001531 (SFD)Building
Address
Owner
Mailing
Address
City
79-3W N. amset
Zip
P.O. BOX 1504 No.. 001531
78-105 CALLE ESTADO
Ridge or. LA QUINTA,.CALIFORNIA 92253
Tel.
Contractor
Address . .
P.O. B= x.73
City.. .. Zip .. Tel.
02111CM
BUILDING:•TYPE.G,ONST- V -N ' . OCC..GRP.- P. 3
270 A. P.. Number
Legal Description '
Project Description VA -W 2m P&IM -
34
State Lic.
& Classif.�
City
Lic. # 237
MTI 1U7
Sq. Ft. No. No. Dw.
Size M .433 Stories Units•.-
Arch., Engr:, ... ._. .
Designer ..
'New 19 Add ❑ Alter ❑'. Repair ❑ ' Demolition ❑
Address
Tel.
_..... 340 S. Vis?:' ft.,
323-7877
City
Zip
State
_.
Lic..# ..
LICENSED CONTRACTOR'S DECLARATION
a
I hereby.affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3•o)f:the Business and Professions Code, and my license is,ih full force'and
effect..
1 1
-
SIGNATURE - / J - 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
permit to construct, alter, improve, demolish, or repair any structure; prior to its issuance also
requires•the applicant. for such permit to lite a signed statement that he is licensed. pursuant to
.,. the provisions o/ the' Contractor's License Law, Chapter.9 (commencing with Section 7000) -of
Division, 3' df'th'e Business' and Professions Code, 'or. that. he is exempt therefrom,- and the basis •'
•. for;. thealleged exemption. Any violation o/ Section 7031.5. by. 'any 'applicant ..for a permit
' 'subjects the applicant to.a civil penalty'of normore than five hundred'dollars.(S 500). '- '.'. -• ' -
❑ I; as, owner of the property, or my employees with wages as their sole compensation, will . ;t
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 (o_an owner o/ property who
Estimated VdlUatlOn ,
D �$m
r^- -•
PERMIT•+. AMOUNT' '
- -
Plan. Chk. Dep.. , ,
.,
Plan Chk: Bal. �e�S+q e� eE
saiiiG.64
�a� qq//��
COt1St. 3674,00
- .3674, 0
Mech. - Ads '
3'7.00
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or :offered, /or sale. If, .however; the, building
or improvemenhis sold within one year o/ completion, the owner -builder will have the.burden
ofproving that he did not.build or improve, for the purpose of sale.).. -
Electrical - - ;!ki. s
Plumbing 1.
0.1;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
- such projects with a contractor(s) licensed pursuant to, the Contractor's License Law.)-
O 1 am exempt under Sec.. . B.,& P:C. for this reason -
-
S.M.I.-
• .
Grading
Driveway Enc.
Date Owner
Infrastructure mat I a
��
ith 012110. -DM 31� -Dixwbw
WORKERS' COMPENSATION DECLARATION '
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. ❑,Certified copy is hereby furnished.
TOTAL fR" Ifi;(t' iP7i1^i.�h
REMARKS
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
'
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less:) .. . _- .. ..
certify that in the performance of .the work for which this permit is issued, I shall not
employ any person in any manner sojas to'become subject to the Workers' Compensation
Laws of California.
_
-
—'
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
' subject -to the Workers' Compensation provisions of the Labor Code, -you must forthwith
- .comply with such provisions or this permit shall be deemed revoked.'
ZONE: BY: '
Minimum Setback Distances: • • - '
Front Setback from. Center. Line
Rear Setback from Rear. Prop.. Line
CONSTRUCTION LENDING AGENCY
I hereby affirm rthaf there is a con§truction lending agency for the performance of the
. work for which this permit is issued: (Sec. 3097, Civil Code.)."..'
Side Street Setback from'Center Line
Side Setback from Property: Line
Lender's Name
Lender's Address
FINAL. DATE :' INSPECTOR
This -is a building permitwhen properly filled out, signed and validated, and is subject to
expiration if wor$ thereunder is suspended for 180 days:. .
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 ordinancesandstate laws relating to building
• construction, and hereby authorize representatives ' of -this city to enter thes•above
mentioned property for inspectjion purposes. J✓ ' . x
Signature of applicant •/ 1 Ji! ! ft,' Date f • f
Mailing Address•/ v " / 1
Issued by: Date per
"
• Validate d by:
Validation:
T
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT. p
POR. SO. FT. ®
GAR. SQ. FT. ®
CARP. 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 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.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR p 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 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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES11NITIALS
GARDEN WALL FINAL
LICENSED CONTRACTORS DECLARATI
(commencing with Section 7000) of Divi
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 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 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 riot 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. ll, 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.
7004, 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.).
O 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 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 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 i1 work not commenced within 180 days from date o1 issuance. OR, if work has been suspended or abandoned for a period of 180 days.
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
ON: 1 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 o1 the work for which this permit is
sion3olthe Business and Professions Code, and mylicense isinfull force issued, I shall not employany person inanymanner so asto become subject lothe Workers'Compensation Laws of
California.
APPLICANT NAME (L. F. NilJLCionstruction
ADDRESS
P.O. Box 173
MU
CITY/COMNITY/STATE/ZIP
Nestor; CA 92053
JOB SITE ADDRESS/SPACE
CITY/COLMdLMITY/STATE/ZIP ,
La• into CA 92253
BOK
PAG
PRC
C
37.00
TWN
RNG
SE
s
Elect, Fee
60.18
Fee
5.46.
Moo
85.00
Tnfrastructure
19903o'�c�
862.60
105.72 DEP. PAID
756.88
TRACT NAME
HORIZON PAIMS
OWNER NAME (L, F. MI) General Management Corp-
o '
CONTRACTOR -FIRM NAME -
CONTRACTOR-FIRM
J. L. Construction
ADDRESS
above
CITY/COMMLINITY/STATE/ZIP
ahlipm
PHONE •
LICHC •
2.60
ARC/ENO FIRM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CITY/COMMUN ITY/STATE/ZIP
Palm rin s CA 92262
PHONE LICNC •
323-7877
USE OF PERMIT '
Single FamilyDwellin
BL
ZON,
FSB
SSB
SSB
RSB
DEC
ZONE ORD a
LOT SZ
END
SIDE
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should became 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:
O 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 o1
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. l 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 b`153
Date
APPLMRMT T ,
0-5-22-85
DATE
S.F.D.
Permit to construct
1247 sq. ft. of
livingarea and 433
. ft. of garage
as r approved fans.
mech. Fee
37.00
Plan Check Fee
307.96
Const. Fee
367.00
Elect, Fee
60.18
Fee
5.46.
Planbing Fee
85.00
Tnfrastructure
862.60
105.72 DEP. PAID
756.88
*
a eemAnt
t Department
TOTAL •
FEE
2.60
H 1 L 7 J L} / j& 8 8 CK
FINANCE VALUATION 77, 948.00