001535 (SFD)Building
Address 79�— 65 N. swa.` t.
Owner
City ZiP 92353
State Lic.
& Classif. . 442822
'
-Arch.-; Engr.,
Designer. YA►s�1
City
palm
I hereby.affirm that
7000).of Division 3 of
effect... . . .. I
T4,Yl 4
P.O. BOX 1504
78-105 CALLE ESTADO
* Axpe Dr. LA QUINTA, CALIFORNIA 92253
No. 00.535
`^r BUILDING: TYPE CONST: V N OCC: GRP., .R .3
Ltz-, 2700 _ A.P.,Nu,mber
Tel. '
...(Q Legal Description
Project Description.
HIS lklits MsIdmtial.
Tel.
City
Lic. # 237
Tel.
0` .. St. 323-7877
Zip State
92M2 Lic. #' ....
LICENSED CONTRACTOR'S DECLARATION .
n. licensed under provisions of Chapter 9 (commencing with'Section
Business and Professions. Code, and my license is`in•full'force and
l
DW- 1247
Sq. Ft., ' No. No. Dw.
Size' WAR, - 433. Stories Units
INew fel Add O Alter ❑
.Repair O
Demolition ❑•
.. , SIGNATURE __V y d I DATE
mmal Nmcg.
Mailing
" OWNER•BUILDER DECLARATION
Address
IOU Pda,>im, -. ;
City
Zip
00.
,reason:. (Sec.L
. 70P 1. and Professions Code: ,Any city or• county which requires .a.:
• Contractor
j.
r• permit to construct, alter, improve, -.demolish, or repair any structure, prior. to its issuance also..-
Address. -..
. .
City ZiP 92353
State Lic.
& Classif. . 442822
'
-Arch.-; Engr.,
Designer. YA►s�1
City
palm
I hereby.affirm that
7000).of Division 3 of
effect... . . .. I
T4,Yl 4
P.O. BOX 1504
78-105 CALLE ESTADO
* Axpe Dr. LA QUINTA, CALIFORNIA 92253
No. 00.535
`^r BUILDING: TYPE CONST: V N OCC: GRP., .R .3
Ltz-, 2700 _ A.P.,Nu,mber
Tel. '
...(Q Legal Description
Project Description.
HIS lklits MsIdmtial.
Tel.
City
Lic. # 237
Tel.
0` .. St. 323-7877
Zip State
92M2 Lic. #' ....
LICENSED CONTRACTOR'S DECLARATION .
n. licensed under provisions of Chapter 9 (commencing with'Section
Business and Professions. Code, and my license is`in•full'force and
l
DW- 1247
Sq. Ft., ' No. No. Dw.
Size' WAR, - 433. Stories Units
INew fel Add O Alter ❑
.Repair O
Demolition ❑•
.. , SIGNATURE __V y d I DATE
.. .... .. .. .. ..
... _ _ ._ .. .. .-
" OWNER•BUILDER DECLARATION
Estimated Valuation
-
I hereby affirm that I am exempt from the Contractor's License Law for the following'
00.
,reason:. (Sec.L
. 70P 1. and Professions Code: ,Any city or• county which requires .a.:
-
j.
r• 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
-PERMIT
AMOUNT•
the provisions of the Contractor's,License Law, Chapter.9 (commencing with Section 7000). of
Division 3 o/ the Business and Professions Code, or that. he is exempt therefrom, and basis.-
p
for the alleged exemption. Any violation of Section 7031.5 by>•any applicant for.a permit-
Plan Chk. Dep.
-„105,
subjects the applicant to's civil penalty'of not more than live'hundred dollars ($500):
Plan Chk. Bal.
O I, as owner of the property, or my employees with wages as their sole compensation, will
202.24
do the work, and the structure is not intended or offered. for sale. (Sec. 7044, Buisness and
CD' t.
w-� A
367.0
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
31, _
or improvement is sold -within one year of completion, the owner -builder will have the.burden
1 Electrical
” x:18
o/ proving that he did not build or improve for the purpose o/ sale.) - - ,
❑ I, as owner of the property, am exclusively contracting with licensed contractors.to con-
Plumbing
8FJe��
-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.) .
Grading
... ❑ I.am exempt under Sec... B. & P.C. for this reason -
Driveway Enc.
Date Owner'
Infrastructure
wfm=ed mwwnt is a=eema
WORKERS' COMPENSATION DECLARATION
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
❑ Copy.is filed with the city. ❑ Certified copy is hereby furnished. '
TOTALRrraa�i
�► ��
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 the work for which this permit is issued, I shall not
employ any person in any manner so as to becomesubject to the Workers" Compensation
Laws of California.
Date ' "' Owner
NOTICE TO APPLICANT: If, alter making this Certificate o/ Exemption you should become
-ZONE: •
BY:
subject to the Workers' -Compensation provisions of. the Labor 'Code, zyou must forthwith
comply with such provisions or this permit shall be deemed revoked. -
Minimum Setback Distances: -
Front Setback from Center.Line
Reay Setback from Rear Prop. -Line
CONSTRUCTION LENDING AGENCY
Side Street Setback.from'Center Line
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 Setback from, Property. Line
Lender's Name
Lender's Address
FINAL DATE
INSPECTOR
This'is a building permit when'properly filled out, signed and validated, and is'subject io
.
expiration it 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
1 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-. 1.
^Validated
mentioned property for inspectionlpdrposes.
by:
y
J
Signature of applicant.�'��;' 1 t Date
Mailing Address ^� ` v V t
Validation:
City, State, Zip 1
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SO. 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.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL
LICENSED CONTRACTORS DECLARATI
(commencing with Section 7000) of Divi
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 700D) 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 (5500.):
❑ I, as owner o1 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 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, the owner -builder will have the burden of proving that
he did not build or improve for the purpose of sale.).
O 1. as owner of the property. am exculsively contracting with licensed contractors to construct the project (Sec.
7034, 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.).
❑ 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 self -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
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 of 180 days.
CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE: This section need not be completed if
ON: 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
s
ion 3ofthe Business and Professions Code, and mylicense isinfull force Issued, I shall not employany person inany manner so asto become subject to the Workers'Compensation Laws of
California.
APPLICANT NAME (L. F. MI)
JL Construction
ADDRESS P.O. Box 173
CITY/COMMUNIT V/STATE21P
Nestor; CA 92053
JOB SITE ADDRESS/SPACE ,
CIT V/COMMUNITV/STATE/ZIP
La. to CA 92253
Bac
PAG
loft
c
TWN
RNo
sE
s
TRACT
19903
. LOT
37.00
MOD
SO
TRACT NAME HORIZON PAUL
OWNER NAME (L. F. MI) (bneral Management CorP. '
CONTRACTat-FIRM NAME
J.L. Construction
ADDRESS
above
CITY/COM AUNITY/STATE/ZIP
abQue
PHONE .
RW Fee
LICNC .
ARC/ENG FIRM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CIT//COMMUNITY/STATEaIP
Palm Springs, CA 92262
PHONE • LICNC .
323-7877
USE OF PERMIT '
Single Famil Dwelling
BL
862.60
ZON,
•FSB
SSB
SSB
ASS
*
OFC
with Ommmity
ZONE ORD .
LOT SZ
END
SIDE
a
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:
❑ thereby certify that no excavation five (5)ormore feet indepth into which aperson isrequired todescend. 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.)
❑ 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.
O 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 stale 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 Dale
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 o1 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
Dale
APPL/PRMT ',
n
DATE
5-22=85
'
S.F.D.
Permit to construct
1247 sq. ft.
of
livingarea and 433
. ft. of
age
as r a roved plans.
metch. Fee
37.00
Plan Check Fee
307.96
Const. Fee
367.00
Eftect. Fee
60.18
RW Fee
5.46.
.Pillm-bing Fee
85.00
Tnfrastnicture *
862.60
105.72 DEP. PAID_
756.88
*
a e�nt
with Ommmity
t Department
TOTAL
FEE
2.60
H 1 L D l D L-) / 5& 8 8 CK
FINANCE VALUATION 77, 948.00