
. .. — _, a A.' —A--
DM =7
Sq. Ft.MR 433 No.
Size Stories
New Jj Add ❑ Alter ❑
Address
lel.
Minimum Setback Distances:
340 S. PaMn St.
323-7877 .
CityZip
State
Side Street Setback from Center Line
.. '92262
Lic. # .
_
-� LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that,.l am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 ofahre`Business and Professions• Code; and my license is in full force and
effect.. _. / 1 / 'K % lr .
INSPECTOR
Issued by:
r
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 thathe 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 Profe3sions 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 ($500).'
❑ 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
b 77A
- PERMIT
Plan.Chk. Dep.
-
Plan Chk. Bal..
COr1St.
Mech.•
'
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
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.) '
Plumbing
❑ 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. 8 P.C. for this reason
S. M.1.
Grading
Driveway Enc.
Dale 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
O 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 (5100) valuation
•' • or less:)
I certify that in the performance of thg work for whichthis 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 I have read this application and state that the above'!nformation 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. r
Signature of applicant ''+�.I� % r`P �%'.^" s Date
Mailing Address /'
City, State, Zip
HARD COPY
TOTAL
REMARKS
No. Dw.
Units
Repair ❑
Demolition ❑ _
AMOUNT
105.72
202.24
37.00
60.19
5.46
I paymert as amt
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
X
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT. ®
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. Q. 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.COOL 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
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:
VENTILATION
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.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
IIYJYCIi I V r\ J JI V IYM I YnCJ/1 ri111NLJ
GARDEN WALL FINAL
LICENSED CONTRACTORS DECLARATI
(commencing with Section 7000) of Divi
and effect.
License Class Llc. Number
Date Contractor
OWNER -BUILDER DECLARATION: 1 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 (5500.):
O 1, 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 Contractor's 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 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.).
❑ 1, 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
builQs 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. 8 P.C. (Attached Certificate).
Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that 1 have a certificate o1 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
PERMIT APPLICATION
City of La Ouinta
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 o1 180 days.
CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE: This section need not be completed if
ON: I hereby affirm that 1 am licensed under provisions of Chapter 9 the permit Is for one hundred ($100) o. less. I certify that In the performance of the work for which this permit is
sion3olthe Business and Professions Code, and mylicense isinfull force -issued, I shall not employany person inanymannersoasto becomesubjecl to the Workers'Compensallon Laws of
California.
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
a"
PAG
PRC
C
mech. Fee 37.00
TWN
FIND
SE
S
LD��
ENT Fee 5.46.
Moo
SO
19903
862.60
105.72 DEP. PAID
I
TRACT NAME
HORIZCN PALMS
OWNER NAME IL. F. MI) Coneral Managmimt Corp. '
CONTRACTOR -FIRM NAME
J.L. Construction
ADDRESS
ablove
CIT W COMM UN I TY/STATE/Z I P
ahipm
PHONE .C/
LICNC .
ARC/ENG FIRM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CITY/COMMUN ITY/STATE/ZI P
Palm Sorinas. CA 92262
PHONE . LICNC .
23-7877
USE OF PERMIT
Sin le Famil Dwelling
BL
ZON,
FSB
-SSB
SSB
RSB
OFC -
ZONE ORD
LOT SZ
END
SIDE
Date Applicant
NOTICE TO APPLICANT: It, after making this Certificate of Exemption, you should become subject to the Workers'
Compensation provisions at 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 136) feet high. (Chap 32, Grp 2, Art 2, Sec341, 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
y 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 buldling
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
APPL/PRMT /. 5-2t=85
S.F.D.
Permit to construct 1247 sq. ft.
of
livingarea and 433 . ft. of
age
as r a roved plans.
mech. Fee 37.00
Plan Cieck Fee 307.96
Const. Fee 367.00
Rlec+. Fee 60.18
ENT Fee 5.46.
lumbing Fee 85.00
862.60
105.72 DEP. PAID
756.88
* a eem�nt
with Ccmminity t De
t
TOTAL
FEE
862.60
H 1 1 7 L 7 ID / 7 6 8 8 CK
FINONC77
F VALUATION ,948.00