001462 (SATT)P.O. BOX 1504
Building , 7 ,,495. Hoet �� 78-105 CALLS CALIFORNIAESTAD9
Address � LA QUINTA, ORNIA 92253
Owner
Mailing
AddressioDi 1At. ft. suite 2700
City IZip 9e,,,&1.5 ITO
Contractor
Aaaress.... _.
T.O. BOX
No. 001462
BUILDING: TYPE CONST. V r OCC: GRP. R 3
A.P. Number
Legal Description
Project Description I palm
City
Zip _
Tel. -
Front Setback from Center Line
S2053
340-551.
Side Street Setback from Center. Line
State Lid.
& Classif. �
"282Size-•
City,:
Lic. #` .g
Sq. Ft.. 47
GM • 43.3
No. No. Dw.
Stories Units
Arch.,-Engr.;
New. Add ❑
Alter ❑. Repair ❑ Demolition ❑
Designers, ^. B
Address
Tel.
.340 S...Faa .��. _
23�78�►"f... .
City
Zip
State
Clai :i 'emifto,
92U2.
—. LICENSED CONTRACTOR'S 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 licensee is in full force and'
effect..
SIGNATURE +' ,f > DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law forthe following -
reason: '(Sec. 7031..5, Business and Professions Code:. Any city or county. which requires a
permit. to construct, after, 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 thathe is exempt therefrom, and the' basis
for thealleged exemption. Any violation of Section 7031.5 by 'any applicant for a 'permit
subjects the applicant to a'civil penalty of not more than fivehundred dollars ($500).'
. .❑ 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 improv
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.) I I . .. 1.a
Estimated ValUatlOn
«yryr.�y� '
.. PERMIT
` AMOUNT
r r
Plan- Chk. Dep.:
'
105.72
Plan Chk. Bal.'}„
Const.
t �4 '
.
Mech��>�
_ _
Electrical
'00 *.W '
Plumbing
VSn 00
❑ 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.) -
0.1 am exempt under Sec. B. & P.C. for this reason
S.M,j,
- 5:"
Grading
Driveway Enc.
Date owner
Infrastructures
_
3rJ.'I 7bliatiit: t "r.1c3
WORKERS' COMPENSATION DECLARATION
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 ($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.
CONSTRUCTION LENDING AGENCY.
1hereby 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.
1 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. J/ J
Signature of applicant /! l/F' f Date` ^' 1
v,.
Mailing Address '
City, State, Zip
HARD COPYI
TOTAL iiY!•b /b.ttR
REMARKS
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
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP./EQUIP.
DRINKING FOUNTAIN
SQ FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
`
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 ® 1+/. c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
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./EQUIP.
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
t
/r
PERMIT APPLICATION
City of La Duinta
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
APPLICANT NAME (L. F. MI) JL Construction
CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE: 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. I certify that in the pertormance of the work for which this permit is
(commencing with Section 7000) of Division 3of the Business and Professions Code. and my license Is In full force
Issued. I shall not employany person Inanymannersoasto become subject to the Workers'Compensation Laws of
and effect.
California.
License Class tic: Number
Date Applicant -
Date Contractor
NOTICE TO APPLICANT: 11, after making this Certificate of Exemption, you should become subject to the Workers'
OWNER -BUILDER DECLARATION: I hereby affirm that I em 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 ofthe Contractor's License Law
D 1 hereby certify that no excavation five (5) or more feet in depth Into which a person is required to descend, will be
(Chapter 94commencing with section 7000) of Division Sof 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, Sec341, TitleB,
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
C.A.C.)
O 1. as owner o1 the property, or my employees with wages as their 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 o1 property who builds, or improves thereon• and who does such work himself or
ADDRESS
340 S. Farrell Dr. A212
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. the owner -builder will havethe burden of provingthat
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
O 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 not 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
RSBOFCZONE
Contractor's License Law.).
Lender's Address
O 1 am exempt under Sec. B. 8 P.C. (Attached Certificate).
I 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 above4mentioned property for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell -insure, or a
SIDE
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. Q.
Signature of Applicant or Agent Date
Policy No. Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I 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.
Date Applicant
Signature of Applicant or Agent 'Date
APPLICANT NAME (L. F. MI) JL Construction
ADDRESS P.O. Box 173
CITY/COMMUNITY/STATEIZIP
Nestor, CA 92053
JOB SITE ADDRESS/SPACE
CITYICOWL)NITY/STATE/ZI P
Ia. to CA 92253
BOL(
PAG
PRC
C
TNM
RNG
SE
S
TRACT
19903
LOT
Elect, Fee 60.18
MOD
Set
.Plurrbina Fee 85.00
T*��
TRACT NAME HORIZON
HORIZON
I1P�A,l„l.•�L7 M
OWNER NAME (L. F. MI)
1�11CL 1• ana mnt Corp.
CONTRACTOR -FIRM NAME
J.L. Construction
ADDRESS
above
CITY/COMMUNITY/STATVZI P
PHONE •
756.88
LICNC •
* gqreentnt
ARC/ENG FIRM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CI iCOMMUNITY/STATMIP
Palm rin s •CA 92262
PHONE F LICNC /
23-7877
TOTAL •
FEE
USE OF PERMIT
Single Familv Dwelling
BL
20N,
F$B�.I)
SSB
RSBOFCZONE
ORD 1
END
SIDE
L_�
Print Applicant/Agent Name
APPIJ"MT `� T”
y �s
S.F.D.
Pennit to construct 1247 sq. ft.
of
living area and .433 sq. ft. of
age
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.'
.Plurrbina Fee 85.00
Tnfrastructure
862.60
105.72 DFP. PAID
756.88
* gqreentnt
with CmminitzZ t Department
TOTAL •
FEE
7862,60
/111oU L 5IS88 CK
FINONeg VALUATIONF77,948.00