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001528 (SFD)for P.O. BOX 1504 N.O. 001528 Building7� 78-105 CALLE ESTADO Address OA OUINTA, CALIFORNIA 92253 Owner BUILDING: TYPE -CONST. VR -OCC -GRP.. Mailing Address 101 Biedbop St. Suite 2 A.P. Number City Zip Tel. 1WAMD1U1U 968 g..� a .. �,,.r Legal Description Contractor •� O ... Project Description l7.£�w - .Address...... WW 171 City. Zip. Tel.... . 9205: 340-55U, State Lic. City ���, & Classif. 442922 Lic. # 237 r Sq. Ft. No. No. Dw. Arch:, Engr., Size • 433 - --Stories Units . Designer 106mel aia6ln6 -�6 New:[ Add ❑ Alter ❑." Repair ❑ Demolition ❑- Address Tel. 1A n 1 1714-7Q77 City Zip State Palm 322Q - Lic: # ...- , . _. LICENSED CONTRACTOR'S DECLARATION " I hereby affirm that 1 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. tt. ! DATE .. . , . _ .. .. OWNER:BUILDER DECLARATION Estimated Valuation hereby affirm that I am exempt.from the Contractor's License Law for the following$90600 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_R- requires the applicant for. such permit to file a signed -statement that. he is licensed pursuant to PERMIT - -u AMOUNT - the provisions or the Contractor's License Law, Chapter 9 (commencing with'Section 7000).of- : • .>.z - Division 3 V the Business and 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 . Plan -Chk. Dep. -� subjects the applicant'to a"civil penally of not more than rive hundred dollars -($500). :. - - - ❑ 1, as owner of,the "property, or my employees with wages -as their compensation,.will Plan Chk. bal. _ %T -U do the work, and the- structure is not intended or offered for sale. (Sec. 7044; Buisness and Cst �� .Professions Code:' The Contractor's License Law does.nof ,apply to an owner of property who _ Const. ' V i s builds. or improves thereon and who does such work himself or through his own employees,- - provided.that'such improvements are not intended ooffered.for sale. If, -however, the building Mech. or improvement is. sold within one year r ar of completion, the owner -builder will have the burden _ Electrical''$ of proving that he.did not build or Improve for the purpose of sale.) - w O I, as owner of the property, am exclusively contracting with licensed contractors to corn 'Plumbing struct the project. (Sec. 7044-, Business and Professions Code: The Contractor's •License' Law �j 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.)- - 0Aam exempt under. Sec. B. 8 P.C. for this reason Grading Driveway Enc. Date owner. Infrastructure Deft� finer* ice' with 03M. NN16 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 ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. _ TOTAL�.g; 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 tha work for which thispermitis 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'youu should become -ZONE: BY: subject" to the Workers' Compensation provisions of:'the Labor Code, you, must forthwith .M1111f11Um Setback Distances: ' comply with such provisions or this permit shall be deemed revoked.' - Front Setback from Center.Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY -• Side Street Setback -from Center Line ' I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Cron code.) 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 subjecf to FINAL.DATE INSPECTOR 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. •'.'Issued.by:' Date Permit . I *agree to comply with all: ciiAand county ordinances and -state -laws. relating to building construction, and hereby authorize representatives -of this city to enter the above-. ' mentioned property for inspecttion`purposes. } Validated by: Signature of applicant: �' �i /y ��' 1 Date `� a Mailing Address—f�' `T f Validation: City, State, Zip f HARD COPY T .I CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES r 1ST FL. SO. FT. ® $ 2ND FL. SO. FT. POR. SO. FT. ® GAR. SO. FT. ® CARP. 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 WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEOUIP. LAUNDRYTRAY AIR HANDLING UNIT CFM TEMP. POLE KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. 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: VENTILATION GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE M=CH.FEE LPL.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 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 SIGNATURES/INITIALS GARDEN WALL FINAL APPLICANT NAME (L, F. MI) JL (instruction ADDRESSP.O. Box 173 CITY/COMMUNITY/STATE/ZIP ' Nestor, CA 92053 JOB SITE ADORESSISPACE - CITYICOMMUNITY/STATE/ZIP ' La• to CA 92253 BOK PAG PRC I C j •TwN ' PERMIT APPLICATION ' r City of La Ouinta Department of Building and Safety This permit becomes void i1 work not commenced within 180 days from date of issuance. OR, i1 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 it LICENSED CONTRACTORS DECLARATION: 1 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 o1 the work for which this permit is ,(commencing with Section 7000) of Division 3of the Business and Professions Code, and my license is in full force issued, I shall not employ any person Inanymanner soasto become subject tothe Workers'CompensationLaws 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 'Any Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall ' be deemed revoked. ''following reason (Sec. 7031.5. Business and Professions Code: city or county which requires a permit to ARC/ENG FIRM -NAME - Michael Buccino Assoc. 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 life a signed statement that he is licensed pursuant to the provisions of the Contra ctor'sLicense Law 01 hereby certify that no excavition five (5) or more feet in depth into which a person is required to descend, will be (Chapter 9 (commencing with sect ion 7000) of Division 3 of the Business and Professions Code) o r that he is exempt made in connection with work authorized by this permi1. and that nobuilding structure, scaffold ing,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. Title B. subjects the applicant to a civil penalty of not more than five hundred dollars (5500.): C.A.C.) 0 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the 0 As owner -builder, I will not employ anyone to do work which would require a permit from the Division of structure is rot 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 through his own employees, provided that such improvements are not intended or offered for sale. If, however, the r 0 Division of Industrial Safety Permit No. building or improvemnt is sold within one year of completion. the owner -builder will havethe burden of proving that 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 0 I, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec. of the work for which this permit is issued (Sec. 3097, Civ. C.). 7044. Business and Professions Code::The Contractor's License Law does not apply to an owner o1 property who Lender's Name builps or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.). ' Lender's Address 0 1 am exempt under Sec. B. & 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 Date Owner 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. 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.). • Signature of Applicant or Agent Date Policy No. Company - CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state that 0 Certified copy is hereby furnished. the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling O Certified copy is filed with the City Building Inspection Department or City Department. construction, and authorize a representative of the.Cily of La Duinta 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 J ' • • Signature of Applicant or Agent Date Print Applicant/Agent Name AoI'S a � APPLICANT NAME (L, F. MI) JL (instruction ADDRESSP.O. Box 173 CITY/COMMUNITY/STATE/ZIP ' Nestor, CA 92053 JOB SITE ADORESSISPACE - CITYICOMMUNITY/STATE/ZIP ' La• to CA 92253 BOK PAG PRC I C j •TwN Mech. Fee 37.00 I RNO I SE . S TRACT 19903 LOT / U/J 60.18 ' MOD 'SB - TRACT NAME HORIZON PAIMS OWNER NAME (l. F. MI) f Gwieral Management Corp. CONTRACTOR -FIRM NAME ' J.L. Construction ADDRESS above CITY/COMMUNITY/STATE/ZIP - - PHONE • 756.88 LICNC 9 *Dmef ermd payment as pgg qgreentint ARC/ENG FIRM -NAME - Michael Buccino Assoc. ADDRESS 340 S. Farrell Dr. A212` CITY/COMMUNITY/STATE/ZIP Palm Springs, CA 92262 PHONE • LICNC 0 323-7877 TOTAL • FEE USE OF PERMIT ' Sin le Fandly,Dmllinq eL ZON. FSB SSB SSB ' RSB OFC ZONE ORO • LOT SZ END SIDE ilt APPL/PRMT T _ •� h 5 2�=85 S:F.D. , Permit to construct 1247 sq. ft: of living area and .433 sq. ft. -of garage as per approved plans. = Mech. Fee 37.00 -,Plan Check Fee 307.96 Const Fee 367.00 60.18 ' SM Fee 5.46 Tlurrbi= Fee 85.00 Trifrastructure 862.60 105.72 DEP. PAID 756.88 *Dmef ermd payment as pgg qgreentint with Commini t Department TOTAL • FEE 862.60 A i L D U D LS 75"6,88 CK µ FINANCE VALUATION 77,948.00