001525 (SFD)4 1. 1 - . . 6 ,
P.O. BOX 1504 No. 001525.
Building78-105 CALLE ESTADO
Address .79-442 R• Samaiss
MAP' Dr -LA QUINTA, CALIFORNIA 92253
Owner.
Gawrell. iumveamt ' ` '
BUILDING: `TYPE CONST. -'•'V R OCC: GRP. R 3
A,P. Number.
Legal. Description
Project Description r'wrivm Vmlnq
Mailing'.
Address' ifs St_, 2700
City
Zip �
Tel.
Contractor
Address....
F.O. 373
-
City. .. ."
Zip :Tel.'
State Lic.
City
& Classif...
a.
Lic. #
Sq. Ft.
No. No. Dw.
•.
Arch., Engr:, -
Size _M_433
Stories Units
Designer
New I* - Add ❑
Alter ❑' Repair ❑ : Demolition ❑
Address
Tel.
340
S'." Farrell
323-7877
City
Zip -
State
_ ....
122962
Licr#
• / 5j • .LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter (commencing with' Section
Division
,7000) of 3'of)t/he Business and Professions Code; and'my licenseis.ih full force and
effect.
! o'
SIGNATURE v„ f [ . _.. J DATE
.. ., ..
.. .. .. .. .. ..
OWNER -BUILDER DECLARATION
EStlmated Valuation
' I hereby affirm that I am exempt from the Contractor's License Law for the following
.qy �p �qp�
.� ! i�s"isV�f '
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
. vQ
requires.the applicant forKsuch permit to file a signed statement that he is licensed pursuant to
- - PERMIT.
- '. r AMOUNT
the provisions of the Contractor's License" Law, Chapter 9 (commencing with -Section 7000) of
.
Division 30f the'Business`and'Professions Code, 'or.that. he is exempt therefrom, and the basis-
• -alleged Any Section 7031.5 for
Plan-.Chk. D.ep:
for the exemption. violation of by'any applicant a- permit
subjects the applicant to a civil penalty of not more than five.hundred'dollars ($500):
Plan.Chk.
202.24do
❑ I, as owner of the property, or my employees with wages as their sole compensation,; will
.Bal.
-
the work, and the structure is not intended or offered for sale. (Sec: 7044; Buisness and
COhSt.
` e�• p�lyq
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,
Mech..
- -
provided that'such. improvements are -not intended or offered .for sale. If, however,, the. building
orimprovement is sold within one year of completion, the owner -builder will have. the burden
_7->
Electrical
-
of proving that he did not build or improve for the purpose o/.sale.), ,.
��,
❑ I,:as ownerof the property, am exclusively contracting with licensed contractors to con-
Plumbing
--00
struct the project. (Sec. 7044; Business and Professions Code: The Contractor's Lrcense..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. 8 P.C..Grading for this reason
•
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have'a certificate of consent to'self-insure, of a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
0 Copy is filed with the city. ❑ Certified copy is hereby furnished.
-.
TOTAL
_
• CERTIFICATE OF EXEMPTION FROM
REMARKS
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 -
BY:
' ..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:
Minirriurri.Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
hereby 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.Li.ne' - -
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.
-
1 -certify that I have read this application.and state that the'above information is correct.
"county
Issued by:
Date - Permit
agree to comply with all ciy,and ordinances and state .laws relating to building
construction, and hereby authorize representatives -of- this city to' enter the above-. ..
mentioned property for. inspection purposes.
Signature of applicant` . !J !7 • Date
Validated by:
Mailing Address �� "� �`'
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. @ $
UNITS
SLAB GRADE
2ND FL. SQ. FT. g
_
YARD SPKLR SYSTEM
POR. SQ. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT, @
POWER OUTLET
ROOF DRAINS
CARP. SQ. FT. �o�
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT. @
OTHER APP./EQUIP.
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
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. Fr. p c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE, DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® V4c
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 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 SIGNATURES/INITIALS.
GARDEN WALL FINAL
PERMIT APPLICATION ;
City of La Duinta
Department of Building and Safety
This permit becomes void it work not commenced within 180 days from date of Issuance. OR, If work has been suspended or abandoned for a period of ISD days.
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
(commencing with Section 7000) of Division 3ol 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 1 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 3 of the Business and Professions Code) or that he is exempt
therefrom and 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 of not more than five hundred dollars (MM.):
0 I, as owner o1 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. It, 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 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
builgs 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. 3000. Lab. C.).
Policy No. Company
❑ 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. MI) JL Construction
ADDRESS
P.O. Box 173
CITY/COMMUNITY/STATE/ZIP
Nestor, CA 92053
JOB SITE ADDRESS/SPACE
CMY/COM4UNITY/STATE/ZIP .., _... ....;_:,._, :._. ,.-. _. ....... ......
La.Quinta, CA 92253
BOK
PAG
PRC
I C
Thm-bing Fee 85.00
TWN
RNG
SE-
S
TRACT
LO�
, j
TOTAL •
'FEE
MOD
SB
19903
~t
TRACT NAME HORIZON PALMS
OWNER NAME (L. F. MI) Cbneral Management Corp. '
CONTRACTOWFIRM NAME
J.L. Construction
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
PHONE a
LICNC e
ARC/ENO FIRM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CITY/COMMUN ITY/STATE/ZI P
Palm springs, CA 92262
PH014E LICNC 0
323-7877
USE OF PERMIT '
Single .Farni1v Dwelling
BL
I
ZON,
FS8
SSB
SSB
RSB
OFC
ZONE ORD 0
1
LOT SZ
END
SIDE
1
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: 11, 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 I 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 3.2, Grp 2, Art 2, Sec 341, Title e.
C.A.C.)
0 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 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 herebyauthorize representatives
of this county to enter upon the above-mentioned property for inspection purposes.
Signature o1 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. l agree to comply with all state laws and county ordinances relating to buidling
construction, and authorize a' representative o1 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 %,o `ta 5
Date
APPL/PRMT _ - DATE
5-22=85 S.F.D.
Pennit to construct 1247 sq. ft. of
livinq area and 433 sq. ft. of qarage
as Per a roved plans.
mech. Fee 37.00
Plan Check Fee 307.96
Const. Fee 367.00
Elect, Fee 60.18
T Fee 5:46
Thm-bing Fee 85.00
Tnfrastructure
862.60
105.72 DEP. PAID
756.88
*Deferred payMent as = a eewdmt
with r-cainmit'y rit Department
TOTAL •
'FEE
862.60
H 1 L 4/ 7 L
FINANCE VALUATION 77,948.00