001541 (SFD)Is
P.O. BOX 1504 No. 001541
Building
Address 79-267 S. Smgnt ROM D.
Owner
Genemi Mmagemmt cam.
Mailing
Address 1001 Ung St. Suit.-- 2700
78-105 t-ALLE ES I ADO
LA QUINTA, CALIFORNIA 92253
City Zip Tel.
-054
.12MIMIU, 9603 I -800w367-5
Contractor
Address.
P.O'. WW 171
City'' . lZip . Tel:. *
oritor, 920-53 U15- U_
BUILDING: -TYPE CONST.. - V .'.00C'. GRP.. R 3.,
A.P. Number
Legal Description
Project Description Fftr11 T�lvm
State LiC7 City DM1247
& Classif. . Lic.'# Sq Ft
237
Size- * - No GM.. • 433 - stories
Arch.*, r-ngr:,
-Designer New -ig Add 0 Alter 0- Repair 0. Demolition 0
Address`' Tel.
340 S. FarMll ;t.. 323-7877
7—
City Zip State
palm 9*inm 92262 LiC. #
,--LICENSED CONTRACTOR'S DECLARATION
No. Dw.
Units
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing withiSecti
70 1 on,
00' of Division 3 of the 6bsiness and Professions Code, and my license is in full force and
affect ,r'!
ZONE:
..BY:
SIGNATURE I I f DATE...
OWNER -BUILDER DECLARATION
I. hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation
reason:. (Sec. 7031.,5, Business and Professions Code: Any city, or, county. which..requi . res a
permit to construct, alter, lmpr6�e, demolish, or repair. any. structure, prior,.to its, issuance also
requires.th ' elapplicant for such permit to file a -signed statement. that, he is ficensed. pursuant to
Frqnt Setback from Center Line
PERMIT.,
the provisions. of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
DiJision_3 of the Busiheis 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 penaltyof not more than five,hundred dollars ($500).
'0 1 as owner of the property, or my employees with wages as their sole compensation, will.
_Plaii Chk. Dep. -
PWChk. Bal.,
7
c6fist.
• do ih6 work, and the structure is not intended or offered for safe. (Sec. 7044,. Buisness and
Professions Code: The Contractor's License Law does - not apply to,an owner or prope�rty-who
,
Mech..'
or improv * thereon and who. does such work himself or through
builds as ough his own employees,
provided that such improvements are not intended or -.offered for sale: If, however, the building
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
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
S. M. 1.
such projects with a contractors) licensed pursuant to the Contractor's Lkense-Law.)
•
0 1 am exempt under Sec.. - _.. B. & for this reason
Gradi ng
-
Driveway Eric.
Date Owner
Infrastructure
7
with
expiration it work thereunder is suspended for 180 days.
WORKERS' COMPENSATION DECLARATION
I hereby affirm that'l have "a certificate of consent to "self insure, or a certificate of
Issued by:
Worker's Compensation Insurance, ora certified copy thereof. (Sec..3800, LaborCode.)
I agree to comply with all city',an'd county ordinances and state laws'relating to building
Policy No. ' ' Company
0 Copy is filed with the city.. 0 Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS'
of applicant Date
Mailing, Address r i
(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 thp 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.
City, State, Zip
AMOUNT
1050.72
'202.24.
367.
37.00
60AR
.85.00
5.46.
V,
rait as aqreoneat
_v A. 'Director
Date Owner
NOTICE TO APPLICANT:. If, after making this Certificate of Exemption you should become
ZONE:
..BY:
subject to the Workers' Coinpensation piavisions of -the Labor Code,' you must forthwith
comply with such provisions or this permit shall be deemed revoked. -
Minimum Setback Distances:,
Frqnt 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 performance of the
. : I
work for which this permit is issued. (Sec. 3097, Civil Code.)
'Nam
Side Setback from Property Line
Lender's'
Lender's Address
FINAL.DATE
INSPECTOR
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 correct.
Issued by:
Date Permit
I agree to comply with all city',an'd county ordinances and state laws'relating to building
construction, and hereby authorize representatives -of 'this city to enter the''gbove-..
mentioned property for inspectiorV,purposes. . . .. / '
Signature Iti-7 1r JI '// 2 -)
. Validated by:
of applicant Date
Mailing, Address r 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. SO, FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP.IEOUIP.
DRINKING FOUNTAIN
SQ 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.000L 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,TEMIPERM
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/ac
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
i
PERMIT APPLICATION
City o1 La Duinta
Department of Building and Safety
This permit becomes void if work not commenced within 180 days from date o1 issuance. OR, it work Inas been suspended or abandoned for a period of 180 days.
CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE: This section need not be completed if
LICENSED CONTRACTORS DECLARATION: I hereby affirm that 1 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 h e 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 arid 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 o1 not more than five hundred dollars
❑ 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 sate. It, however, the
building or improvemm 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 o1 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
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. 8 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
APPLICANT NAME (L. F, M1)
JL C,nnstruction '
ADDRESS
P.O. Box 173
CITY/COMMUNITY/STAT MIP
' Nestor; CA 92053
JOB SITE ADDRESS/SPACE
CITY/COMMUNITY/STATE/ZIP '
La, Quinta, CA 92253
Boa
PAG
PAC
c
TWIN
RNG
SE
S
TRACTLOT
19903
Const. Fee
367.00
1 MoD
se
60.18
TRACT NAME
HORIZON PALMS
OWNER NAME (l, F. MI) General Management Corp. '
CONTRACTOR -FIRM NAME
J.L. Construction
ADDRESS
abosre
CITY/COMMUNITY/STATE/ZIP
PHONE a
LICNC 0
ARC/ENG FIRM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CITY/COMMUNITY/STATVZIP
Palm Smincrs. CA 92262
PHONE LIC14C e
323-7877
USE OF PERMIT
Single Family Dwelling
BL
with Ch=inity
ZON,
FSB
I SSE,
SSB
RSB
TOTAL •
'FEE
DEC
862.60
ZONE ORD e -
LOT SZ
END
SIDE
as
the permit is for one hundred ($100) 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: 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:
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 32, Grp 2 Art 2, Sec 341. Title 8.
C.A.C.)
❑ 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. 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: 1 certify I have read this application and state that
the information given is correct. l 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
ow
�1
Date
APPLNRMT'r
O 3,
5 2:�85
S:F.D.
Permit to construct
1247 sq. ft.
of
livincr area and 433 sq. ft. of gaage
as per approved plans.
mech. Fee
37.00
Plan Check Fee
307.96
Const. Fee
367.00
Elect, Fee
60.18
M Fee
5.46
Fee
85.00
_.PlumbiW
Infrastructure
862.60
105.72 DEP. PAID
756.88
*
agreemfint
with Ch=inity
t Department
TOTAL •
'FEE
862.60
h 1 L O) L J / 7 U 6 6 UN
ICINAN� F VALUATION 77,948.00