001472 (SATT)44
P.O. BOX 1504 No. 001472
Building'1 53 � � Pal= CL—C SLA QUINOTACL CALIFORNIA 92253
Address
Owner.
C43.1QWP. ' ' BUILDING: 'TYPE CONST. OCC: GRP.- R 3
Mailing
Address M01 Rini A —Chita 2700 ». A.P. Number
City Zip t , Tel.
Legal Description
Contractor —l:'�.'�iC! Pai
J.L.-. a , r Project Description
Address _ 146 Mdts .
F.O. D= 173
Zip Tel.-
State
el.State Lic. City .
& Classif. ., � Lic. # 237 Sq. Ft. M 3247 No. No. Dw.
Size MR Stories Units
Arch., Engr.,
.Designer Michael Bwaim Assm. New 19: -Add ❑ Alter ❑. Repair ❑ Demolition ❑
Address Tel.
340 S. FaMM. St. .323-7877
.. . -
CityZip State
Lic. #
.'-LICENSED CONTRACTOR'S DECLARATION �.
I hereby affirm that I ani; licensed under provisions of Chapter 9 (commencing with Section
70 130) of Division 3 of the Business Professions Code, and my license is in full force and • '
effect./ v .7
••
SIGNATURE DATE ". ..
OWNER -BUILDER DECLARATION EStlmated Valuation
hereby affirm that I am exempt from the Contractor's License Law for the.following$s
reason: (Sec._, 7031...5, Business and Professions. Code: Any city or county which requires a l
00
permit to construct, lter,. improve, demolish, or repair any structure, prior to its issuance. also AMOUNT
requires the applicant for such permit to rile a signed. statement that he is licensed pursuant to PERMIT -
the provisions or the Contractor's License Law, Chapter 9 (commencing with Section 7000) or '
Division 3 of the Business and Professions Code, or that. -he is exempt therefrom, and the 'basis- __
for the alleged exemption. Any violation or Section 7031.5 by 'any applicant for a permit Plan Chk: Dep. 185.72
subjects the applicant to a civil penalty of not more than rive hundred dollars. ($500):
24
❑ I, as owner of the property, or my employees with wages as their sole compensation,. will.., Plan Chk.. Bal. .
do the work, and -the structure is not intended or -offered for sale. (Sec. 7044, Buisness and COr1St. ' 36740
Professions Code: The Contractor's License Law, does 'not apply. to an owner o/ property who
builds or improves thereon and who does such. work- himself or through his own employees, Mech. 37.00
. ,provided that such improvements are.not intended or offered for sale. If, however, the buildinge
or Improvement is sold within one year of completion, the owner -builder will have the burden Electrical - � ; .
or proving that he did not build or improve for the purpose of sale.)
O 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 or property who builds or improves4hereon, and who contracts for • S. M. 1., - 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 Infrastructure Daftmd PaW as >? emm
Vith-COM. WM1. DS=
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 $62.60 756,$0 -
CERTIFICATE OF EXEMPTION FROM REMARKS_
WORKERS'.COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($ 100)' valuation
or less.),
.. .._ ,
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any 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 ZONE: BY:
subject to the 'Workers' 'Compensation provisions - or the 'Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked. '
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
Ihereby 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
This is a building permit when properly filled out, signed and validated, and is subject to FINAL,DATE INSPECTOR
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 relating.to building
construction, and hereby authorize representatives sof this city to enter the)above-.
V811dated by:
mentioned property for inspection purposes. f
Signature of applicant / / / ff� i / r i i Date C /
Mailing Address ! / Validation:
City, State, Zip `
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SO. 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
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 APPJEQUIP.
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
IWATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11A c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/.c
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 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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
PERMIT APPLICATION
City of La Duinta
Department of Building and Safety
This permit becomes void if work not commenced within 190 days from date of issuance, OR, It work has been suspended or abandoned for a period of 1110 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
the permit is for one hundred ($100) o. less. l certify that in the performance of the work for which this permit is
(commencing with Section 70110) of Division 3 of the Business and Professions Code, and my license is in full force
- Issued. I shall not employ any person In any manner so as to become subject to the Workers'Compensation Laws ki,
and effect.
California.
License Class Lic. Number
Date Applicant
Date Contractor
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'
OWNER$UILDER DECLARATION: 1 hereby affirm that I am exempt from the Contractor's license Law for the
Compensation provisions at the Labor Code, you must forthwith comply with such provisions or this permit shall
be deemed revoked.
following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a•permit to
SE
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
such permit to file a signed statement that he is licensed pursuant tolheprovisions ofthe Contra ctor'sLicense Law
El [hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend. will be
(Chapter 9 (commencing with section 7000) o1 Division 3 of the Business and Professions Code)_or that he is exempt
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2, Sec 341. Titles,
subjects the applicant to a civil penalty of not more than five hundred dollars (5500.):
C.A.C.)
0 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
0 As owner -builder, I will not employ anyone to do work which would require a permit from the Division of
structure is not intended or offered for sale (Sec. 7044. Business and Professions Code: The Contractor's license
Industrial Safety, as noted above, unless such person has a permit'to do such work from that division.
Law does not apply to an owner of property who builds, or improves thereon, and who does such work himself or
TRACT NAME
HOPJZCN PAIMS
through his own employees, provided that such improvements are not intended or offered for sale. If, however, the
0 Division of Industrial Safety Permit No.
building orimprovemntissold within oneyearofcompletion. Meowner-builder will have the burden ofprovingthat
Date Applicant
he did not build or improve for the purpose of sale.).
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
0 1, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec.
of the work for which this permit is issued (Sec. 3097, Civ. C.).
7044. Business and Professions Code: The Contractor's License Law does rat apply to an owner of property who
Lender's Name
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
CMYICOMMUNI Y/STATE/ZIP
Contractor's License Law.).
Lender's Address
0 1 am exempt under Sec. B. 8 P.C. (Attached Certificate).
1 certify that I have read this application and state that the above information is correct. I agree to comply with all
Date Owner
'city and county ordinances and state laws relating to building construction, and hereby authorize representatives
BL
of this county to enter upon the above=mentioned property for inspection purposes.
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.).
Signature of Applicant or Agent Date
Policy No. Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify l have read this application and state that
0 Certified copy is hereby furnished.
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
0 Certified copy is filed with the City Building Inspection Department or City Department.
•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.
Date Applicant
APPLICANT NAME (L. F. MI)
JL Ctnnstruction '
ADDRESS
P.O. Box 173
CITY/COMMl1NITY/STATE/ZIP
Nestor; CA 92053
JOB SITE ADDRESS/SPACE
CitTY/GOeal LJNITY/STATE/ZIP
La.Quintar CA 92253
BOK
PAO
PRC
C
Mech. Fee 37.00
TWN
ANG
SE
S
TRACTLD�
Elect, Fee 60.18
SM Fee 5.46.
MOO
S13
Infrastructure
862.60
105.72 DEP. PAID
756.88
TRACT NAME
HOPJZCN PAIMS
OWNER NAME (L. F. Mq GBneral Management Corp. '
CONTRACTOR•FIRM NAME '
J.L. Construction
ADDRESS
ablove
CITY/COMMLINITY/STATE/ZI P
PHONE a I
. ,
LICNC .
ARC/ENG FIRM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CMYICOMMUNI Y/STATE/ZIP
Palm Spirings, CA 92262
PHONE • LICNC .
323-7877
USE OF PERMIT
Sin le Family Dwelling
BL
ZON,
'FSB
SSB I
sea I
RSB
OFC
ZONE ORD F
LOT SZ
END
SIDE
Signature of Applicant or Agent
Print Applicant/Agent Name
no I Li
ry,)
Date
;�-�1;" DATE
22-85
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
SM Fee 5.46.
P1 i mbiM Fee 85.00
Infrastructure
862.60
105.72 DEP. PAID
756.88
*DpferrPd paMent as = ggreentint
with Cn=initzZ t Department
TFEE 0862
60
nll/U /76.88 CK
flaN ARIfIr VALUATION 77, 948.00