001524 (SFD)Contractor
... Address
QUMN {IV
P.O. BOX 1504 No, 00152
78-105 CALLE ESTADO
Be Mm ELA QUINTA, CALIFORNIA 92253 4
Wt Corp. ` ~ BUILDING TYPE CONST. .._V. OCC: GRP.
Tel
1,73
.Zio ... - ., Tel.-
A,P..:„Number.
367_.50!;4 Legal, Description
Project' Description . P '
s ..... __..:... 146 mi Dsvels ....
r.
Avi'
State Lia
City
= -1247
& Classif:
Building
Sq. Ft. No. No. Dw.
Size - • - 433 ..Stories..... Units
Address
79-4151
Owner
Tel.
'. PUM11. ..
Mailing
Address
3003 ni
City
State
Zip
92262
Lic• #
W
Contractor
... Address
QUMN {IV
P.O. BOX 1504 No, 00152
78-105 CALLE ESTADO
Be Mm ELA QUINTA, CALIFORNIA 92253 4
Wt Corp. ` ~ BUILDING TYPE CONST. .._V. OCC: GRP.
Tel
1,73
.Zio ... - ., Tel.-
A,P..:„Number.
367_.50!;4 Legal, Description
Project' Description . P '
s ..... __..:... 146 mi Dsvels ....
r.
Avi'
State Lia
City
= -1247
& Classif:
Lic. #
237
Sq. Ft. No. No. Dw.
Size - • - 433 ..Stories..... Units
Arch., Engr.;
' Designer fugma fes. X.MW. _
New'. Add ❑• • Alter ❑.. Repair ❑ Demolition 13.
Address
Tel.
'. PUM11. ..
323-7877 . ,...
City
Zip
State
3ir-m30ri*i4-
92262
Lic• #
W
LIQENSED.CONTRACTOR'S DECLARATION,
hereby affirm thatA am licensed under provisions of Chapter.9 (commencing'with'Section
7000) of Division 3,I6f'the Business and Professions Code, and my license is in full force and
effect... :•/ J 7 I .1.
., .. .. .. ,.
SIGNATURE 9 DATE
' 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 /ilea signed statement that -he is licensed, pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with'Section 7000) oP�-
'Division 3 of the, Business'and'Pro/essions Code, or that. he is' exempt therefrom, and the basis.
for the alleged exemption. Any violation of Section 7031.& by�'any 'applicant /or a permit
` 'subjects the applicant to a civil penalty 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..
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness andCOr1St..
Professions Code: The Contractor's License Law does not apply to an-owner.of property who ', ,
Estimated Valuation
748.00
%4 AMOUNT
.� PERMIT .-
. • '
.-
Plan Chk. 'Dep... 105.72
Plan Chk: Bal. 202+24
'$'�. 0
+9
,
Mech. laR
37•x✓
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 improvement is sold within one year of completion, the. owner-buildei'will have the burden
o/ proving that he did not build or improve for the purpose ofsale.) ..
Electrical ��
- •
Plumbing 85�0g
0. 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 o/ 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. & P.C. for this reason -
s.
S.W.. 5.46 .
Grading
Driveway Enc.
Date Owner
Infrastructuree�� Imo. t
... with' cm. ft. ml. Direebw
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.)'
t
Policy No. Company
7'
❑ Copy is.filed with the city.. ❑ Certified copy is hereby furnished.
TOTAL s 0
_ . ...
CERTIFICATE OF EXEMPTION FROM
WORKERS', COMPENSATION INSURANCE
REMARKS'
(This section need not be completed i/ the permit is for one hundred dollars (S 100) valuation
or less:) _ .. _ .... ... .. ..
certify that in the performance of,the work for which this permit'is issued, I shall riot
• employ any 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
hereby affirm that Were 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
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.
1 certify that I have read this application and state that'the above information.is'correct.
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. they above -r
mentioned property for inspecttion purposyes.p- , /
Signature of applicant f �d� l / ,' ! Date-//-,)
Issued by: Date Permit
Validated by:
Mailing Address
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING -;:EES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT. p
BONDING
Y
ARD SPKLR SYSTEM
POR. SO. FT. p
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL S0. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN
SO 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
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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 ® 1Va c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.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 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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL
PERMIT APPLICATION
City of La Duinta
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 for a period of 180 days.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) o1 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) o1 Division 3of 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 (M.):
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 safe (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 o1 sale.).
0 1, 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
builds or Improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the
Contractor's License Law.).
❑ 1 am exempt under Sec. B. 1L P.C. (Attached Certificate).
Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
certificate o1 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 truction
lJii i� 1..1 11
ADDRESS
P.O. Box 173
CITY/COMMUNITY/STATE/ZIP
Nestor; CA 92053
JOB SITE ADDRESS/SPACE
CITY/COMMUNITY/STATE/ZIP
La. to CA 92253
BOK
PAG
PRC
I C
Mech. Fee 37.00
TWN
I RNG
SE
S
TRACT
LOT ri
FM Fee 5.46.
MOD
SB
19903
C^Y/
862.60
105.72 DEP. PAID
756.88
TRACT NAME
HORIZON PAIMS
OWNER NAME (L. F. MI) General Management Co
CONTRACTOR -FIRM NAME
J.L. Construction
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP '
PHONE
LICNC
ARC/ENG FIRM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CITY/COMMUNITY/STATE/ZIP
Palm Sigings, CA 92262
PHONE • LICNC /
323-7877 I
USE OF PERMIT
Single Familv Dwelling
BL
ZON,
iSP
'SSB
SSB
RSB
OFC
ZONE ORD a
LOT SZ
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE: This section need not be completed if
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 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, falsework, or
demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2. Art 2, Sec341, Title B,
C.A.C.)
❑ 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.
❑ Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Sec. 3097, 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 Duinta Department of Building and Safety to enter
upon the property for which 1 have applied for this permit for the purpose of making inspections.
Signature of Applicant or Agent Date
Print Applicant/Agent Name
0015dZ/
APPL/PRMT DATE 2BRIMS2=85
Y'
1✓�
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
Elect- Fee 60.18
FM Fee 5.46.
—.21urrbing Fee 85.00
*
Tnfrastructure
862.60
105.72 DEP. PAID
756.88
* agreentint
t Derlartment
TOTAL
FEE
2.60
AiL4b 7 Z5 75&88 CK
FINANCE VALUATION77 , 948.00