001543 (SFD)R .�..
Building
Address 79-2187 S. &Mset
P.O. BOX 1504 No. . 543
78-105 CALLE ESTADO
idip D'. LA QUINTA, CALIFORNIA 92253
�" BUILDING TYPE CONST AT T4 OCC G !
' Mailing
Address 1001 BLSb= S-1`6: Mdta ZM
A.P. Number
"
City Zip
Tel.
Legal Description
.
.Cont ractorr
Project Description
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I
. .Address. ....
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.. Toed l,,,en . - ♦ � • .. .. -
1468i"Ya6i�
P.O. B= 173
' City
Zip....
._
TO.-
:..
Nastor
92053
340-5511
State Lic.
& Classif:..Q�
City
Lic. # 7
q , �
S Ft.r-#.1247No.
No. Dw.
_
-Size' QR. '•
Sto it ••
ries. --Units-.
Arch.,-Engr.,. .. .
• Designer,
a
New Add ❑
Alter ❑ Repair ❑ -.. Demolition ❑
Address
Tel.
City
Zip
State
.
Palm -ingS
92262'
—LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I amjlicensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of th{e Busi1ness and Professions Code, and my license is in full
effect. .
t�1 f „JJri...�
.. ..
SIGNATURE '.—,•" r, J i.! DATE
.. . ..
._
OWNER -BUILDER DECLARATION
Estimated Valuation.
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'.
-_
ls..l�lz
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 hems licensed pursuant to
--a. PERMIT
...
�` AMOUNT
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
-
Plan •Chk.. Dep."'
subjects the applicant to a'civil penalty of not more"than five hundred dollars ($500).'
Plan Chk. Bal.
2'i�2w-,� d.
compensation; will
O I, as owner'of-the property, ,ormy employees with wages:as their sole comp
do the work, and the structure is not intended or'offered for sale. (Sec. 7044, Buisness and
COf1St.
_
' '
. Professions Code: .The Contractor's License Law does not apply to.an owner of, property who
-builds or improveis'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 -
or improvement is sold within one year of completion, theowner-builder. will have, the burden
Electrical,
- -
• . , of, proving that he did not build or improveJor the purpose of sale.) _ - . _. -
.
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
QCae�,
• 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' whb contracts for
S•M.I.
5.46•
suchprojects-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.
InfraSVUCtUfe
as agreftralt
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
O Copy is,filed,with the city. ❑ Certified copy is hereby furnished.
TOTAL
862.6 79KER
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 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 ''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
complywithsuchprovisionsorthispermitshallbedeemed-revoked.
Minimum Setback Distances:
- -
.• _
Front Setback from Center Line
Rear Setback from Rear,Prop.:Line
CONSTRUCTION LENDING AGENCY
Side Street.Setback.frori Center Line`
hereby affirm that there is a construction lending agency for the performance of the
. .
• work for which this permit is issued. (Seca 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..
[,car tify that I have read this application and state that the above information is correct.
'city
Issued'by;'
Date Permit
I agree to comply with all 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-. -14 �t i- �:• .. • DateF
Mailing Address
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT. p
POR. SO. FT. ®
GAR. SQ, FT. ®
CAR P. SQ. 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.COOL 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.
SQ. 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 ® 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 —ANK
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.).
Policy No. Company
O Certified copy is hereby furnished.
O Certilied copy is filed with the City Building Inspection Department or City Department.
Date Applicant
APPLICANT NAME (L. F. MI)
JL Oxnstruc.-tion
ADDRESS
P.O. Box 173
CITY/COMYUNITY/STATE/ZIP
Nestor; CA. 92053
JOB SITE ADDRESSISPACE
CITY/C0MML1NITY/STATE/ZIP
La. to CA 92253
BOK PAG PRC C TNN FIND SE S
TRACT LO MOD SB
19903
TRACT NAME HORIZON P,ATMS
OWNER NAME (L. F. MI) lam.ial Management Corp.
CONTRACTOR -FIRM NAME
J.L. Construction
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE . LICNC .
ARC/ENG FIRM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
PHONE • I I LICNC •
USE OF PERMIT '
Single Family Dwelling
BL ZON• FSB SS8 .SSB I RSB J OFC -
ZONE ORD 9 LOT SZ END SIDE
Signature of Applicant or Agent - Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
the information given is correct.) 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
APPL/PRMT
5-22-85
S.F.D.
Permit to construct
1247 sq. ft.
of
livincr area and 433
sq. ft. of garatge
PERMIT APPLICATION
City of
La Duinta
Department of Building and Safety
This permit becomes void it work not commenced within 180 days from date o1
issuance. OR, if work has been suspended or abandoned for a period of 180 days.
Mech. Fee
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9
the permit is for one hundred ($100) o, less. I certify that in the performance of the work for which this permit is
(Commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
issued. I shall not employ any person In any manner so as to become subject tothe Workers'Compensation Laws of
and effect.
California.
License Class Lic. Number
Date Applicant
Date Contractor
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
be deemed revoked.
'following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
01 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend. will be
(Chapter 9(commencing with section 7000) of Division 3 o1 the Business and Professions Code) or that he is exempt
made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or
therefrom and the basis for the alleged exemption. Any violation o1 Section 7031.5 by any applicant for a permit
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2. Art 2, Sec341, Title 8.
subjects the applicant to a civil penalty of not more than five hundred dollars ($W.):
C.A.C.)
O 1, as owner of the properly, or my employees with wages as their sole compensation, will do the work, and the
D As owner -builder, I will not employ anyone to do work which would require a permit from the Division of
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License
Industrial Safety, as noted above, unless such person has a permit to do such work from that division.
Law does riot apply to an owner of property who builds, or improves thereon, and who does such work himself or
O Division of Industrial Safety Permit No.
through his own employees, provided that such improvements are not intended or offered for sale. II, however, the
building orimprovemntissold within one year ofcompletion, the owner -builder will have the burden of proving that
Date Applicant
he did not build or improve for the purpose of sale.).
CONSTRUCTION LENDING AGENCY: 1 hereby affirm that there is a construction lending agency for the performance
O I, as owner of the property, am excursively contracting with licensed Contractors to construct the project (Sec.
o1 the work for which this permit is issued (Sec. 3097, Civ. C.).
7044. Business and Professions Code: The Contractor's License Law does rat apply to an owner of property who
Lender's Name
builQs or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
Lender's Address
O 1 am exempt under Sec. B. 8 P.C. (Attached Certificate).
I certify that 1 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
Date Owner
of this county to enter upon the above-mentioned property for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell -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 Certilied copy is filed with the City Building Inspection Department or City Department.
Date Applicant
APPLICANT NAME (L. F. MI)
JL Oxnstruc.-tion
ADDRESS
P.O. Box 173
CITY/COMYUNITY/STATE/ZIP
Nestor; CA. 92053
JOB SITE ADDRESSISPACE
CITY/C0MML1NITY/STATE/ZIP
La. to CA 92253
BOK PAG PRC C TNN FIND SE S
TRACT LO MOD SB
19903
TRACT NAME HORIZON P,ATMS
OWNER NAME (L. F. MI) lam.ial Management Corp.
CONTRACTOR -FIRM NAME
J.L. Construction
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE . LICNC .
ARC/ENG FIRM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
PHONE • I I LICNC •
USE OF PERMIT '
Single Family Dwelling
BL ZON• FSB SS8 .SSB I RSB J OFC -
ZONE ORD 9 LOT SZ END SIDE
Signature of Applicant or Agent - Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that
the information given is correct.) 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
APPL/PRMT
5-22-85
S.F.D.
Permit to construct
1247 sq. ft.
of
livincr area and 433
sq. ft. of garatge
as pgr approved plans.
Mech. Fee
37.00
Plan Check Fee
307.96
Const. Fee
367.00
Elect- Fee
60.18
M Fee
.5.46.
.Plumbing Fee
85.00
Tnfrastructure
862.60
105.72 DEP. PAID
756.88
*Deferred paymnt
as = gqreembnt
t Department
TOTAL
FEE
862.60
A I L 6 Y ZS 75688 CK
FINANCE VALUATION 77,948.00