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001436 (SFD)P.O. BOX 1504-No. +:J Building 78-105 CALLE ESTADO 1436 Address 44-201 W.' Stniftim cieft, Dr. LA QUINTA, CALIFORNIA 92253 ' Owner Mailing BUILDING: TYPE CONST. VN. 'OCC:'GRP.: R 3 Address 1001RiMhMft.gjit.p . 274 A.P. Number City Zip jKc�'%J' Tel. ' T�l.�1 .. 1-800-367!.--5054-_Legal Description Contractor. Project Descriptions 'i P. Ins JAI,. cmisftuatim ..Address. ��f��.' Pao. B=-173 _ _a 'City Zip Tel.: _ 9"53 .340--551 State Lic. " City & Classif. Lic. # �� ~' " "2822. 237_ a .. - Sq. Ft. No. No. Dw. Arch.,-Engr., . .. , �.. Size '= -.�- Stories Units . Designer New Add ❑ Alter ❑ Repair ❑.:. Demolition ❑ Address Tel. 340 Sft2nMan Dr, City Zip State _2 Lic. #.. _ LICENSED_CONTRACTOR'S DECLARATION I hereby affirm that f am licensed under provisions of Chapter 9 (commencing with Section ' 7000) of Division 31¢of th/e Business and Professions Code, and my license is in full force and effect. SIGNATURE _' i - - - t' _ -, DATE OWNER-BUILDER DECLARATION. Estimated Valuatic, tiR I hereby affirm that I am exempt from the Contractor's License Law for the following $ ,77 5418.0' .reason: (Sec.- 7031.5, Business, and Professions '.Code:. Any- city or county which requires-a, •g 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 he4s licensed pursuant to PERMIT - AMOUNT 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 exempt the4fr6n, and the basis' - for the alleged •exemption. Any violation of Section 7031.5 by 'any applicant for a permit PlanChk. subjects the applicant to a civil penalty of not more than live hundred dollars ($500). ' • - ❑ I, as'owner,of.toe property, or my employees with wages as their sole compensation; will. Plan Chk. Bal. do 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 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 . 37.00 or improvement is sold°within one year of. completion, the owner,builder will have the burden Electrical AS .fie �A - ol proving that he did.not build or improve for the purpose of sale.) " .. WAS ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-. Plumbing`�� strucl the project. (Sec. 7044, Business and Professions Coder The Contractor's License Law /I 'does not.apply to an owner of property who builds'or improves thereon, and who contracts for S.M:I. �a4l� • such projects with a' contractor(s) licensed pursuant to the Contractor's License Law.) Grading ❑ I am exempt under Sec. B. 8 P.C. for this reason Driveway Enc. ` Date owner Infrastructure lRii_ pay= t as -pw, aqm t WORKERS' COMPENSATION DECLARATION Thereby 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., _ ❑ Certified copy is hereby furnished: TOTAL 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. ) _...... certify that in the performance of thg work for which this permit is issued; I shall. not employ any person in any mannerso as'to become subjectto-the'Workers' Compensation ' Laws of California. Date .. Owner NOTICE TO APPLICANT: If, after making this Certificate df: Exemption you should become ZONE: —BY:' _ subject to. the Workers' 'Compensation provisions o/.-the Labor 'Code, you "must forthwith Minimum.Setback'Distances: comply with such provisions or this permit shall be deemed revoked. - Front.Setback.from .Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING,AGENCY Side Street Setback from Center Line 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.) Slde. Setback from Property Line Lender's Name "Lender's Address _ 'This is a building permit when properly filled out, signed and validated, andis subject to FINAL DATE INSPECTOR 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:clty,and county ordinances and state laws* relating to building construction, and hereby authorize representatives .of this city to enter the` above — mentioned property for inspectii'on%•9purposes.`, Validated by: Signature of applicant �I !far }jr-ii r.: Datr'� Mailing Address J' i Validation; City, State, Zip HARD COPY CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING 1ST FL. SQ. FT. ® $ 2ND FL. SQ. FT. POR. SQ. FT. ® GAR. SQ. FT. ® CARP. SQ. FT. WALL SQ. FT. p 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 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, TEMIPERM 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: VENTILATION 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 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 INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL 9 PERMIT APPLICATION City of Le Ouinia Department of Building and Safety This permit becomes void it 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 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 (commencing with Section 7000) of Division 3 of 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) of 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 permit subjects the applicant to a civil penalty of not more than five hundred dollars (E500.): O 1, as owner o1 the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sate (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. IL 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 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 of property who builQs 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: 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. O Certified copy is tiled with the City Building Inspection Department or City Department. Date Applicant APPLICANT NAME (L. F. MI) JL Construction ' ADDRESS P.0."Box 173 CITY/COMMUNITY/STATE/ZIP Nestor; CA 92053 JOB SITE ADDRESS/SPACE CITY/COMMUN1TY/STATE2IP La. to CA 92253 BOK I PAG I PRC I C TNN RNG SE L TRACTLO� 19903 60.18 MOO SB ..Plurrbing Fee 85.00 TRACT NAME HORIZON PALMS OWNER NAME (L, F. MI) gyral Management Corp. ' CONTRACTOR -FIRM NAME J.L. Construction ADDRESS above CITY/COMMUNITY/STATE/ZIP PHONE • I LICNC e * acrreembnt ARC/ENG FIRM NAME " Michael Buccino Assoc. ADDRESS 340 S. Farrell Dr. A212 CITY/COMMUNITY/STATVZI P Palm Springs, CA' 92262 PHONE • LICNC'/ 323-7877 TOTAL °. FEE USE OF PERMIT Sin le Family Dwelling BL ION. "FSB SSB SSB "RSB DEC ZONE ORD # LOT SZ END SIDE the permit is for one hundred ($IOD) 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: IL 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 l 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 Z Art 2, Sec 341. 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: Ihereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. Q. 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 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 i DATE ` 5-2�=85 S.F.D. Permit to construct 1247 sq. ft. of living area and 433 sq. ft. of garage as per appricived plans. mech. Fee 37.00 Plan Check Fee 307.96 Const. Fee 367.00 60.18 SM Fee 5.46 ..Plurrbing Fee 85.00 862.60 105:72 DEP. PAID .756.88 * acrreembnt with rriminity t Department TOTAL °. FEE 80.60 A11D4 D LS )56.88 CK FINANCE VALUATION 77,948.00 '•