001530 (SFD)a -
P.O. BOX 1504 NO,. 001530
Building 79-250 �'' LA QUINTA78-105 CCALIFORNIA92253.
Address •• '
Owner (o q ... .. >
Mailing ' TZ
BUILDING: TYPE CONST: - OCC: GRP: IR 3
Address 1,001 Bishm - . Suite 2700 A.P. Number
City Zip ITO..58Z3 367_,SLegal- Description
s
ContractorProject Descriptionygg .
- . ..
Address ... _ .. 1.46 Uraitsa -
P.O. Bax 173
City ...... Zip Tel. _
92-053 340-5511.11
State Lic. City VW 1247
& Classif. 442= Lic. # '237Sq. Ft. '(;W 433 No. No. Dw.
Size Stories Units
Arch.; Engr.;
Designer New R Add ❑ . Alter ❑. '• Repair ❑ Demolition ❑
Address Tel.
340 - S. &a 3 - St— .323-7977,
.
City Zip State
palm.. .2262- LiC. # n
-LICENSED CONTRACTOR'S DECLARATION
hereby affirm that) amllicensed under provisions'of Chapter 9 (commencing. with Section
7000) of. Division 3 of b'Business and Professions Code; and my license is)In full force and
effect..- . . fi 1 1�. 1'.
. ... . . � f > J )
SIGNATURE F J t" <./ DATE -
:j OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following. Estimated V21UatlOn 8
77i .€ 0
reason: (Sec. 7031.5,Business and Professions Code: Any:city, or county which requires a' I t� iiia „
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 .z•.
Divisiori 3 of the Business and Professions Code,. or thaChe is exempt therefrom,. and the basis' - - !�
for the. alleged exemption. Any violation of Section 7031.5' by any -applicant' for a .permit Plan Chk. Dep. - •. �547b
subjects the applicant to a civil penalty'of not more than five hundred dollars ($500). '-..
Plan Chk. Bal.
q.1, as owner of the property, or my employees with wages as their sole,compensalion,.will. ' 202.24
do the work, and the structure is not intended or offered for sale. (Sec!, 7644, Buisness and Const. 3 �
Professions Code: The _Contractor's License Law, does not -apply •to an owner of property who ' .
builds• or improves thereon and who does such work himself or through. his own employees, Mech. `4;
prbvided.that' such, improvements are not intended or -offered for sale: If, however, the building .
orirtip'rovement is sold within one year of completion, the owner -builder will have the -burden
Electrical' '
of proving that he did not build, or,lmprove, for the purpose o/ sale.) , ' ' 60.18
❑l;`as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
struct the project. (Sec... 7044, Business and -Professions Code: The Contractor's License Law _ .
40
does not apply to,an owner of property who builds or improves thereon, and who. contracts for S.M'-I: .5.46 '
such projects. with a contractor(s) licensed pursuant to the Contractor's License -Law.) - - -
Grading
..O 1 am exempt under Sec. -B: & P.C. for this.reason
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that'I have a certificate of consent to self -insure, or a. certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec: 3800, Labor Code.)
Policy No. Company
❑ Copy is filed.with the city. , 0 Certified copy is hereby furnished.
TOTAL 862..60 7516..9$
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 permitisissued, 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 ZONE:
BY:' _
subject to the, -Workers" Compensation provisions of the Labor"Code, you must forthwith - Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked. -
Front Setback:from Center. Line
Rear 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 performanceof the ^
.,work for which this permit is, •issued.,(Sec. 3097, 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: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. ! Validated by:
Signature of applicant .! / /� i�`.% e s Date 1,
Mailing Address Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT. ® '
SO 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 APPJEOUIP.
LAUNDRY TRAY
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
SO.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
SMI FEE TLUMB. 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 APPJEOUIP.
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
Cale 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 pursuanttothe provisionsolthe Contra ctor'sLicense 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 (W.):
O 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• 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 properly, am exculsively contracting with licensed contractors to construct the project (Sec.
7064, Business and Professions Code: The Contractor's License Law does not apply to an owner o1 property who
builds or improves thereon. and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
O 1 am exempt under Sec. B. & P.C. (Attached Certificate).
Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that 1 have a certificate o1 consent to self -insure, or a
certificate of 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 tiled 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, it work has been suspended or abandoned for a period of 1BO days.
CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE: This section need not be completed it
ON: I hereby affirm that I am licensed under provisions o1 Chapter 9 the permit is for one hundred ($10D) o, less. I certify that in the performance of the work for which this permit is
sion 3of the Business and Professions Code, and my license Is in full force Issued. I shall not employ any person inanymanner so asto become subject to the Workers'Compensation Laws of
California.
APPLICANT NAME (L. F. MI)
JL Construction '
ADDRESS
P.O.' Box 173
CITY/COMMUNITY/STATE/ZIP
Nestor; CA 92053
JOB SITE ADDRESSISPACE
CITY/CO6MLMITY/STATE/ZIP
La . to ' CA 92253
Bore
PAD
PRC
C
TNM
FIND
SE
-S
19903
LOT
Elect. Fee 60.18
MOD
sa
TRACT NAME
HORIZON PALMS
OWNER NAME ll. F. MI) Gmeral Management Corp. '
CONTRACTOR -FIRM NAME
J.L. Construction
ADDRESS
CITY/CG M6UNITY/STATE/ZIP
PHONE a
105.72 DEP. PAID
LICNC .
.
ARC/ENG FIRM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CITYICOMMUNITY/STATVZIP
Palm rin"s CA 92262
PHONE • LICNC •
323=7877
USE OF PERMIT
Single Famil Dwelling
BL
862.60
ZOIC,
•FSB
SSB
SSB
RSB
OFC
ZONE ORD •
LOT SZ
END
- SIDE
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 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 32. Grp Z An 2, Sec 341, Title B,
C.A.C.)
0 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 of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: 1 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 p) () % 5
Date
APPtJPRMT - - DATE
S:F.D. -
Permit to construct 1247 sq. ft.
of
livingarea and 433 . ft. of
age
as a roved laps.
h. Fee 37.00
Plan Check Fee 307.96
Const. Fee 367.00
Elect. Fee 60.18
c269 Fee 5.46
.Plumbing Fee 85.00
Tnfrastructure
862.60
105.72 DEP. PAID
756.88
* a eentnt
with rlaminijzZ t De
t
TOTAL •
'FEE
862.60
til L D L D c 3 / j& 8 8 CK
VALUATION 77,948.00
FINANCE