001520 (SFD)t� P.O. BOX 1504 00 1520
Building 78-105 CALLE ESTADO
Address 79-470 N* Sftwim pj4fte ,D'„ LA QUINTA, CALIFORNIA 92253
Owner
Mailing '
�.oD- BUILDING:' TYPE CONST:' "' -�- .. OCC' GRP.-
Address 1001 SiShM It. . Suite 2700 A.P. Number
City Zip Tel.
:...�� 96813: 1-400-367-5054Legal Description .. .
Contractor Project Description
• •e r w T H O
Address �.
�.�.B= 173
City , .. Zip . Tel..
State Lic. City
& Classif. s- Lic. # 237.
Arch:, Engr.;..
X64222
Designer,Hichma ASSM
Address. Tel.
iFrovw J.444 0 '
Size-. "• � Stories'
New Add ❑ Alter.❑
No. Dw.
Units .
Repair ❑ Demolition ❑
HARD COPY
City
Zip
State
palm smium
9,2262'
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 Business and Professions Code, and my license is in4ull.force and .
effect... /•/ .1�r S r . .. . . . . � C. _) .J
.. .. ..
.. SIGNATURE e.f i',d f Y- P .- .l f r J / ,>' DATE.
r
" OWNER -BUILDER DECLARATION f
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
Estimated Valuation
s�.� !� �yp�
'' A. a f .948.00.
.
- AMOUNT
.r . PERMIT - - '
the provisions of the Contractor's License Law, Chapter. 9 (commencing with Section 7000) of
' 'Division 3'of the Busiriess'arid 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
s �7
Plan Chk: Dep. - q
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
33qf. I/!�
Plan Chk. BBI. - `�/2.r2yg ,
Const.
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
Medh: 3;>.00
-
.
. '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
Electrical
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 85.00
❑ 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
- ^
S.M.I., - 5.46
• such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ..
• O I. am exempt under Sec. B.• & P.C. for this reason
- ...
Grading
-
Driveway Enc.
Date Owner
Infrastructure Defened pwfflm nt as a
with 0=. DM al. Dftwuw
WORKERS' COMPENSATION DECLARATION
" -1' 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
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
H
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 thg work for which this permit is issued, I'shall not '
employany 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
- I Hereby-affiim that there is'a construction -lending agency for the performance of the.
work for which this permit is issued. (Sec. 3087, Civil Code.)
Side Street Setback from Center Linc
'
Side Setback from Property Line
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. .• - .-
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 city to enter the - above-
mentioned mentioned property for inspectiorn Ourepoles.• 3f>f
Signature of applicant {r /d' i .ri' Date •�� ,ff ,i
Issued by: Date Permit
Validated by:
Mailing Address f / .'
Validation:
City, State, Zip ✓ '
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CARP. SQ. FT.
WALL SO. FT. ®
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM 1
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
WASHER(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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL :d
v
PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
This permit becomes void 11 work not commenced within 180 days from date of issuance. OR. If work has been suspended or abandoned for a period o1 180 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 3of 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 penally of not more than five hundred dollars ($500.):
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 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 imprdvemnt 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
builps 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. Q.
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/STATMIP
Nestor; CA 92053
JOB SITE ADDRESS/SPACE
CITY/COMMILMITY/STATE/V- —
La. QWnta, CA 9225
BOK
PAC
PRC
I C
TNN
MCI
SE
S
19903
LOT/�
Elect, Fee 60:18
Moo
I SS
21imbing Fee 85.00
TRACT NAME HORIZION P,AIM
LariQgement
OWNER NAME (L, F. MI) Gmeral MCi1LCorp • '
IR
CONTRACTOR -FM NAME
J.L. Construction
ADDRESS
aboxm
CITY/COMMUNITY/STATE/ZIP
abm
PHONE I
756.88
LICNC .
* agrewhnt
ARC/ENO i1RM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr..A212
CITY/COriMUNITY/STATE/ZI P
Palm rin s CA 92262
PHONE . LICNC .
323-7877
TOTAL •
FEE
USE OF PERMIT '
Sin le Familv Dwelling
Bl
ZON,
'FSS
SSe
SSB
Ass
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 o1
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 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, fafsework, or
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap a2, Grp Z An 2, Sec341, Title 8.
C.A.C.)
O As owner -builder, 1 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'tD do such work from that division.
O Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: 1 hereby affirm that there is a construction lending agency for the performance
o1 the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
I certify that' I have read Misapplication and state Mat 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 mQ, C n o
APOI�RMT �' DATE
H,
S.T.D.
Permit to construct 1247 sq. ft.
of
livincr area and 433 sq. ft. ofage
as per approved plans.
mech. Fee 37.00
Plan Check Fee 307.96
Const. Fee 367.00
Elect, Fee 60:18
cWT Fee 5.46
21imbing Fee 85.00
862.60
105.72 DEP. PAID
756.88
* agrewhnt
t Department
TOTAL •
FEE
862.60
H 1 L 4 L J L J
FINANCE
/7688 CK
VALUATION 77 T 948 .00