001401 (SFD)Building
Address
Owner
4
l�GGl�GV�
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address
City Zip Tel.
r.;wa__4._. ssr _.-„a n�o4� . a_�,nn_•���s�trtr;n
Contractor
Estimated Valuation
x�•' .
1.
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
Address. .
PERMIT- AMOUNT
`_ice
City
Zip
Tel.
-
Plan Chk. Bal.
❑ I, as. owner of the property, or my employees with wages as their sole compensatlon, will
State Lic.
City
& Classif.
Lic. # Ole
Arch:, Engr.,
"
Designer �IP'�4
-
Electrical
Address
Tel.
No. 0011*01
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description��
Sq. Ft.
Size - -
e
New_W Add ❑
- G7"ti:d p'J 1i �: iaili3L"sLd. 11:,v f ' JC�J-" ZlY f i
City Zip State
Daks Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that l am licensed under provisions of Chapter 9 (commencing with Section
3
7000) of Division ,of.'the, Business and Professions Code, and my, license is in full force and
effect.. ..
a..
SIGNATURE - DATE
OWNER -BUILDER DECLARATION
No.
Stories ..
Alter ❑
No. Dw.
Units
Repair ❑ Demolition ❑
srxef n,-1 /t'ri rsr rvclr rr^e -, ;Dfn
I hereby affirm that I am exempt from the Contractor's License Law for the following ,
Estimated Valuation
x�•' .
1.
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
PERMIT- AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 301 the Business and Professions Code, or that. he is' exempt therefrom,- and the basis
for the. 'alleged exemption. Any violation o/ Section 7031.5 by 'any applicant for a permit
' Plan.Chk. Dep. F1A,d =±^ap niJP3 ,01
subjects the' applicant to a civil penalty of not more than live hundred dollars ($500).
-
Plan Chk. Bal.
❑ I, as. owner of the property, or my employees with wages as their sole compensatlon, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and_Ti
Const. r,
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,
that such improvements are not intended or for 11, however,: the' building
Mech.
provided offered sale.
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:) -
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing •
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
$, M. I. ,
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
Grading
0 1 am exempt under Sec. B. & P.C. for -this reason
Driveway Enc.
Date owner
Infrastructurer;�,
WORKERS' COMPENSATION DECLARATION
y
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.° / • -o , .Company
❑ Copy is tiled with the city. ❑Certified copy is.hereby furnished.
TOTAL rQt!rf?9f?s: <,.R
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 thg work for.which this permit is issued, 1 shall not
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
ZONE: BY:
subject to the' Workers' Compensation provisions of theLabor 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 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, Civil Code.)
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.
Issued by: Date Permit
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 property for inspection purposes.
Validated by:
Signature of applicant Date! -�
Mailing Address r
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. p $
2ND FL. SO. FT. @
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT. ®
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME'SVC.
POWER OUTLET
YARD SPKLR SYSTEM -
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
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, 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 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$-=$-
lusx$=$ROOFING
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/It, ITIALS
GARDEN WALL FINAL
�► RMIT APPLICATeRnd.f.ty
City of
la Duin%
Department of Building /
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 IBO days.
BOK
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
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 as to become subject to the Workers'Compensation Laws of
and effect.
California.
License Class Lic. Number
Date Applicant
Date Contractor
NOTICE TO APPLICANT: IL 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 Lew 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. 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
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
01 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, w ill 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 authorised 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 32, Grp 2 Art 2, Sec 341, Title 8,
subjects the applicant to a civil penalty of not more than live hundred dollars ($500.):
C.A.C.)
O I. as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
O 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
O 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. theowner-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 performance
O 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. Q.
7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
Lender's Name
builQs 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 1 am exempt under Sec. B. B P.C. (Attached Certificate).
I certify that 1 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 herebyauthorize representatives
862.60
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. Q.
ignature 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. l agree to comply with all state laws and county ordinances relating to•Duidling .
O Certified copy is filed with the City Building Inspection Department or CityDepartment.
construction, and authorize a' representative of the_City of LaOuinta Department of Building and Safety to enter
upo the property for which I have applied for this permit for the purpose of making inspections.
Date Applicant
Signature of Applicant or Agent Date
Prinf Applicant/Agent Name D it
APPLICANT NAME (L. F. MI)
JL C mstruction
ADDRESS �eoa r
P.O. Box 173
GITY/COMMUNITY/STATEIZIP
Nestor; CA 92053
JOB SITE ADDRESS/SPACE
ARCAM FIRM NAME
Midiael Bucc
ADDRESS
340 S. Fam
CITYIC'.OMMUNm/STATE/ZIP .
Palm rj
PHONE a LICNC I
323-7877
USE OF PERMIT
Single Fami:
BL ZON, -FSB SSB
ZONE ORD I LOT SZ
APPIJPRMT
ME
CITYICOMMUNITY/STATE/ZIP -
S.F.D.
La.Quinta, CA c
•
BOK
PAG
WIC
C
T
i
Mech. Fee
37.00'
TRACT
19903
II --
LOT
MOD:`
367.00
TRACT NAME �••�
HORIZON PARIS, -'*-
OWNER NAME (L. F. Mq
G neral Manager
.
CONTRACTOR -FIRM NAME
J.L. ' C7onstructic
SMI Fee
ADDRESS .. .
above
'
•
GTY/COIIMUNITY/STATE/ZIP
)IJ!lAftastmiature
- . LIQNC I
ARCAM FIRM NAME
Midiael Bucc
ADDRESS
340 S. Fam
CITYIC'.OMMUNm/STATE/ZIP .
Palm rj
PHONE a LICNC I
323-7877
USE OF PERMIT
Single Fami:
BL ZON, -FSB SSB
ZONE ORD I LOT SZ
APPIJPRMT
ME
5-2-2 =85
S.F.D.
Pen -hit to construct
1247. sq. ft.
of
living area and .433
sq. ft. of garage
as.,Per approved plans.
Mech. Fee
37.00'
II --
307.96
Const. Fee `x-,
367.00
Elect, keel,-
60.18
SMI Fee
5.46.
Fee
85..00 -
)IJ!lAftastmiature
862.60
105.72 DEP.. PAID
756.88
*
agrewitint
t Department
TOTAL ,
FEE
862.60
H1114 7 LL /j(a8 CK
FINANCE y VALUATION 77,948.00