001532 (SFD)ti
P.O. BOX 1504 NO. . 001532
Building78-105 CALLE ESTADO
Address 79.3.4 N. SUnMt-Rid= jtrrLA QUINTA,,CALIFORNIA 92253
Owner
Via' ��t Caro. BUILDING: TYPE CONST: - V 11 - OCC: GRP.
Mailing -
Address 1001 Bighop s,, SmitP_ 2700 A.P: Number• -
City Zip Tel.
M`W,54 Legal Description
Contractor Project Description .'
x46 *Mit Off. .
Td—dress. ..... ..... _
-7 P.O. Bm 173
Zip Tel.. .
NaskW 92053340-5511
State Lie. City I= 1247
& Classif.. 442822 Lie. # 237 ,Sq. Ft. w 433 No. No. Dw.
Size. Stories Units
Arch., Engr.;.
DesignerNew.[It Add O Alter O Repair 0 : Demolition 0. -
Ideva �: Pi M. ff. 's . _.. -.
Address Tel.
340 S Fa%ry023-•7877
CityZip State
'Yk .�at31e'3FI .. Lie. #
-N. LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that yam,licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the�Business and Professions Code, and my license is in fulCforce,,and'
effect.. ���!>ir.') >/
SIGNATURE DATE t .. .... .. . • ..
OWNER -BUILDER DECLARATION iy ` Estlrnated Valuation �f �pp y�
I hereby affirm that 1 am exempt from the Contractor's License Law for the following $., i i,e�"u8*40.
reason: -(Sec. 7031.5,13usiness and Professions Code:, Any, city or county which. requires a,
permit to construct, atter, improve, demolish, .or repair any structure, prior. to its issuance 'also '
. requires the applicant for such permit to rile a signed statement thafhe•is licensed pursuant to PERMIT ' -'AMOUNT'
the provisions of the Contractor's License Law,.. -Chapter 9 (commencing with Section 7000) of - '-
Division 3 of the Business and Professions Codi, -,or that. he.Is exempt thereliom,' and the. basis 7
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 penatty'of not more than five hundred dollars ($500).-
0 I, as owner of the property, or my employees with wages as their. sole compensation, will Plan Chk. Bal. 202.24
do the work, and,the structure is not intended or offered -for sale: (Sec. 7044, Buisness and q a�
Professions Code: The .Contractor's License Law does, not p p Const, 7 - 36'! 00
apply to an owner of,property erty .who .
builds or improves thereon and who does such work himself or through his own employees, ._
Mech.' 37 .40
provided that such improvements are not intended or offered for sale. If,• however, the building .7% sOi7
or improvement is sold* within one year of completion, the owner -builder will have the burden Electrical
-of proving that he did not build or improve for the purpose of sale.) 4s'e+lam
0 1, as owner of the property, am exclusively contracting with licensed contractors to con-' Plumbing 85.00struct 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. .�-
such projects with a contractor(s)-licensed pursuant to the Contractor's License Law.)
• 0 I am exempt -under Sec. B. t% P.C. for this reason • Grading
Driveway,Enc.
Date owner Infrastructure Mtayya� —
Z.
WORKERS' COMPENSATION DECLARATION
I hereby affirm that Ihave a certificate'of consent to self•insuie, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800,.Labor Code.)
Policy No Company
. 0 Copy is filed with the city. 0 Certified copy is hereby furnished. ,
TOTAL 962.060 756.88
CERTIFICATE OF EXEMPTION FROM I REMARKS
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed if the permit is for one hundred' dollars (S 1.00) . 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 -
Date_LL• Owner
.NOTICE TO APPLICANT: N,. ager making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the- Labor Code, -you must forthwith '
comply with such provisions or this permit shall be deemed revoked Minimum Setback Distances: '
Front Setback from.Center. Line
Rear Setback from. Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street -Setback from Center Llne -
1 hereby affirm that there I.),.construction lending agency -for the performance of the
work for which this permit is issued. (Sec: 3097, Civil Code.)
Side Setback from Property Line
Lender's Name
Lender's Address *•. rf
This.is a -building permit when properly filled out, signed and validated; and-is'sublect to FIN AL.DATE . INSPECTOR
expiration if work thereunder is suspended for 180 days.
1 certity that.l have read this application and state thaf.the above information -is correct. 'Issued by:- Date Permit -
I agree to comply with all;city and county ordinances and state laws relating to building
construction, andherebylauthorize representatives iof this city to enter the above:
mentioned property for inspecttifion purposes. _
—Validated by:
Signature of appltcany'/in�///4, Date
Mailing.Address �' ✓T. Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. @ $
2ND FL. SQ. FT.
POR. SQ. FT. @
GAR. SQ. FT. @
CARP. SO. FT. @
WALL SQ. FT. @
SQ. 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.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EOUIP.
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
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. 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./EOUIP.
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
I NSU LATION/SOU N D
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
/
APPLICANT NAME,(L. F. MI) "
JL Construction
ADDRESSP.O. Box 173 -
CITY/COMMINITY/STATE21P
Nestor; CA 92053
JOB SITE ADDRESS/SPACE
CITYPCO�UNITY/STATMIP-~
La . ta• CA 92253
BOK
PAG _�
PRC
C
. 'TNM
•
PERMIT APPLICATION
City of La Oulnta,
.• Department of Building and Safety
This permit becomes void if work not commenced within 180 days from date
o1 issuance. OR, if work has been suspended or abandoned for a period of 180 days.
1
CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE: This section need not be completed if -
LICENSED CONTRACTORS DECLARATION: I hereby aflirm'that I am licensed under provisions of Chapter 9
the permit is for one hundred ($100) It. less. I certify that in the performance of the work for which this permit is
-(commencing with Section 7000) of Division Sol the Business and Professions Code, and my license is in lull force ,
:Issued. I shall not employany person inanymannersoasto become subject to the Workers'CompensationLaws of
and effect.
California. y
License Class Lic: Number
Date Applicant
Date Contractor 'I
NOTICE TO APPLICANT: If, after making this Certificate of 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. 1
following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to
ADDRESS - - ..•
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 asigned statement that he islicensed pursuant to the provisions of the Contractor's License Law
01 hereby derlify 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) of 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 of 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, Sec341, Title 8.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
C.A.C.)
❑ I, as owner of 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 not apply to an owner of property who builds, or improves thereon, and who does such work himself or
D Division of Industrial Safety Permit No.
through his own employees, provided that such improvements are not intended or offered for sale. If, however, the
DEC '-
T
building orimprovemntissold within one year ofcompletion, the owner -builder will have the burden ofprovingthat
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 perlormance
O 1, as owner of 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 not apply to an owner of property who
Lender's Name
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
! Lender's Address
O t 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. l agree to comply with all
DateOwner
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 1 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 t Date ,
Policy No. Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I 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 ,
O Certified copy is filed with the City Building Inspection Department or City Department.
construction, -and authorize a' representative of the City of La Ouinla 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
1
r
i Print Applicant/Agent Name
l lJ
/
APPLICANT NAME,(L. F. MI) "
JL Construction
ADDRESSP.O. Box 173 -
CITY/COMMINITY/STATE21P
Nestor; CA 92053
JOB SITE ADDRESS/SPACE
CITYPCO�UNITY/STATMIP-~
La . ta• CA 92253
BOK
PAG _�
PRC
C
. 'TNM
•
RNO
SE
S
TRACT
19903
LDT�
/
Plan Check Fee
307.96
MOD
I SB .
367.00
TRACT NAME -
HORIZON PALMS
OWNER NWE (L. F. MI) General Management Corp-rp-
CONTRACTOR-FIRM NAME
J.L. Construction
ADDRESS
CITY/COMMUNITY/STATE/ZIP V ° •
PRONE .
LICNC .
85.00.
ARC/ENG FIRM NAME ,
Michael Buccino Assoc.
ADDRESS - - ..•
340 S. Farrell Dr. A212
CITYMOMMIMITY/STATE/ZIP
Palm cin s ` CA 9If.
PHONE • - LICNC A
323-7877
r
USE OF PERMIT
Single Familv Dwelling
BL
ZON•
as pgr agreemknt
FSB
SSB
SSS
-RSO
�
DEC '-
T
ZONE ORD I
LOT SZ
END
- SIDE
APPL/PRMT-- f
�,
DATE
5-22-85
'
S:F'.D.-
Permit to construct
1247 sq. ft.
of
living area and 433
sq. ft. of!'garage
as per appraved,plans.
•
e•
Mech. Fee
37.00.,,
Plan Check Fee
307.96
Const. Fee
367.00
iFee
60.18
SMT Fee-
5.46.'
85.00.
Trifras;trUCtUre
862.60'
105 M DEP. PAID
756.88 '
*neferred pa=mt
as pgr agreemknt
t Department
TOTAL
FEE
862 60
-M 1 L J 4 J. L D
75&88 CK
VALUATION .,'77, 948.00