001515 (SFD)A.
..P.O. BOX 1504 N o .
Building 78-105 CALLE ESTADO
Address 79--4 »_ ! -y+i THt%a 'Ir- LA QUINTA, CALIFORNIA 92253
Owner
clme
r * BUIL`DING: -TYPE CONST. V P OCC: GRP: `
Mailing - . _.. . , _
Address 3.001 BL&M S$. SUite 2700 A.P. Number
City Zip Tel.
BMDIUI96833 Legal Description _...
.Contractor Project Description k7'2T .palm .
Address...... 146 ts iF� oideretial i71 tel .
P.O. baK 173
City. Tel.'..
92053 _M0 511 --
State Lic.
& Classif:
'Size.
city w
Lic. #
OM 1297
Sq. Ft.:
- -
No. No. Dw.
Stories Units,.
Arch., Engr:; ...... .. _ .. _.
Designer �� ..
Newfl Add ❑
Alter 0. Repair ❑.. Demolition
Address.
Tel. f
ZONE:
BY:
Minimum Setback
Distances:
City
Zip
State
.. JiC$iF'tt22
-
Lic. # ..
Side Setback from Property Line .
_
LICENSED CONTRACTOR'S DECLARATION
w
'Date Permit
I hereby affirm'tfiat I am licensed under provisions of Chapter 9 (commencing,with Sectioni
7000) of Division3 of, the Business and Professions Code, and my'license is in."full forcerand
effect.. .. 71. t/,, �- -- t` / 1. V
... .... .... ..
- .. .
_SIGNATURE --+Y A i s If - P Y f 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
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) o/ _
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 hundreddollars($500).-��
❑ 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, Buisne'ss and
Pro/essions 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' improvements are not intended or offered for sale. ,If, .however; the building..
or improvement 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.).' -,-.
Estimated ValuatlOn
�r n�,y
w . �.V�i'
.77IP
PERMIT, ..
- -
'-AMOUNT '
•R. -
- PIan;Chk --,Dep.
� .9�a
- 105.72
- 105.72
Plan Chk: Bal..
`� '
Const.
s00.
36700
� Mech..
-
r� q ,
'37.033
Electricals,
- - ��$$ _
Plumbing
$5100
❑.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
doesnot 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.)
[].I am exempt under Sec.. B. & P.C. for this reason -
S.M.I.
- `
Grading
Driveway Enc.
Date owner � �
Infrastructure
� �
� as agreomft _
.... ... _ .. . -
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. .O Certified copy ishereby furnished...
CERTIFICATE OF EXEMPTION FROM
_WORKERS' COMPENSATION INSURANCE .
(This section need not be completed if the permit is • /or one hundred dollars ($100) 'valuation
or less.)
I certify that in the performance of tha 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_1Owner'
NOTICE TO APPLICANT: If, after making this Certificate or -Exemption -you should become
subject - to the Workers' Compensation provisions or the Labor Code, you 'must- forthwith
comply with such provisions or this permit shall be deemed revoked..
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, Civil Code.)' "
Lender's .Name
Lender's Address
This is a building permit when properly filled out, signed'and validated, and is -subject to
expiration it work thereunder is suspended for 180 days. .
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 tobuilding
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date�'y
Mailing Address "'' 7) : _ ` r f
City, State, Zip 1
HARD COPY
TOTAL'
REMARKS
ZONE:
BY:
Minimum Setback
Distances:
Front Setback from. Center. Line
Rear -Setback from Rear Pro.p..Line
Side Street Setback from Center Line
Side Setback from Property Line .
FI,NAL.DATE
INSPECTOR
Issued by-
'Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. S0. FT.
WALL SO. FT.
SO 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
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEOUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
I TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
S0. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.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.IEOUIP.
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/NITIALS
GARDEN WALL FINAL
LICENSED CONTRACTORS •DECLARATI
(commencing with Section 7000) o1 Divi
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 3 of the Business and Professions Code) o r 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 penally 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 riot appy 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, Me
building or improvemnt is sold within one year of completion.1he 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 not 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
O Certified copy is hereby furnished.
0 Certified copy is filed with the City Building Inspection Department or City Department.
Date Applicant
PERMIT APPLICATION
City of La Duinta
Department of Building and Safety
This permit becomes void if work not commenced within 180 days from date of Issuance, OR, i1 work has been suspended or abandoned for a period o1 180 days.
CERTIFICATE OF EXEMPTION FROM WORKERSTOMPENSATIONINSURANCE: This section need not be completed if
ON: 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
sion 3ol the Business and Professions Code. and my license is in full force Issued. Ishall not employ any person inanymannersoastobecome subject to the Workers'Compensation Laws of
California.
APPLICANT NAME (L. F. MI) JL Cans L.1 Uctlon
ADDRESS
P.O. Box 173
CITY/COMMt)NITYSTATE/ZI P -
Nestor; CA 92053
JOB SITE AODRECS/SPACE
CITYICOW L1NITYSTATE/ZI P
La. ti CA' 92253
BOK
PAG
PRC
C
as r a roved plans.
TWN
RNO
SE
S
TRACT
19903
LOT
'
Q`
Plan Cbeck Fee
MOD
SS
Const. Fee
TRACT NAME
HORIZON PALMS
NAME ME (L. F. MI) (wneral Management Corp. '
CONTRACTOR•FIRM NAME
J.L. Construction
ADDRESS
above
CITY/'COMMUNITYSTATE/ZIP -
PHONE . '
5.46.'
LICNC 1
.Plimbina Fee
ARC/ENG FIRM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CITY/COMMUNITYSTATE/ZIP
Palm rin s CA 92262
PHONE a
323-7877
UCNC .
USE OF PERMIT
Sin le Famil Dwelling
BL
ZON,
FSB
SSS
SSB
-RSB
with Omminity
OFC
t
ZONE ORD .
LOT SZ
TOTAL .
FEE
END
SIDE
i
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 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 thirty-six (36) feet high. (Chap 3 2, Grp 2, Art 2, Sec341. Title 8,
C.A.C.)
0 As owner -builder, 1 will not employ anyone to do work which would require a permit from the Division o1
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 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 1 have applied for this permit for the purpose of making inspections.
Signature of Applicant or Agent Date
Print Applicant/Agent Name l)� 1. �/ / J
APPL/PRMT i 1-3
DATE
2-2=85
S.F.D.
Permit to construct
1247 sq. ft.
of
livingarea and 433
. ft. of
age
as r a roved plans.
mach. Fee
37.00
Plan Cbeck Fee
307.96
Const. Fee
367.00
Elect. Fee
60.18
SMT Fee
5.46.'
.Plimbina Fee
85.00
Tnfras
862.60
105.72 DEP. PAID
756.88
*
eint
a em
with Omminity
t De
t
TOTAL .
FEE
862.60
AIZ5/ 5 Z5 756,88 CK
FINANCE VALUATION 77, 948.00