001404 (SFD)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 44-20O E. &M&M CIVSt Dr. LA QUINTA, CALIFORNIA 92253
Owner .. .... .. ,.... .. _. ..
BUILDING:- TYPE CONST. - V N 'OCC GRP •` .R 3
Mailing
Address 001 Bid= St.'' te
City lZip ITel.
Contractor
Address .. _ .
A.P,Numb,er
- n .. til ♦ - '
Legal Description
Project Description H=i2mle Palms,— Traft
City.Zip
; .. -..:
Tel.:
State Lic.
& Classif..:
City
Lic. # 237
=4 .124
Sq. Ft. No. No. Dw.
Size • Q Stories' Units
Arch:, Engr:,
Designer. Midbea x
New O Add'❑ Alter O Repair O:' Demolition O
Address
Tel.
CityJZip
State
palm �
92262
Lic-.#
LICENSED.CONTRACTOR'S DECLARATION
= —
I he affirm h t l am licensed under provisions of Chapter,9 (commencing with Section
7000) of Division 33ryo'fjgthe
lBusiness and Professions Code, and:my license. is in full force and
-.. .effect. i i i I f. `1 f d.% . . . .. . .. -
.. .. _. ,- .. .•. ... • • - ,.
SIGNATURE DATE
" . OWNER -BUILDER DECLARATION
' I hereby affirm that I am exempt from, the Contractor's License Law for the following
.- reason: (Sec. 703 1.5, Business. and Professions. Code: Any city op county which requires' a
it
permto construct, alter, improve, demolish, or epair any .structure, prior. to its issuance also
.. requires the. applicant.'for..such permit to file a signed statement that het is licensed pursuant to
the.provisions of the Contractor's License'Law, Chapter (commencing with'Section 7000) of..
.Division 3 o/ the Business and'Professions Code; or* that. *he le 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 o/not more than'five hundred ($500).
O I, as owner of the property, or my employees with wages as their sole compensation, will .._
d•the work, and the structure is not intended or offered for sale. (Sec. 7044: Buisness and
- Professions Code: The Contractor's License. Law does not apply to_an owner of property who,
builds. or improves ihereon and who does such work himself'or through his own employees,
. • ,provided that' such improvements are, not intended or -offered for sale.. -l/, :however, the building '
or improvement is sold within one year ofcompletion, the owner -builder will have the burden
• of proving that he, did not build or, Improve for the purpose of sale.)-
ES1lmat6d ValUatlOn
X76 l p�iif 3
..
PERMIT - - - AMOUNT
_
_ •
Plan Chk. Dep. - ..
_
Plan Chk. Bala.
COf1St.".
Mech.37.00" -
Electrical
Plumbing {`
❑ 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-LicensezLaw
does -not apply to an owner o/ property who builds or improves thereon, and who contracts for.
. such projects with a contractors) licensed pursuant to the Contractor's License Law.)
❑.I am exempt under. Sec. B. B.P.C. for this reason
•
S.M.I'.-
5.4
Grading
-
Driveway Enc.
Date Owner
I nf_rastructu re M ymawMa A
S�SPM qM
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.) ,
Polioy No. Company
O.Copy.is filed with the city. 0 Cerlified.copy is hereby furnished.
TOTAL' 7tRlw(dt3
_
CERTIFICATE OF EXEMPTION FROM
.WORKERS' COMPENSATION INSURANCE ..
REMARKS
•- -
(This section need not be completed i/ the permit is for -one hundred dollars. ($100) valuation
'• or less.)- .. .. ,. .. ..
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' "' Owner
.. NOTICE TO APPLICANT: If, after making this Certificate o/' Exemption- you should become
' subject to the' Workers' 'Compensation provisions o/. 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
•I hereby affirm that there is a construction lend ing'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.
I certify ;that l 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.
!B_
Signature of applicant `'�i 'f .7C %�i':•:t a.� Dated�v �+
Mailing Address y r - `r ./
Issued by: Date Permit
Validated by:
Validation:
. '
City, State, Zip a y
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST 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
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
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./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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/1N ITIALS
GARDEN WALL FINAL
LICENSED CONTRACTORS DECLARATI
(commencing with Section 7000) of Oivi
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 3 of 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 permit5500
subjects the applicant to a civil penalty of not more than five hundred dollars (.):
❑ 1, 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. ll, 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.).
O I, 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 o1 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. 8 P.C. (Attached Certificate).
Date Owner
WORKERS' COMPENSATION DECLARATION: 1 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.
O Certified copy is filed with the City Building Inspection Department or City Department.
Date Applicant
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 o1 180 days.
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed it
ON: I hereby affirm that I am licensed under provisions of Chapter 9 the permit Is for one hundred (S10O) o, less.) certify that in the performance of the work for which this permit is
sion 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 asto become subject lothe Workers'Compensation Laws of
California.
APPLICANT NAME (L. F. MI)JLC7onstruction
ADDRESS '
P.O. Box 173
CITY/COMM NITY/STATWIP
Nestor; CA 92053
JOB SITE ADDRECSISPACE '
CITY/COMM4l1NITY/STATE/ZIP
La. to CA 92253
BOK
PAG
PRC
C
TWN
RNO
SE
S
TRACT
LOT
with rjmmmit2Z t De t
OD M
SB
19903-low
TRACT NAME HORIZON PALMS
OWNER NAME IL. F. MI) Quieral Management Corp. '
CONTRACTOR -FIRM NAME
J.L. Construction
ADDRESS
abom
CITY/COMMUNITY/STATE/ZIP
PHONE N
LICHC •
ARC/ENG FIRM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CITY/COMMUN ITY/STATE/ZIP
Palm rin s CA 92262 _
PHONE F LICNC'4
323-7877
USE OF PERMIT .
Single FamilyDwelling
BL
ZON,
'FSB
Sao
SSB
RSB
OFC
ZONE ORD •
- LOT SZ
END
SIDE
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificateof 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:
❑ 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.Z Grp Z Art 2. Sec 341, Title 8.
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-fientioned 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 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
APPUWiMTn o i: DATE
, .= 2-2=85 S:F.D.
Permit to construct 1247 sq. ft. of
livingarea and 433 . ft. of garage
as approved plans.
Mech. Fee 37.00
Plan Check Fee 307.96
Const. Fee 367.00
Flect. Fee 60.18
Sn Fee 5.46
-Plllinbing Fee 85.00
*
Infrastructure
862.60
105.72 DEP. PAID
.756.88
* a eemtnt
with rjmmmit2Z t De t
AL
TOT •
' FEE
862.60
H111/ LL /D6.68 GIC
FINANCE VALUATION 77,948.00