001537 (SFD)Building
Address
Owner
Mailing
Address
City
P.O. BOX 1504 No. 001537
79-252 S. � D,. 78-105 CALLE
LA QUINTA, CALIFORNIAORNIA 92253 •- • . -
(Zip Tel
Contractor
J.L. CmstntftJ !
Address s�.y .._ .
P.O. 3.6.E
City JZio - .- Tel
BUILDING: TYPE'CONST. V V OCC: GRP. R,3
,. A.P.,Number -
r
�.37,.�,51DS4 Legal Description
Project Description Harizim
State Lic.
& Classif.F
City
Lic. # 7,
1249
Size -=. _4 Stories .. " .. Units
Arch., Engr.; _
DesignerMidk-101- CiM �. Y
New [ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
}
....340 S. - ll St.
-.323,14877
City iZip
State
Dat i f Q122
Lic. #
' LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am,licensed under provisions of Chapter 9 (commencing with Section
_7000) of Division 3 of the BBusin�ress and Professions, Code, and my license is -in full force•and�
effect.}_ / 1P e� 1? ! f. f ! of
'
SIGNATURE - 1 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 r�
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. o/ Section .7031.5 by"any-applicant for a.permit
- 'subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ' '--' "•.
• p 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 o/•property who
'own
�7 �j��{ �/y.
Estimated Valuation., O I pTd•Did
0 � _
- - AMOUNT
PERMIT .+
.a -
. Plan.Chk. Dep: 3M.72
•
Bal. 4q�
Plan Chk: Ba� 2a24A*C
COrist. �� •
Mech. yy q
- 3 .00
builds, or improves thereon and who does such work himself or through his employees,
provided that such improvements are not intended .or offered for sale. I/, however, the building
-Electrical—*
f�tJ. ida
or improvement is sold within one year of completion, the owner -builder will have the burden,
-, o/ proving that he did not build or improve for the purpose of sale.).
Plumbing
O I, 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 I.am.exempt under Sec. B: 8 P.C. for this reason
" S.M.I.' - G�',wy�
Grading_
.. .
Driveway Enc.
Date owner.
Infrastructure n0fi=Vldat��� as
�yem
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. I' Company
❑ .Copy,is filed with the city. O.Certified copy is hereby furnished..
TOTAL - �;i 716.88
_
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 certify4hat in the performance of thg work for which this permit is issued; I shallnot•
employ any -person in -any -manner so -as to become subject to the Workers'•Compensation
Laws of California.
...
Date ' ' ' ' Owner "
NOTICE TO APPLICANT: ff,•after making this -Certificate of Exemption you should become
' 'subje6i' to the Workeis' 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'6 construction 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 permit when properly filled out, signed and validated, and is subject to
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.
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 abode.
• mentioned property for ifispe[ction purposes. d% }
Signature of applicant>�A' f %T'! Dae / , ` �_S 7
t
• Mailing Address �� i ,`
Issued -by'. Date Permit
Validated by:
Validation:
City, State, Zip
_
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINP FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO, FT, p
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. ®
GAS (ROUGH)
DRAINAGE PIPING
WALL S0. FT.
OTHER APP./EOUIP.
DRINKING FOUNTAIN
SO 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.COOL HOOD
SIGN
WASHER(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, 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 ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/4c
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
M'ECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
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 APP./EOUIP.
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
I NSU LATION/SOU N D
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
PERMIT APPLICATION
City o1 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.
LICENSED CONTRACTORS DECLARATION: 1 hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division Sof 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 3of 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 ($500.):
0 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 improvemni 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.).
0 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 riot 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.).
0 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 of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.)•
Policy No. Company
0 Certified copy is hereby furnished.
0 Certified copy is filed with the City Building Inspection Department or City Department.
Date Applicant
APPLICANT NAME (L. F. Mo JL Construction
ADDRESS
P.O. Box 173
CITY/COMMUNITY/STATE/ZIP
Nestor; CA 92053
JOB SITE ADDRESSISPACE - -
CITY/COMMUNITY/STATE/ZIP
La. to CA 92253
BOK
PAG
PRC
C
TWN
RNO
SE
S
TRACT
19903
LO��
Pleat, Fee 60.18
MOD
SB
Tlurrbiw Fee 85.00
TRACT NAME
HORIZIM PALMS
OWNER NAME (L. F. MI) General Management Corp.
n^
CONTRACTOR -FIRM NAME
J.L. Construction
ADDRESS
CITYR'.OMMUNITY/STATE/ZIP
PHONE O
756.88
LICNC
* a eemlint
ARC/ENG FIRM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CITY/COMMUNITY/STATE21 P
Palm Sminds, CA 92262
PHONE LICNC /
323-7877
TOTAL
FEE
USE OF PERMIT
Sin le Family Dwelling
BL
ZON,
FSB
SSB
SSB
RSB
I
OFC
ZONE ORD 0
LOT SZ
END
- SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
the permit is for one hundred ($100) o, less. I certify that in the performance o1 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: It. 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 thiny-six (36) feet high. (Chap 3.2, Grp 2, Art 2. Sec341, Title B,
C.A.C.)
11 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 o1 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 Date
Print Applicant/Agent Name 0 o,
APPL/PRMT DATE
Pennit to construct 1247 sq. ft.
of
living area and 433 sq. ft. of garage
as Per approved plans.
mech. Fee 37.00
Plan Check Fee 307.96
Const. Fee 367.00
Pleat, Fee 60.18
cmr Fee 5.46
Tlurrbiw Fee 85.00
862.60
105.72 DEP. PAID
756.88
* a eemlint
with rimminity t Department
TOTAL
FEE
862.60
A1LDY D z 5 75&88 CK
CINANf_F VALUATION F77,948.00