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001431 (SFD)P.O. BOX 1504 No. 001.431 Building 78.105 CALLE ESTADO Address 44x-051. ff. SarKIOM Ckeft J)ro LA QUINTA, CALIFORNIA 92253 Owner 7 BUILDING: TYPE CONST. OCC: GRP.- R, 3 Mailing, Address 1.001 Sts Suite 27W A.P. Number CityZip may} Tel. / Td' 11 ��..;i tlr $t -di A—SW3�:5054.' Legal Description.. Contractor Project Description 7.rm J. _ arlr v�ifrsnr. .,Address ... - .... _ ._.... . . _ . .:.. 146 its P.O. 173 City. .. ........^ .,.. Zlp Tel.: 92053 MEW 340-5521 State Lic. City , & Classif...442822Lic. # Sq. Ft. 1M+ 147 No. No. Dw. :_ 237.*..-,-,, Size "., 433 Arch:, Engr., ries Units Stories Designer New Add O Alter O Repair Demolition O Address " Tel. CityZip State ftliau .. . _ 92M.Lic: •#. . .. _ t LICENSED CONTRACTOR'S DECLARATION , I herebyaffirm,that I -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., . -.. . SIGNATURE !. dI' r c '" = DATE ' OWNER -BUILDER DECLARATION I e I hereby affirm that I am exempt from the Contractor's License law for the following reason: (Sec, 7031.5, Business and Professions R .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 thahhe is licensed pursuant to Estimated Valuation ds rete 'ea s� - - 77.A� IAO - - - PERMIT':.' - the provisions of the Contractor's License Law, Chapter 9 (commencing with.. Section 7000) of, ' 'Division 3 of.the'Business and Professions. Code, or that. he is e4fti therefrom, and the basis for the .alleged exemption. Any violation of Section 7031:5 by 'anyapplicant, for -a. permit _ Plan Chk. Dep.; ' subjecls'the applicant to -a civll'penalty of not more than live hundred -dollars ($500). - 0 I, as owner of.the property, or my employees with wages As their. sole -compensation, will do the. the structure is not intended or offered for sale: (Sec. 7044,-Buisness;and y who �• Professions Code: The Contractor's License Law does, not apply-to.an owner of property Plan Chic• Bal. - . COhst' ... buiids or improves. thereon and' who does such work himself or through his own employees, . -Mech. provided that such improvements are not intended or offered for sale. If, however,: the -building -' EledtrlCal ' ' or improvement 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 of sale.)... ' _ i. Plumbing, ' 0 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 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.) - 0 1 amexempt under Sec. . B. & P.C. for this reason .. Grading Driveway Enc. FINAL'DATE Date owner. Infrastructure DE' 'Mom Date :Permit_ .. .. ...• .� .fit' A �: iii WORKERS' COMPENSATION DECLARATION 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 0 Copy is filed with the city.._ 0 Certified copy is hereby furnished.' -CERTIFICATE OF EXEMPTION FROM - . • 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 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 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. r, 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, Civil Code.) Lender's Name Lender's Address 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. I 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. Signature of applicant Mailing Address— ' 7 City, State, Zip HARD COPY TOTAL REMARKS -------------- ZONE: BY: M inimum'Setback' Distances: FrontSetbackfrom Center. Line Rear Setback. from.Rear Prop. Line Side Street.Setback,from Center Line ­ Side Setback from Property, Line FINAL'DATE INSPECTOR ' Issued.by: Date :Permit_ Validated by: .Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. ® $ 2ND FL. SQ. FT. POR. SO. FT. ® GAR. SQ. FT. ® CAR P. SQ. 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.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. SQ. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1+/a c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER REMARKS: GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE NECH.FEE PL.CK.FEE --JCONST. 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$ _$ 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 V PERMIT APPLICATION City of La Oulnta 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. CERTIFICATE OF EXEMPTION FROM WORKERSTOMPENSATIONINSURANCE: This section need not be completed if LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 .(commencing with Section 7000) of 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 1 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 io life a signed statement that he is licensed pursuant to the provisions of the Contractor's license Law (Chapter 9 (commencing with section 7000) of Division 3of 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 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 sale (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. II, 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 of sale.). O 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 contractor(s) licensed pursuant to the Contractor's License Law.). O 1 am exempt under Sec. 8.4 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 of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.). Policy No. 'Company O Certified copy is hereby furnished. ❑ Certified copy is filed with the City Building Inspection Department or City Department. 'Date Applicant APPLICANT NAME (L. F. MI) JL C(nnstruction ' ADDRESS P.O. Box 173 C ITY/COMMIN ITY/STATE/ZI P Nestor; CA 92053 JOB SITE ADDRESS/SPACE CITY/COMMLONITY/STATE/ZIP - lia..Quinta, CA 92253 BOK PAG PRC C - I TWN RNG SE .S TRACT 19903 LO,T / Elinc-_t_ Fee 60.18 MOD SB TRACT NAME HORIZON P,AI RGA LiVi�~tl Val OWNER NAME (L. F. MI) lam' liGl Management Corp. ' CONTRACTOR -FIRM NAME J. L. Construction ADDRESS above - CITY/COMMUNITY/STATE/ZIP PHONE • 105.72 DEP.- PAID UCNC • ASIC/ENG FIRM NAME Michael. Buccino Assoc. ADDRESS 340 S. Farrell Dr. A212 CmIC.OMMUNITY/STATE/ZIP Palm Sorinds. CA 92262 PHONE • 323-7877 LICNC'• - - USE OF PERMIT Sin le Family Dwellin SL 'ZONA 'FSB SSB 'SSB RSB DEC ZONE ORD • LOT SZ 'END SIDE the permit is for one hundred ($100) o. less. l certify that in the performance o1 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 fee I 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 Z Art 2. Sec341, Title 8. C.A.C.) O 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. O 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 1 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 1 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 Ouinta Department of Building and Safety to enter upon the property for which I have applied for this permit for the purpose of making inspections. Signature of Applicant or Agent Date Print Applicant/Agent Name ,/) ^ APPL/PNMT0 0A DATE 5-2-2=85 J S.F.D. Permit to construct 1247 sq. ft. of ,living area and 433 sq. ft. of garage as Per approvedplans. Mech. Fee 37.00 307.96 Const. Fee 367.00 Elinc-_t_ Fee 60.18 SW Fee 5.46. —Plurrbing Fee 85.00 Tnfrastructure 862.60 105.72 DEP.- PAID ..756.88 * agreerrifint with Onnmm t Derartmient TOTAL • fFEE 862,60 '• CINONCp c� /76188• CK VALUATION 77,948.00