001461 (SATT)P.O. BOX 1504
Building 79-499 � {�� 78-105 CALLS CALIFORNIAESTAD9
Address \�, e� LA QUINTA, ORNIA 92253
Mailing
Address 1001 `tet°- ,
City Zip ;
Contractor
. JZ. bk"t3G'I:Y 'J 2
Address
P.O. 173
•
'City lZio .
Tel.
No. 001461
(BUILDING: TYPE CONST. - V IIT OCC: GRP. A I
A.P. Number
Legal Description
Project Description R=d T"Iyrn -
146 U14ts °R3 c iii t DOMI.
State Lic.
& Clas,sif. 442822
City
Lic. # 237
IIM 1247
Sq. Ft.
fR• 433'.
No. No. Dw.
Stories -Units
Arch.; Engr., ... .. •.. ... -
Designer��
-Size.
New E? - Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
340 SN Tr1.
323-7877
_.
City Zip
palm Springs. .922
State
Lic.-#. .. .. , . .
~
r LICENSED CONTRACTOR'S DECLARATION •
- �•
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.
-
- -
SIGNATURE .f r ° - - - / f DATE•
OWNER -BUILDER DECLARATION d'
I hereby affirm that I am exempt from the Contractors 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 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 =s
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 offeredfor 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 of proving that he did not build or improve, for the purpose of sale.)'
Estimated Valuation
N �f[i Am;
Y� s00
,�7P
- -
PERMIT
- -
AMOUNT
Plan Chk. Dep.
'
-
Plan Chk, Bal.
`
COnSt.
!
3�� .
Mech.'�'
- . 00
Electrical
' 13
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
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
Infrastructure_'
Deferred ,y as >
with rt1flb'14. Tillaw 1. msec '.
WORKERS' COMPENSATION DECLARATION
I hereby affirm that'( 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
QI . � 75149
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
- or less.) - --•� .
1 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
-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
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.)
Side Street Setback from Center Line
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
expiration if work thereunder is suspended for 180 days.
FINAL DATE
INSPECTOR
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 thea above-:
mention ed property for inspection
��purposes.r♦
Signature of applicant I /f l % 4 Date)/'2 r
Issued by:Date
Validated by:
Permit
-
Mailing Address / %
Validation:
City, State, Zip '
HARD COPY(
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND Fl_. SQ. FT.
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ. FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
I 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.
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/. 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
JEENST. 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 SIGNATURES/INITIALS
GARDEN WALL FINAL
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 160 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 o1 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 MY
O 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. 7074. Business 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 improvemnt is sold within one year of completion, Me owner -builder will have the burden of proving that
he did not build or improve for the purpose of sale.).
0 I, as owner of the property, am excuisively 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 of property who
builQs 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. (Attached Certificate).
Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell -insure, or a
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.).'
Policy No. Company
0 Certified copy is hereby furnished:
0 Certified copy is filed with the City Building inspection Department or City Department.
Date Applicant
APPLICANT NAME (L. F. MI) JL �„Stru�on
Wit
ADDRESS
P.O. Box 173
CITY/COMM ITY/STATE/ZIP
Nestor, CA 92.053
JOB SITE ADORESS/SPACE
CITY1COMMUNIT V/STATE/ZIP
La. to CA 92253
BOK
PAG I
PRC
J C:
I
TWIN
I RNG
SE
S
TRACT
LOT
TOTAL
FEE
MOD
I SB
19903
TRACT NAME
HORIZON PAIMS
OWNER NAME (L. F. MI) Gwieral Management Co rp-
CONTRACTOR-FIRM NAME
J. L. Construction
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
PHONE .
LICHC .
ARC/ENO FIRM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CM/COMMUNITY/STATE/ZIP
Palm Springs, CA 92262
PHONE • LICNC /
323-7877
USE OF PERMIT
Single Family Dwelling
BL
ZON,
'FSB
SSB
SSB
RSB
DEC
ZONE ORD
LOT SZ
ENO
SIDE
the permit is for one hundred ($100) o, less. I certily that in the performance of the work for which this permit is
Issued, l 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 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.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
0 1 hereby certify that no excavation live (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 32, Grp 2 Art 2.Sec341. 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.
0 Division o1 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-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 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 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 DD///Q
APPL/PRMT- T � � DATE - .
=ti 5-2-2 5 S.F.D.
Permit to construct 1247 sq. ft. of
livinq area and 433 sq. ft. of gaage
as per approved plans.
Rech. Fee 37.00
Plan Check Fee 307.96
Const. Fee 367.00
F-lect- Fee 60.18
M Fee 5.46
.plurrbing Fee 85.00
TnfrastrUCtUre
862.60
105.72 DEP. PAID
756.88
*nefe=ed paymmt as pgr a eendnt
t Department
TOTAL
FEE
862.60
/5&88 CK
enueLUec VALUATION 77,948-00
Sep 11'04 04:13p Fire -Station 93 (760) 345-7668 p.1
RIVERSIDE COUNTY FIRE DEPARTMENT
In cooperation with. the
California Department ofForestry and Fire Protection
210 West an Jacinto Avenue • PCalifornia ornia • Fax (909) 940-6910;
Craig Anthony
•Fire Chief
Proudly serving the
Unincorporated
Areas of Riverside
County and the
Cities of:
Baiu►ing
Beaumont
4.
Calimesa
Canyon Lake
Coachella
Desert Hot Springs
Indian Wells
Indio
•
Lake Elsinore
4.
La Quinta
Moreno Valley
4.
Palm Desert
Perris
v
Rancho Mirage
San Jacinto
4.
Temecula
Board of Supervisors
Bob Buster,
District 1
John Tavaglione,
District 2
Jim Venable,
District 3
Roy Wilson,
District 4
Marion Ashley,
Distria 5
September ►°t, ZUU4
City of La Quinta
Building Department
Re. Fire Life Safety Clearance
The Riverside County Dept Department is granting a fire and life safety clearance
For the following project Iocated at 44-555 Hwy 111, La Quinta.
NS/jl
Neal Stephenson
Fire Systems Inspector
EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE
82-675 Highway 111, 2id R., bullo, CA 92201 (760) 8638886 • Fax (760) 863-7072