001539 (SFD).. f • ..
' . Qum'&
P.O. BOX 1504 N o . 001539
78-105 CALLE ESTADO
Address 79-282 S. SMSISt RUIP D'• LA QUINTA, CALIFORNIA 92253
Owner
BUILDING: TYPE CONST. V N OCC: GRP: -R-3
Mailing _
Address1001- � �} t _ , , -A:P. Number
City Zip Tel.
Q ,.%Soo-, - .• Legal Description
Contractor Project Description -
Address
P.O. 173
'City' ......_. .... Zip Tel...
r 920 3. 340€ 55U r »
State Lia City
& Classif. 44m.22Lic. # 237 Sq. Ft. 5247 No. No. Dw.
• Size' -GM- 433-. -Stories. -Units.
Arch., Engr., ....
Designert New 0 a Add .0 .Alter ❑ :-•... Repair ❑ - Demolition ❑
facbmi .
Address Tel.
U_.r qt-_ 322-79"
City Zip State
'elm . 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 Businessp-and, Professions, Code, and my license Win full forrce;and
effect..... f 1 1 r ri f ,% •-i ! '�i _
SIGNATURE r J - J 'DATE -
OWNER -BUILDER DECLARATION'
I hereby.affirm that 1 am exempt -from the Contractor's License Law for the following. Estimated Valuation
reason: (Sec, 7031.5,Buslness and Professions Code: Any city or county .which -requires,• a
p _ •s [ - .3r+++.5i�
ermit to construct, alter, Improve; 'demolish, or repair any structure, prior to its issuance also AMOUNT
requires the applicant for such permit, to file a signed statement that heas'licensed pursuant .to PERMIT -
the provisions of the Contractor's License Law, Chapter 9 -:(commencing with Section 70001 of -
Division.3'of the -Business' and Professions Code, or that, he is exempt 4herefrom,' and the basis
for the •alleged exemption.. Any violation of Section 7031.5 by 'any- applicant for a permit Rlan Chk. Dep.,
.. subjects the applicant to a civil penalty ofnot more than' live, hundred dollars ($500):
Plan Chk. Bal.
O 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 forsale. (Sec. 7044, Buisness and /�
Professions Code: The Contractor's License -Law does. not 'Const, apply to an of.property who 36T. -OT
.
builds or improves theieon and who does such .work himself or through his own. employees, ':Mech. �q p .
' provided that' such improvements are, not intended or offered' for sale: If, however,: the building - 3S a0W
or improvement is sold within one year of completion,, the owner -builder will have the burden Electrical '
of proving that he did not build or Improve for the purpose of,sale.) , - , r' o As ..
O I, 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
does not apply to an owner of property who. builds or .improves thereon, and who contracts for . ' S.M.I:
such projects with a contractor(s) licensed pursuant to the Contractor's.License Law.) • -
❑ I am exempt under Sec. B. & P.C. for this reason. Grading
-
Driveway Enc.
DateOwner Infrastructurew�
with im., Dewl.
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
O Copy is filed with.the city. O,Certified copy is hereby furnished.'
TOTAL N2.60 75.88
CERTIFICATE OF EXEMPTION FROM REMARKS.
WORKERS'.COMPENSATIONINSURANCE
(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 thg work for which -this permit is issued, I shall not e .
employ any person in any manner so as to become subject to'the Workers' Compensation '
Laws of California.
Date ' Owner
NOTICE TO APPLICANT: If, aper 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 lendind.agency for the performance'of 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
agree to comply with all dity*and county ordinances and slate laws relating to building `
construction, and hereby authorize representatives. -of this city to enter the"above.
mentioned property for.inspeectior
jn purposes. //%� Validated by:
Signature of applicant ! l �f` f V-1.1,
Date^
Mailing Address ' ' f Validation:
City, State, Zip ✓
ti
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
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.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
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.
SQ. 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 TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
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
1;'
PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
This permit becomes void it work not commenced within 180 days from date of issuance. OR. It work has been suspended or abandoned for a period o1 180 days.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
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. MIA 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 sect ion 7000) of Division 361 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.):
❑ 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. 7004. Business and Professions Code: The Contractor's License
Law does not apply to an owner o1 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 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.).
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 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. MI)
JL Construction
ADDRESS
P.O. Box 173
CITY/COMMUNITY/STATE/ZIP
Nestor; CA 92053
J08 SITE ADDRESS/SPACE
CITY/COMMUNITY/STATE/ZIP -
La. to CA 92253
BOK
PAG
PRC
C
mech. Fee 37.00
TMM
RNO
SE
S
19903
LD%,
SM Fee 5.46
MoD
I sa
TRACT NAME HORIZON PALMS
OWNER NAME (L. F. MI) General Management Corp. '
CONTRACTOR -FIRM NAME
J.L. Construction
ADDRESS
CITY/COMMUN ITY/STATE/ZI P '
PHONE .
LICNC .
t Departirient
ARC/ENG FIRM NAME
Michael. Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CITY/COMMUNITY/STATE/ZIP
Palm in s CA 92262
PHONE • LICNC •
23-7877
USE OF PERMIT
Single Familv Dwelling
Bl
ZON,
FSB
SSB
SSB
RSB
OFC
ZONE ORD a
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,) 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 shalt
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 hereby certify that no excavation live (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 Z Art 2, Sec 341, Title B,
C.A.C.)
❑ 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.
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. Q.
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 I 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 [
`Date
APPLMRMT '.!!. - 'r K DATE
T 5-2-2=85
'
S.F.D.
Permit 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
Meat- Fee 60.18
SM Fee 5.46
.1ilimbim Fee 85.00
Tnfrastructure
862.60
105.72 DEP. PAID
756.88
* 4greentint
t Departirient
TOTAL .
FEE
862.60
AIZ61. 5 Z3 756,88 CK
FINANCE VALUATION 77,948.00