001468 (SATT)'r
Building
Address ;
Owner
Tlihf 4 4 QU&M
Mailing
Address 1001 !§t. SUM
City Zip J� •�`'/
Honolulu - 9
Contractor
Address..
P.o. BC 173
City Izip
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
No. 001468
D.. BUILDING: 'TYPE CONST, OCC. GRP. R 3
2"0. A.P. Number -
Tel.
-� Legal Description
Project Description Hwiaoix Palm,
146 F,hits , Resi&yyt aal tit
State Lic.
& Classif.. ,"2822*
City
Lic. # 23
c`iM 1247
Sq. Ft. No. No. Dw.
Size •(= $33Stories Units
Arch., Engr., ._..
New 10 Add El Alter ❑ Repair ❑ Demolition ❑
DesignerVi i .
W AS
Address
Tel.
... .. 340 - S. Farxe-11 St, .
City Zip
State
AM sm9M2
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that Ijam licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of,�tytt'e Business and Professions Code, and my license is in full forceand
effect. 1 ✓' / 1I i� -.�% l I / .�, ,
SIGNATURE- - A DATE
OWNER -BUILDER DECLARATION
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• �.
' - perrnit to construct, atter, 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 (8500).
❑ 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
- 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
- p4
948.00
- �? 77,948.00
.. PERMIT AMOUNT
-•s- - -
Plan Chk.. Dep. ,. .. 105.72
Plan Chk. Bal. 02.2
COI1St. JV I.if
_
Mech. •. y�•y
+c f +
Electrical Q.��
_ A
Plumbing 5.00'
V
❑ I, 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.)
•. O I am.exempt under Sec. B. & P.C: for this reason
S.M.I. . -,•
Grading
Driveway Enc.
Date Owner _
`�
Infrastructure -red pwim
.y Director
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 862.60 756. Sa
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE w f
REMARKS
-
(This section need not be completed if the permit is for one hundred dollars (8100) 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 subjectto 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
coNsraucrloN 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.) -
Side Street Setback from Center Line
$Ida Setback from Property Line
Lender's Name
FINAL DATE INSPECTOR
• 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 -of this city to enter the,, above-
mentioned property for inspection purposes.
Signature of applicant �!f ,� / . r J! �� I'X Dated
Issued by: Date Permit
Validated by:
Mailing Address J f ✓
Validation:
City, State, Zip
HARD COPYI
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES NO.
PLUMBING FEES
IST FL. SQ. FT. 0 $
2ND FL.SQ. FT.
POR. SO. FT. ®
GAR. SQ. 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
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, 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.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/.c
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
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
PERMIT APPLICATION
City o1 La ouinta
Department of Building and Safety
This permit becomes void if work not commenced within 1110 days from date o1 issuance. OR, if work has been suspended or abandoned for a period of 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 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 o1 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 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 sate (Sec. 7044, Business and Professions Code: The Contractor's license
Law does not apply to an owner of property who builds, or improves thereon• avid 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.).
O L as owner of the property. am exculsively contracting with licensed contractors to construct the project (Sec.
7644. 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.).
O 1 am exempt under Sec. B. 8 P.C. (Attached Certificate).
Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that t 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. MI)
JL Construction
ADDRESS
P.O. Box 173
CITY/COMMUNITY/STATMIP
Nestor, CA 92053
JOB SITE ADDRESS/SPACE
CITY/COM ML)NITY/STATE/ZIP
La. to CA 92253
BOK
PAG
PRC
C
qW Fee 5.46:'
TWN I
RNG
I SE 1
S
199 03
LOT/
with ecarminity t Departmmt
Moo
so
TRACT NAME '
HORIZON PALMS
OWNER NAME (L. F. MI) (neral Management Corp. '
CONTRACTOR -FIRM NAME
J. L. Construction
ADDRESS
abcve
C1TY/COMMUNITY/STATE/ZIP
PHONE •
LICNC .
ARC/ENO FIRM NAME
Michael.Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CITY/COMMUN ITY/STATE/ZI P
Palm sorinas, CA 92262
PHONE LICNC /
323-7877
USE OF PERMIT
Single Family Dwellin
B
L7ZONE
ZON,
FSB
SSB
SSB
RSB
OFC
ORD •
LOT SZ
i
END
SIDE
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, after making this Certificateol 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 Z 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: 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-Imentioned 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 Duinta 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 I ► (6
APPL/PRMT - Tt S.F.D.
Permit to construct 1247 sq. ft. of
livincr 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
qW Fee 5.46:'
.Plirribing Fee 85.00
Infrastructure
862.60
105.72 DEP. PAID
756.88
* gqreembint
with ecarminity t Departmmt
TOTAL
'FEE
862.60
•• FINANCE
J L / 56. 6 8 CK
VALUATION 77,948.00