001526 (SFD).7
P.O. BOX 1504 N o . DO ,� .
Building 752 s. � P� Dia LA QUINTACCALIFORNIAALLE 92253 .
01526
Address '
Owner
Mailing
Address
City
Contractor
Address
City
1
State Lic.
BUILDING: TYPE CONST. . , OCC: GRP; R3
1001 WAZO St. Suite 2700 _ A.P,_NumbeC��
Zip Tel.
U_
.96813 1-800--367-50!54 Legal Description
Project Descriptionl��
0.0. B= 173.... `. .....
Fz
ip Tel...
& Classif. 442822' LLic. # 237
Arch.,-Engr.
Designer NiChMl EaotdW .
Address Tel.
340 •Si. Pam. '323-787. 7-
City Zip State
-AIM 1iP� Lic. #. ..
t LICENSED CONTRACTOR'S DECLARATION , "
Ihereby affirmytliat I am licensed under provisions of Chapter 9 (commencing with'Seclion '
7000) of Division�3 of.the Business and Professions Code; and my license is in full force and
effect. .... f j ! !..J .)
DIM 1247
Sq. Ft. '(;M 431. No. - No. Dw.
Size Stories Units
New Add .0. Alter ❑, Repair ❑
-Demolition O
_SIGNATURE 4. A DATE s i' - •: .� 1
_ ...
. .. ... .. .. ... .. ...
OWNER -BUILDER DECLARATION" ° '
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
- Irequires.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 30/ the Business and Professions Code, or that. he is: exempt therefrom, *and the basisDe
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 Jive hundred dollars ($500).'
. , .O I, as owner of the property, or_my employees with -wages as their sole. compensation, will ..
Estimated Valuation
�t �qft
i UOsLii/ '
..
PERMIT
- i+•
- AMOUNT
'
Plan Chk. p..
- -
-
Plan,Chk. Bal:
�q "
2M.-24
Const.
� "f .� ..,
• .
.do the•work, and the structure is not intended oroffered for sale. (Sec. 7044, Suisness and
. Professions; Code: The Contractor's License Law does not apply to an owner of property who .:
-Mech. -
g��9
_ .a8lW .
builds'or improves thereon and who does such work himself or through his own employees,
provided that' such improvements are not intended or offered /or sale. If, however, the building
Electrical'
, G!
or improvement is sold within one year o/.completion,the owner -builder. will have the burden•
. of proving that he. did not build or improve for the purpose of sale:); •
Plumbing ..
.85 s �
❑ 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
does not apply to an owner o/ 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. 13.4 •'P.C. for this reason '.
Grading
Driveway Enc.
Date owner
Infrastructure
DOMMOd wrym as allgemmt'
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. (Seca 3800, Labor Code.)
' Policy No. Company
. . ❑ Copy is filed with.the city. O Certified copy is hereby furnished.
�
TOTAL
.
962*60 756-.88
' CERTIFICATE OF EXEMPTION FROM
WORKERS' COM PEN SATION 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 any person in -any manner so as to become subject to the' Workers' Compensation
Laws of California.
r
" 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 affirm fhafthere is a construction 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
FINALDATE
..
INSPECTOR
-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 relatingAb building.
construction, and hereby, authorize representatives -of • this city to. enter the •above=:
mentioned property for in�s}pectti& purposes. j•
" Signature of applicant •moi ,j1104r` ( .` Date
Mailing Address
City, State, *Zip f
•Issued by:.
'
Validated by:
Validation:
- Date Permit -
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. � SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. p
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM 1.
BAR SINK
I 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 APPJEOUIP.
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 -ANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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
I
r.-
�' PERMIT APPLICATION
City o1 La Duinta
Department of Building and Safety
This permit becomes void i1 work not commenced within 180 days from date o1 issuance. OR, if work has been suspended or abandoned for a period of 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 o1 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
(commencing with Section 7000) of Division 3 of the Business and Professions Code. and my license Is in full force
- Issued. I shall not employ any person in any manner so asto become subject to the Workers' Compensation Laws of
and effect.
.
California.
License Class Lic. Number
Date Applicant
Date Contractor
NOTICE TO APPLICANT: If, after making this Certificate o1 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
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall
be deemed revoked.
following reason (Sec. MIA 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
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
.❑ 1 hereby certify that no excavation five (5) or more feet in depth into whicha person is required to descend, will be
(Chapter 9(commencing with section 7000) o1 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 o1 Section 7031.5 by any applicant for a permit
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2. Art 2, Sec 341. TitleB,
subjects the applicant to a civil penalty o1 not more than five hundred dollars ($500.):
C.A.C.)
O I, as owner o1 the property, or my employees with wages as their sole compensation, will do the work, and the
❑ 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 riot apply to an owner of property who builds, or improves thereon, and who does such work himself or
❑ Division of Industrial Safety Permit No.
through his own employees, provided that such improvements are not intended or offered for sale. if, however, the
building orimprovemntissold within one year ofcompletion. the owner -builder will havethe burden of provindthat
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 o1 the property, am exculsively contracting with licensed contractors to construct the project (Sec:
o1 the work for which this permit is issued (Sec. 3097, Civ. C.).
7044. Business and Professions Code: The Contractor's License Law does riot apply to an owner o1 property who
Lender's Name
builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the
Contractor's License Law.).
Lender's Address
O 1 am exempt under Sec. B. 8 P.C. (Attached Certificate).
I certify that I have read this application and state that the above information is correct. I agree to comply with all
Owner
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
Date
of this county to enter upon the above-mentioned property for inspection purposes.
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. 3600. Lab. C.).
Signature of Applicant or Agent Date
Policy No. Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify l 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 .
D Certified copy is filed with the City Building inspection Department or City Department.
construction, and authorize a'representative of the City of La 0uinta 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
APPLICANT NAME (L. F. MR
JL C mstruction
ADDRESS
P.O. Box 173
CITY/COMMUNITY/STATE/ZI P
Nestor; CA 92053
JOB SITE ADDRESS/SPACE
CITYICOMMLIN1TY/STATE/ZIP . v
La.Q!A ta, CA 92253
BOK PAG I c — RNo sE
199 03 LOT Moo se
TRACT NAME
HORIZON PALMS
OWNER NAME (L. F. MI) General Management Corp. '
CONTRACTOR -FIRM NAME '
J.L. Construction
ADDRESS
CITY/COMMLINITY/STATE/ZI P
ab=
I PHONE . . I LiCNC e
ARC/ENG FIRM NAME
ADDRESS
0 S.
PHONE • .I 1 LICNC 9
USE OF PERMIT '
Sin le Family Dwelling
BL ZON, FSB SSB SSB RSB DEC
ZONE ORD • I LOT SZ I END SIDE
Print Applicant/Agent Name ^ O'
APPLIPRMT --- r4 5 TE
S.F.D.
Permit to construct 1247 sq. ft.
of
living area and 433 sq. ft. of garaige
as per approved plans.
mech. Fee 37.00
Plan Check Fee 307.96
367.00
Elect, Fee 60.18
SM Fee 5.46
.21imbing Fee 85.00
Infrastructure
862.60
105.72 DEP. PAID
756.88
*neferred pa=ant as = ggreembnt
t Department
TOTAL •
FEE
862.60
A i L 4 6 D LS /56,88 CK
FINANCE VALUATION F77,948.00