001536 (SFD)TAtyl QUM&
P.O. BOX 1504 No, Q
BuildinAddress ?9-'275 N. SIS -Zd Dr. LA.QUINTA CALIFORNIA 92253_
Owner ....
Mailing-
Address
ailing-Address 1001 P
City
..
B=IUIU
Contractor
J.ra.. C
Address
ftp f. suite 2700
Zip Tel.
AwB- V36f-.YP
BUILDING; TYPE CONST. V N OCC:.GRP.- .R. 3
A.P. Number
Legal Description
Project Description" Hdri.=. Palm
u 146 VAits Dellmi. -
P ?
173
city.
Nesfzw
Zip
92053
Tela
340--5M
State Lic.
City -
-1247
& Classif.�
Lic. # 237
Sq. Ft.
Size- �' 433
No. No. Dw.
Stories Units
Arch., -Engr... ...
Designer -,�`
Newel Add ❑
Alter ❑: Repair ❑ '' Demolition ❑
Address Tel.
.30 S. Mtr=13. . 323-7877 .
CityZip
State
" 5
92262 Lic. # - -. .
_ W LICENSED_CONTRACTOR'S DECLARATION
1 hereby affirm that I am,licensed under provisions of Chapter 9 (commencing with Section
7of Division 3 of the,business and Professions Code, and my license is in full force and '
effec000) t:.
... .. ...:.
.. ... ..... ,
SIGNATURE DATE
_ .
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
perink'to constrict, atter, improve, demolish, or,repair any structure, prior to its issuance also
requires. the applicant for such permit to rile 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, an"d-tlie basis-'
for the alleged exemption. Any violation of Section 7031.5 by Any'applicant. fora permit.
- . subjects the applicant to a civil penalty ol'not more than'8ve hundreddollars ($500).-
. O I, as,owner of the property, or my employees with wages as their sole compensation, will,
do the work, and the structure is not intended or'offered for sale. (Sec. 7044, Buisness and
Professions. Code: The Contractor's License Law does, not apply. to an owner of property who,
builds or improves thereon and who does such work himself or. through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building'
Estimated Valuation
�q g� /�{�
" I I'pS'�tllvad
. ' .:PERMIT
.
- -. '• AMOUNT
-
Plan'Chk. Dep.
Plan Chk. gal..
202.24
CO.nst:
`� ,
Mech. ' -
7 0
3740
7I �•E7M '-
_
' Electrical'
or improvement is sold'within one year of completion, the, owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.) _ -
Plumbing.}rsJ}
❑ I, as owner of the property, am exclusively contracting with licensed contractors•to con-
• Strutt the project. (Sec. 7044, Business and Professions -Code: The Contractor's License Law
does not apply to an owner of property who builds or -improves thereon, and who contracts dor
such projects with -a contractor(s) licensed pursuant to the Contractor's License Law.) -
0 1 am exempt under Sec. B. ti P.C. for -this reason
S:M.I: -
ZL
- -. 5.46
Grading
Driveway Enc.
Date owner
Infrastructure
Def+ yn asa=te
With 0"p— DR Mi. Direct=
WORKERS' COMPENSATION DECLARATION
' I 'hereby 'affirm that I have a'certificate of consent to self -insure, *or -a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) '
Policy No.";•_'.Company
- .. O Copy is,filed.with the city. ❑ Certified copy is hereby furnished.. ...
.
TOTAL
862.60- 756.6$
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.) .. .. .
I 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-
alifornia'Date
-
-
'DateOwner' "
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.
ZONE: - BY: '
Minimum Setback Distances: - - -
Front Setback from Center. Line
Rear Setback from Rear. Prop. Line
CONSTRUCTION LENDING AGENCY
hereby affirm that there is a construction lending agency for'Ahe 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
. FINAL.DATE,
INSPECTQR
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.
- 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 inspectioFfp6 rpp/oses. l'- •' �
Signature of applicant ' ff l0� i .{J ' Dated f > )
- Mailing Address l '. '. l
Issued by:
• +- -
Validated by:
Validation:
Date Permit '
- - -
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. p
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.COOL 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/ac
HOUSE SEWER
REMARKS:
VENTILATION
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
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, it work has been suspended or abandoned for a period o1 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 Sol the Business and Professions Code, and my license is in full force
and effect.
License Class Lic. Number
Date Contractor
OWNER -BUILDER DECLARATION: 1 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 of 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 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, Business and Professions Code: The Contractor's License
Law does not apply to an owner o1 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, the owner -builder will have the burden of proving that
he did not build or improve for the purpose of sale.).
O I, as owner of the property, am exculsively 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
builgs or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the
Contractor's license Law.).
❑ 1 am exempt under Sec. B. 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 o1 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 (� w 1.1 s Ul tion
ADDRESS .
P.O. Box 173
CITY/COMMUN ITY/STATE/ZIP
Nestor; CA 92053
JOB SITE ADORESSISPACE - -
CITY/COIiAUNITY/STATE/ZIP
La. to CA 92253
BOK
PAG
PRC
I C
I
TWN
I RNo
I SE
.s
19903
LOT�
SM Fee 5.46
MOD
S13
TRACT NAME
HORIZON PALMS
OWNER NAME (l. F. MI) Caneral Management Corp. '
CONTRACTOR -FIRM NAME
J.L. Construction
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
PHONE a
LICNC .
t Department
ARC/ENG FIRM NAME '
Michael Buccino Assoc.
ADDRESS
340 S. Farrell. Dr. A212
CITYICOMMUNITY/STATVZI P
Palm Springs, CA 92262
PHONE / LICNC I
323-7877 1
USE OF PERMIT
Single Familv Dwellin
BL
ZON,
FSB
SSB
SSB
RSB
DEC
ZONE ORD /
LOT SZ
END
"SIDE
the permit is for one hundred (5100) 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: 11, 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:
D 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 2, Art 2, Sec 341. Title B.
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.
❑ 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-mentioned property for inspection purposes.
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify 1 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
Print Applicant/Agent Name A r) 1 S g I^
Date
APPL/PRMT DATE
5-2.2 85
S.F.D.
Permit to construct 1247 sq. ft.
of
livincr area and 433 sq. ft. of garage
as per apprcived.plans.
Mach. Fee 37.00
Plan Check Fee 307.96
Const. Fee 367.00
Elect, Fee 60.18
SM Fee 5.46
Plumbi= Fee 85.00
Tnfrastructure
862.60
105.72 DEP. PAID
756.88
* actreemifint
t Department
TOTAL .
FEE
2.60
A1LD6 D LS /5&88 CK
FINANCE VALUATION 77, 948.00