001518 (SFD)ce
amra
P.O. BOX 1504 NO.
Address 79---450. Js?. E4�* 1*,.. LA QUINOTACCAL FORNIIA 92253
Owner � :... . _ .. . __. .. - .. ....
GMOMI`aaa fes. ;
Mailing,
BUILDING• TYPE CONST V W OCC GRP P. •� •
Address 101 &Ukvp St,. SUite 2700 ,
City Zip Tel.
flowidlu 90813 1 801¢x 367-rSQ54
Contractor
Z.L. 0
.. Address
92053
340-55U
A -.-P. Number
Legal Description
Project. Description Ebri= Palm,
.State Lic.
& Classif:.,. 442M
City
LiC. # 237
'
Sq. Ft 5Z.
Size GM -M
No. No. Dw.
Stories - - - Units •• - •
Arch., Engr.,
Designer p
New -9 Add ❑
Alter ❑; Repair ❑ Demolition ❑
Address
Tel.
340 S. - W7=L
323 r` M . .
CityZip
State
Pa3m �S
i. x2262
Lic. #
-7 LICENSED CONTRACTOR'S DECLARATION
1.
,
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 foice and
,.. effect. .t �✓ /n- 7. fir^ 1 `3 4�• .
1 /
. .
•
SIGNATURE I DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the dollowing
reason: '(Sec.. 7031.5, Business and Professions • Code: Any, city or county. which.. requires; a
'perinit. to construct, alter, improve, demolish, or repair any structure, prior. to its issuance also
• requires the applicant for such permit to rile a signed statement that he is licensed pursuant. to
=visionsof the Contractor's License Law, Chapter' 9' (commencing with Section 7000) of
' Divisioh'3 -of 'the Business and' Professiohs 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 .($500).
❑ 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, Buisness and
Professions Code: The Contractor's License Law does not ,apply' to an:owner of "property who
Estimated Valuation .
a•-•
PERMIT.. - 4; ' 'AMOUNT •
-
..
':Plan Chk..Dep.. . . '105572
- .. ..�G.
'Plan. Chk., Bal.. 2. 24
Const... �rp
6 «07�a
- Mech. -'
' ' • '�' ."- .�
builds. or impioves theieon and wtio does such work himself'or through his own employees,
,- provided that.such improvements are not intended or offered.for sale..lf, however, the budding
'ElectrlCdl>
.
«
.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 or sale.)
Plumbing
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
slruct 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 contractors) licensed pursuant to the Contractor's License Law.) •
.0.1 am exempt under Sec..B. . B. & P.C..for this reason
S.M.I:
_ • .
•�>
Grading
-
Driveway Enc.
Date ' owner
Infrastructure
Elefimaed .pqpeni as agremamt
Wtti' .. ',L D12MIDWr
WORKERS' COMPENSATION DECLARATION
' I hereby affirm that I have a certificate of consent to self: insi ie,%or a.certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. w ., - Company -
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. .
TOTAL
862.60 756.88
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 anyperson 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 r
• I hereby affirm that ;there is a oonstructiori lending agency for the performance of the
- work for which this permit is issued. (Sec. 3097, civil code.). - .. .•
Side Street Setback from Center. Line '
'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 slate that the above information is correct.Issued
I agree to comply with'all city 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.
Signature of applicant .f,iT- ia" f t • a. Dater f'> f£
Mailing Address- f 7'
by:
--. •
Validated b
y .
Validation:
Date ' Permit
- -
City, State, Zip %
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT, ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP.IEQUIP.
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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.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 APP.IEQUIP.
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
PERMIT APPLICATION
tj City of La Ouinta
Department of Building and Safety
This permit becomes void if work not commenced within 180 days from date of issuance. OR, If work has been suspended or abandoned tot a period of 180 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
(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. 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 (S50O.):
O 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. 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.
7004, 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. 8 P.C. (Attached Certificate).
Date Owner
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 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/STATMI P
Nestor; CA 92053
JOB SITE ADDRESS/SPACE
CITY/COMMUNITY/STATE/ZIP - - -
La. to CA 9225
BOK •
PAG
PRC
C
TNN
FIND
SE
S
TRACT
19903
LOT/
1TRACT
71
Moo
SB
.Plimbing Fee 85.00
NAME
HOMON
tPutI.�T.,M.,S Corp. OWNER NAME (L. F. MI) 'General Mamge t Corp. '
l�liC.l
CONTRACTOR -FIRM NAME .
J.L. Construction
ADDRESS
above
CITY/COMMUN ITY/STATE/ZI P
abipme
PHONE •
756.88
LICNC It
,
ARC/ENG FIRM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CITY/COMMUN ITY/STATVZIP "
Palm Springs, CA . 92262
PHONE •
323-7877
LICNC It
USE OF PERMIT
Single Family Dwelling
BL
ZON,
.
FSB
SSB
SSB
'RSB
'OFC
ZONE ORD •
LOT SZ
END
SIDE
the permit is for one hundred ($100) o, 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 Applicant
NOTICE TO APPLICANT: If, after making this Certilicat; 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:
• O 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 32, Grp 2. Art 2, Sec341, Titlell,
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.
O Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm tha; there is a construction lending agency for the performance
of the work for which this permit is issued (Sec. 3D97, 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 I have applied for this permit for the purpose of making inspections.
Signature of Applicant or Agent Date
Print Applicant/Agent Name / 9
nh11 �/Cl
APPIJPRMT. i6 DATE 22=85
S.F.D.
Pemit to construct 1247 sq. ft.
of
living area and 433 sq. ft. of gaage
as per approved plans.
Mech. Fee 37.00
Plan Check Fee 307.96
Cons t. Fee 367.00
rJect- Fee 60.18
RVE Fee 5.46
.Plimbing Fee 85.00
Tnfrastructure
862.60
105.72 DEP. PAID
756.88
* agreembnt
With crffrrnmit�z t Department
TOTAL
'FEE
862.60
A I L 4 U D ZS 75&88 CK
FINANCE VALUATION ' 948.00