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001416 (SFD)• Building Address Owner Mailing Address City Contractor Address .. TAtyl 1��I,q�ti1P�t/- P.O. BOX 1504 NO. 00141 78-105 CALLE ESTADO a LA QUINTA, CALIFORNIA 92253 •y] General;mmm.- sr.. BUILDING: TYPE CONST, OCC:'GRP:• 1001 Bisboo St. StAte 2700 A.P. Number Zip . ' L .. .96813 T1,1,!-800-367; 5'5 4Legal Description Project Description' �. City .. _ .. .. - 1. - - Zip.. Tel.'.-. .. w . . _. . 9W53 341..3511 ; State Lic. City VNIGA247 & Classif: ; .. . Lic. # 237 Sq.•Ft.No. A 33 No. Dw. Arch., Engr:; Size - ' " • Stories - Units ' ' Designer Newjor� Add ❑ Alter ❑. ''. Repair ❑ '' Demolition ❑ Address Tel. ...340' ' S.. R=d Dr, 323"°7-877. City Zip State Lic. # .. .. _ LICENSED CONTRACTOR'S DECLARATION 1 herebyy affirm that I am licensed under provisions of Chapter 9'(commencing with Section 7000) of Division 3 of thye,Business and Professions Code, and my license is infull foraand­- - 0ce effect. . . . . . -y/'' �s. ; /I f `) i/ / . • SIGNATURE / ✓ .. - / DATE, .. .. .... -. ... -. OWNER -BUILDER DECLARATION " " ' ' ' " ` "' Estimated. Valuation • I, hereby affirm that I am exempt from the Contractor's License Law for the following C+: �i+et E3'Se9 t3.a ' and, reason: (Sec. 7031.5,Business and Professions" Code:. Any :city or county "which -requires. a qr 7 4,948.00 permit to construct, alter, improve, or repair any structure, prior to its issuance alsoAMOUNT requires the applicant for such permit to file a signed statement that he is 'licensed pursuant'to PERMIT :. -' ' the provisions of the Contractor's License Law, Chapter. 9 (commencing, with, Section 7000) of r.• - - 'Division 3 of the Business and Professions Code,' of that::he.is-exempt therefrom, and the basis -. Any Section 7031.5 'any for ' Plan Chk.. Dep. 5-72 for the alleged exemption. violation of, by applicant a permit -subjects the applicant to a civil penalty of not more than rive hundred dollars'(S500).: : . '­ ' �, _. Plan Chk. Bal.. .. .14 - 20,A2g 2�f6 , .O I, as owner of the.property, or my employees with'wages as their sole compensation, will ; .. 4C.F. r6gr do the work, and the,structure is not intended of offered for sale. (Sec. 7044,'Buisness and'.36+�= Const, ��p!� 7.00 Professions Code: .The Contractor's License Law does not apply to, an: owner of.property who .. . -. . himself or through hisown employees, -builds or improves thereon and who does such work " Mech' '- +j�+y p� - ' .-„ provided that' such ,improvements are not intended or offered for sale. If, •however, the. building :4•11.00- , .37.00- of oofimprovement is sold within one year of completion, the owner -builder will have the burden 'Electrical -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 'S.M.I. �•_ 5.46 such projects wither contractor(s) licensed pursuant to'the Contractor's License Law.) - - Grading Grading - ❑ 1 am.exempt under Sec.- B. & P.C. for this reason - Driveway Enc. _ Date owner Infrastructure Daftxwd mynim-tt as ux acmemmt WORKERS' COMPENSATION DECLARATION Ihereby affirm that I have'a certificate .of consent'to'selt: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 8062.60 753.88 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.) ... _ certifyahat in the performance of thg work for which this permit is issued, I shall not • •- employ -any -person inany 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 Voikers' Compensation provisions. of'the Labor Code, you 'must forihwitn - , 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. r Side Street Setback' from.Center Line 1 hereby affirm that Were is a construction lending agency for the performance of the • , work for which this permit is issued. (Sec. 3097, CivilCode.) 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 it work thereunder is suspended for 180 days. e _ I certify that I.have read this application and state that the above information is correct. 'I 'city Issued by: y' Date Permit agree to comply with all and'county ordinances and state laws relating to -building r construction, and hereby authorde representatives -of this city to enter the above-. mentioned property for inspection'purposes. ./ ,. ✓y Validated by: Signature of applicant F ± = Date' .i` Mailing Address ) '� Validation: City, State, Zip ' HARD COPY CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ ` 2ND FL. SQ. FT. ® POR. SO. FT. ® GAR. SO. FT. ® CARP. SQ. FT. WALL SQ. FT. SO. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR S� 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 APPJEQUIP. 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 SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. 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 NECH.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 APPJEQUIP. 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 SIGNATURESANITIALS GARDEN WALL FINAL PERMIT APPLICATION City of La Ouinta 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 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. 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) L AJ�7 Construction - CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE: 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 o1 the work for which this permit is (commencing with Section 7000) of Division Sof the Business and Professions Code, and my license is in full force issued. I shall not employany person inanymannersoasto become subject to the Workers' Compensation Laws of and effect. California. License Class Lic: Number Date Applicant Date Contractor NOTICE TO APPLICANT: If, after making this Certilicete 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. 'following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to LOT 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 ofthe Contractor's License Law 01 hereby certify that no excavation live (5) or more feet in depth into which aperson 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 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 8, subjects the applicant to a civil penally of not more than five hundred dollars %500.): C.A.C.) O I. as owner of the property, or my employees with wages as Meir 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 o1 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 PHONE . LICNC 323-7877 building orimprovemntissold within oneyearofcompletion. 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 performance O 1, as owner o1 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 contractors) licensed pursuant to the RSB Contractor's License Law.). Lender's Address O 1 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. I agree to comply with all Date Owner 'city and county ordinances and state laws relating to building construction, and herebyauthorize representatives of this county to enter upon the above4mentioned 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. 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) L AJ�7 Construction - AOOi1ES5 P.O. Box 173 CITY/COMMUNITY/STATE/ZIP - Nestor; CA 92053 JOB SITE ADDRESSISPACE CITY/CGIi4UNITY/STATE/ZIP - La. to CA 92253 BOK PAG PRC C Sm Fee 5.46.' TWN MG SE S TRACT 19903 LOT with CYmyminitzz t Department MOD I Sel TRACT NAME HORIZON PAIMS OWNER NAME (L. F. MI) Qsineral Management Corp. ' CONTRACTOR -FIRM NAME J.L. Construction ADDRESS above CITY/COMMUNITY/STATE/ZIP atim PHONE • LICHC e ARC/ENG FIRM NAME Michael Buccino Assoc. ADDRESS 340 S. Farrell Dr. A212 CITY/COMMUNITY/STATE/ZIP Palm Srxincrs CA 92262 PHONE . LICNC 323-7877 USE OF PERMIT ' single Fami1v Dwelling BL ZON, FSB 'SSB SSB RSB OFC ZONE ORD . LOT SZ END • SIDE 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 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/PRMT ?-412-;-85 S.F.D. PeYmi.t. to construct 1247 sq. ft. of living area and 433 sq. ft. of garage as per approved plans. metch. Fee 37.00 Plan Check Fee 307.96 Const. Fee- 367.00 IF1 Fee 60.18 Sm Fee 5.46.' .Plimbi= Fee. 85.00 Tnfrastructure 862.60 105:72 DEP. PAID. 756.88 * agreentnt with CYmyminitzz t Department "T''. 'FEE 2 60 H 1 1 L 7 7 L L / j (�, 8 8 CK VALUATION FINANCE �7,948.00