001441 (SFD)4, : i •
44
P.O. BOX 1504 .N o .
Building�,g �,�, 78-105 CALLE ESTADO
Address 79-307 So �. M". LA OUINTA, CALIFORNIA 92253
Owner
Mailing '
Address ion Bid=st$� 27oo
City Zip Tel.
alQ
Contractor
e T. frllaiarratyta4t5re
Address. .. _. .... q
Pao. 173
City JZi0 Tel. -
State Lic.
& Classif.:,AAW
Arch.; Engr.,
Designer MiAt
Address
_ .. 340
City
!Aa 4tts? 4�r
I hereby affirm that I.
7000) of Division 3 of t
effect... .. ,
BUILDING:•TYPECONST•. OCC:GRP. ,.R.'3
A.P. Number
;367�-SOLegal Description
Project Description Horizon Pal r
.146 MAto ReSid2ntiAl Duml-
I City .
I Lic. # 237
-1 $IMIXiM, ASSoaa
Tel.
17 -.. 323-7877
Zip State
i 4".'%�� Lic..# .. ..
CENSED CONTRACTOR'S DECLARATION
under provisions of Chapter 9 (commencing with Section
and Professions Code, and my license. is%in full force and
Sq. Ft.= 1247• No. No. Dw.
Size • 41,%k Stories Units '
New T -Add ❑ Alter ❑ . ' Repair ❑_ - Demolition ❑ . •.
OWN EA. BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the followings
Estimated Valuation
t3�e �A
7�t8�11tJ
reason: (Sec.-Z031:5.,By iness and Professions Code: Any•clty or county; which requires a
-
PERMIT
-
.. - •' AMOUNT
- permit to construct, alter, improve, demolish, or repair any structure, prior Wits 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 withv Section 7000) of
' Division 3 of.the'Business and Professions' Code, or that. he is exempt therefrom;- and'tne 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'thanfive hundred dollars ($500): •' "' ' .
- p p y, or my employees'with as their sole compensalion,:will.Q
❑ 1, as owner of the property,
016n,Chk: Dep.'
J05.72
Plan Chk. Bdl.
-
C6'hst.'
- '
do -the work, and the structure isnot intended or.offered for sale. (Sec:. 7044, Buisness'and
Professions Code: The Contractor's License Law does. not apply .to an owner -of property who -
MBCh
.,
builds. or improves thereon and who does such work himself or throughhis own employees,
provided that' such improvements are .not intended. or offered: for sale: If, however, the building _
Electrical'
—
orimprovement 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-
Art - (10
O 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.1.-
_46 -
Grading
Driveway Enc.
Date Owner,
_Infrastructure
yf.
`0n1C^m°«3'•^ 10 Bi`
tV
WORKERS' COMPENSATION DECLARATION '
Thereby' 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: O Certified copy is hereby furnished.
TOTAL
Qr. - em
.
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.) .. ..
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 '
' 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
Side Street Setback from Center-Llne
Ihereby affirm that,there is'a construction lending 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
expiration.if work thereunder is suspended for 180 days.
.FINAL.DATE
INSPECTOR '
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 enterthe above.
mentioned property for insfctiopnpurposes. f #
Signature of applicant Date TT
Issued by:
Validated by:
Date Permit
Mailing Address "� /
Validation;
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES'
IST FL. SO. 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
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APPJEQUIP.
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.000L 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, 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.
SQ. FT. RESID ® 1 % c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.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 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 SIGNATURES INITIALS
GARDEN WALL FINAL
.r S
Ie.
PERMIT APPLICATION
City of La Dulnta
Department of Building and Safety
This permit becomes void if work not commenced within 180 days from date of issuance. OR, II work has been suspended or abandoned for a period of 160 days.
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed it
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9
the permit is for one hundred ($100) o, less. l certify that In the performance o1 the work for which this permit is
(commencing with Section 70DO) of Division 3 of the Business and Professions Code. and my license Is In full force
Issued. I shall not employ any person Inany manner so as to become subject tothe Workers'Compensation Laws of
and ellect.
California.
License Class Lic. Number
Date Applicant
Date Contractor
NOTICE TO APPLICANT: IL 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
'following
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
be deemed revolted.
reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to
I AND
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 Sof 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 of Section 7031.5 by any applicant for a permit
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 32, Grp 2. Art 2. Sec 341, Title 8.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
C.A.C.)
O I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
O 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 not apply to an owner of property who builds, or improves thereon, and who does such work himsell or
*neferred pa=mt as Re=r ggremtnt
through his own employees, provided that such improvements are not intended or offered for sale. If, however, the
O Division of Industrial Safety Permit No.
building orimprovemntissold within oneyearofcompletion, the owner -builder will havetheburden ofprovingthat
Date Applicant
he did not build or improve for the purpose of sale.).
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
O I, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec.
of the work for which this permit is issued (Sec. 3097, Civ. C.).
7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
Lender's Name
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
USE OF PERMIT
Sin le Fami1v Dwellincr
Contractor's License Law.):
Lender's Address
O 1 am exempt under Sec. B. 8 P.C. (Attached Certificate).
1 certify that I have read this application and state that the above information is correct. I agree to comply with all '
Date Owner
`city and county ordinances and state laws relating to building construction, and hereby authorize representatives
SSB
01 this county to enter upon the above-mentioned property for inspection purposes.
WORKERS' COMPENSATION DECLARATION: 1 hereby affirm that I have a certificate of consent to self -insure, or a
DEC
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.)•
Signature of Applicant or Agent Date
Policy No. ' Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify 1 have read this application and state that
O Certified copy is hereby furnished.
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling .
O Certified copy is filed with the City Building Inspection Department or City Department.
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.
Date Applicant
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPLICANT NAME (L. F. MI)
JL Construction
ADDRESS
P.O. Box 173
CITY/COMMM ITY/STATE/ZIP
Nestor; CA 92053
JOB SITE ADDRESS/SPACE
Lv
CITYPCOMMLRIITY/STATE/ZIP -
La. Qainta, CA 92253
am
PAG
PRC
I C
TWN
I AND
SE
L
1TRACT 3
LDT/]�/
SMI Fee 5.46.
MOD
so
Tnfrastructure
TRACT NAME
HORIZONtPtt��lN.l.',S .
OWNER NAME lL. F. MI) Gwie ,,al 1•JanagP.Il mt Coif • '
l�liGl
CONTRACTOR -FIRM NAME
J.L. Construction
ADDRESS
abimm -
CITY/COMMLINITY/STATE/ZIP
abQm
PHONE .
*neferred pa=mt as Re=r ggremtnt
LICNC e
ARC/ENG FIRM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CITY/COMMUNITY/STATE/ZIP
Palm Springs, CA 92262
PHONE . LICNC .
323-7877
_
USE OF PERMIT
Sin le Fami1v Dwellincr
BL
ZON,
Fsa
Sao
SSB
RSO
DEC
ZONE ORD .
LOT SZ
-ENO
SIDE
APPL/PRMT,,DATE
,; ��� 5-22=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
Elect - Fee 60.18
SMI Fee 5.46.
.Plunbing Fee 85.00
Tnfrastructure
862.60
105.72 DEP. PAID
756.88
*neferred pa=mt as Re=r ggremtnt
t Departnent
TOTAL `.
FEE
862.60
N 1 1 7 7 7 L
FINANCE VALUATION 77, 948.00