001533 (SFD)�.CV
P.O. BOX 1504 No. 001 33
Building 78-105 CALLE ESTADO
Address )�L -A QUINTA, CALIFORNIA 92253 r
Owner y
BUILDING TYPE•CONST. • V It OCC: GRP. R 3..
Mailing
Address 1031 BiSbM * Sdlite 2700 A:P. Number -
City
City Zip Tel.
$i=l 96913 1-800: �`J0 .. Legal Description
Contractor Project Description _.
. ..Address..... _ . _ ... _. :. ....
P.O. BM 173
`City ]Zip Tela H
92053 340-55U. :
State Lic. City
8 Classif: Lic. #.7 Sq. Ft. ' No. No. Dw.
44"22(W 434
Size Stories Units.
DesignerNew ® Add ❑ Alter ❑ Repair ❑ Demolition ❑
AMC.
Address " Tel.
240 S. ra=ell +9t. 323f877-
City
23f8877 City Zip State
SRxr��S 92262.. Lic:'# ,
! LICENSED CONTRACTOR'S DECLARATION _
I hereby.affirm'that I am licensed under provisions of Chapter 9 (commenci g'with Section
7000) of Divissii/on%'3 of the Business and Professions Code; and my license is in full force and, r. '
effect.';"
SIGNATURE _ r DATE
—77-
-,;OWNER -BUILDER DECLARATION
Estimated Valuation
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' '.77.948'.00
permitto -construct, alter, improve, demolish,. or repair any structure, prior to its issuance- also ' _ AMOUNT
requires the applicant for. such permit to file a signed statement that he is licensed pursuant -to PERMIT - - -
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 ekempf therefrom,. and the basis - - .�+�
for the alleged exemption. Any violation of Section, 7031.5 by"any. applicant for a .permit. Plan Chk: Dep. � � .. - � " 10'5.72 � _•
subjects the applicant to a civil -penalty of not more than' live"hundred dollars ($500). • - --� 01, as owner of,the,property, or my -employees with wages as, their sole compensation, will . Plan Chk. Bal.. .202.24
do•the work, and the structure is not intended or offered for sale. (Sec: 7044,•Buisness and COr1St.
Professions Code: The Contractor's License Law does. not apply to an -owner of.property.who
builds or improves thereon and'who does such work 'himself or.through his own employees,Mech.
provided that' such. improvements are not intended or offered for sale. If, however, the: building!' Y:1Li'
or improvement is sold within one year of completion, the "owner -builder 'will have the burden • Electrical" '
of proving that he did not build or improve for the purpose of sale:),_
O 1, as owner of the property, am exclusively -contracting with licensed contractors to con- Plumbingiy �$
,Strutt 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.1.
such projects with a contractors) licensed pursuant to the Contractor's License Law.). _ . ,
Grading
O I am exempt under Sec.- B. 8 P.C. for "this reason -
Driveway Enc.
Date _ owner Infrastructure
d_fPxrPd rim-n-vt as aareemmit
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.
p Copy is filed with the city:- ❑ Certified copy is hereby furnished. .
TOTAL AA%_AA..
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 thispermitis issued, l 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' of the Labor Code, you must forthwith. -
comply with such provisions or this permit shall be deemed'revoked. - Minimum Setback Distances:
Front Setback.from Center Line
Rear Setback.from Rear Prop. Line
CONSTRUCTION LENDING AGENCY. Side Street Setback from.Center Line' '
hereby affirm that therels a construction lending agency for the performance of 'the
work for which this per is issued. (Sec. 30$7, 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. arid'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. Validated by:
Signature of applicant - -� ✓ !. !r•, '� +•+ Date
Mailing Address' f i Validation:
City, State, Zip `
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. 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.IEOUIP.
DRINKING FOUNTAIN
SO. 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
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
SO. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® 3/4c
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 —ANK
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS.
GARDEN WALL FINAL
APPLICANT NAME (L. F. MI) LTL truction -
W11�
ADDRESS
P.O. Box 173
CITY/COMMUNITY/STATE/ZIP
Nestor; CA 92053
JOB SITE ADDRESS/SPACE
CITY1COIi4UNITY/STATE/ZIP - '
La,Quinta, CA 92253
BOK
PAG
PRC
PERMIT APPLICATION
City o1 La Ouinta
Department of Building
and Safety
This permit becomes void it work not commenced within 180 days from date of issuance.
OR, If work has been suspended or abandoned for a period of 180 days.
19903
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. I certify that in the performance of the work for which this permit is
(commencing with Section 7000) 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 of
and effect.
California.
License Class Lic. 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: 1 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
be deemed revoked.
following reason *(Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to
* a eembnt
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 of the Contractor's License Law
01 hereby certify that no excavation five (5) or more feet in depth into whicha person is required to descend, will be
(Chapter 9(commencing with section 7000) of Division 3 of the Business and Professions Code) orthat 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, Title 8.
subjects the applicant to a civil penalty of not more than live hundred dollars ($500.):
C.A.C.)
O 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
O As owner -builder. 1 will not employ anyone to do work which would require a permit from the Division of
structure is riot 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
DEC
through his own employees, provided that such improvements are not intended or offered for sale. IL however, the
O Division of Industrial Safety Permit No.
building or improvemni issold within oneyear of completion, the owner -builder will have the burden of proving that
Date Applicant
he did not build or improve for the purpose of sale.).
CONSTRUCTION LENDING AGENCY: 1 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. Q.
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
Contractor's License Law.).
Lender's Address
O 1 am exempt under Sec. B. & 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 above-mentioned property for inspection purposes.
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.).
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
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 Certitied 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
Print Applicant/Agent Name
APPLICANT NAME (L. F. MI) LTL truction -
W11�
ADDRESS
P.O. Box 173
CITY/COMMUNITY/STATE/ZIP
Nestor; CA 92053
JOB SITE ADDRESS/SPACE
CITY1COIi4UNITY/STATE/ZIP - '
La,Quinta, CA 92253
BOK
PAG
PRC
I C
I
TWN
RNG
SE
S
19903
LO CV
/
Elect, Fee 60.18
MOD
se
-Plimbing Fee 85.00
?RACY NAME
HORIZON PALMS
OWNER NAME Il. F. MII Cmneral Management Corp. '
CONTRACTOR -FIRM NAME
J. L. Construction
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
PHONE •
756.88
LICNC 1
* a eembnt
ARC/ENG FIRM NAME
Michael.Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CITY/COMMUNIT V/STATE/ZI P
Palm Sbrin s CA 92262
PHONE • LICNC •
323-7877
TOTAL -
FEE
USE OF PERMIT -
Single Familv Dwelling
BL
ZON,
-
FSB
I SSB
SSB
RSB
DEC
ZONE ORD •
LOT SZ
END
SIDE
APPtJPRMT -1 „� N5 2.2-
i � -
S.F.D.
Permit to construct 1247 sq. ft.
of
living area and 433 sq. ft. of garage
as per approved plans.
mach. Fee 37.00
Plan Check Fee 307.96
Const. Fee 367.00
Elect, Fee 60.18
M Fee 5.46
-Plimbing Fee 85.00
Tnfrastructure
862.60
105.72 DFP. PAID
756.88
* a eembnt
with rinmmmitzZ t Departnent.
TOTAL -
FEE
2.60
AiZDD
FINANCE
VALUATION 77,948.00