001481 (SATT)Qum'
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 74
.).a3HOXI= PZ&M CJZClg LA QUINTA, CALIFORNIA 92253
Mailing -
Addressi ,x -
City M _ Zrp �4al�� Tel"
� ' ... MW - 1-808--367-W54
Contractor T
eA aw M� '..im
Address
City Zip' Tel.`"
92053 340-5511'
State Lic. City
& Classif. 442822 Lic. # 237
Arch.,'Engr.;
Designer-
-
No. 001481
BUILDING: TYPE CONST. V V OCC: GRP. R 3
A.P. Number
Legal Description
Project Description Fi zm palm
�
146 i, p�dtS' Dwel.
Sq. Ft. 1247 No.
Size Stories
New EX Add ❑ Alter ❑
Address
Tel.
Minimum Setback Distances:
... 344..S.. FarreU St..
.. 323--7877.. . • ,
Rear Setback from Rear Prop. Line
CityZip
-
State
`iS t 1Ci
92262
Lica#- •
'
_ LICENSED CONTRACTORS DECLARATION "
hereby affiim that I am licensed under provisions of Chapter 9 (commencing' with Section
7000) of Division 3 o theBusiness and Professions Code, and my license isjin full force and
effect:
Date Permit
Validated by:
SIGNATURE '•�-'-'•�" N j.. - r / - 1 f 'DATE
OWNER -BUILDER DECLARATION J -
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation
reason: (Sec. 7031. S,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
requiresthe 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
PERMIT
•I -
Division 3 of the Business and Professions Code, or_that.he isexempttherefrom, 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). •.
.0.1 as owner of the property, or my employees with. wages as their sole compensation, will
Plan Chk. Dep.
Plan Chk. BBI.
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
Const.
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 -
Mech.
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.)
` Electrical
❑ 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
does not apply to an owner of property who builds or improves thereon; and who contracts for
S.M.I.
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
Grading
Driveway Enc.
Date Owner
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 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 OwnTr ' •
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. •
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 if 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 insperction purposes. �, a
Signature of applicant t Ph Date
Mailing �—�—
Address
City, State, Zip
HARD COPY
Infrastructure
TOTAL
REMARKS
No. Dw.
Units
Repair ❑ ' Demolition ❑
77048.00
AMOUNT
W7 7A
��► l�
17 -An
as n
A9
dth cam, Dam I,.
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. SQ. FT. ®
CARP. SQ. FT.
WALL SQ. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
7
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 APP.IEOUIP.
LAUNDRY TRAY
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/.c
HOUSE SEWER
REMARKS:
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE 7rNST.
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.IEOUIP.
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 Oulnia
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 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 o1 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 7DDO) of Division 3 of the Business and Professions Code, and my license is in full force
Issued, I shall not employ any person Inany manner so asto become subject lothe Workers'Compensation Laws of
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 -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License law for the
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
'following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to
be deemed revoked.
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 to the provisions oltheContra ctor'slicenseLaw
01 hereby certify that no excavation five (5) or mote feet in depth Into whicha person is required to descend. will be
(Chapter 91commencing with section 7000) of 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 32, Grp 2 Art 2, Sec 341, Title 8,
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
C.A.C.)
O I. as owner of the property. or my employees with wages as Meir sole compensation, will do the work, and the
O 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
ADDRESS
through his own employees, provided that such improvements are not intended or offered for sale. If, however, the
O Division of Industrial Safety Permit No.
building orimprovemntissold within one year ofcompletion. theowner-builder will have the burden ofprovingthat
Date Applicant
he did not build or improve for the purpose of sale.).
CONSTRUCTION LENDING AGENCY: I hereby affirmthat there is a construction lending agency for the performance
O 1, as owner o1 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. Q.
7004. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
Lender's Name
builQs or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License law.).
Lender's Address
O 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
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 sell -insure, or a
LOT SZ
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 1 have read this application and state that
O Certified copy is hereby furnished.
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
O 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.
Tate Applicant
Signature of Applicant or Agent Date
APPLICANT NAME (L, F. MI) AL i0nnstruction
l.Wi
ADDRESS
P.O.' Box 173
CITY/COMMUNITY/STATE/ZIP -
Nestor; CA 92053
JOB SITE ADDRECSISPACE
CITY/COMMUNITY/STATE/ZIP
La.Quinta, CA 92253
Bac
PAG
PRC .
C I
TWN
RNG
SE
s
TRACTLOT
19903
—r-lect- Fee
J
C/lJ 31
SHI Fee
MoD
sa
85.00
TRACT NAME
HORIZON PAIMS
OWNER NAME (L, F. MI) Ganeral Managerwnt Co
CONTRACTOR -FIRM NAME
J. L. Construction
ADDRESS
above
CITYMOMMUN ITY/STATE/ZI P
PHONE .
LICNC .
*
ARC/ENG FIRM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CMY/COMMUNITY/STATE/ZI P
Palm Springs. CA 92,262
PHONE . LICNC •
TOTAL .
'FEE
323-7877 I
USE OF PERMIT,
Sin le Family Dwelling
BL
ZON,
FSB
SSB
SSB
'RSB
OFC
ZONE ORD F
LOT SZ
END
SIDE
' Print Applicant/Agent Name r� O' L1
8 1
� _
APPUPRMTolo,
g � - y
DATE
5-2.2t S.T.D.
Pennit 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
—r-lect- Fee
60.18
SHI Fee
5.46.'-
.21urrbing Fee
85.00
Tnf e
862..60
105.72 DEP. PAID
756.88
*
agreentint
t Department
TOTAL .
'FEE
862.60
1A1177 7 LS /5&88 CK
FINANCE VALUATION 77, 948.00