001417 (SFD)P.O. BOX 1504 NOL A 4
Bullring44-205 E. �' � Dr- LA QUINOTA CALIFORNIA92253 .
Address '
Owner
,
t BUILDING: TYPE CONST. VNI& O.CC: GRP.'' .R-
Mailing,
Address
City
Zip
. ..Address
P,.0- BW 1173
city--- _ . .. Zip ..
2700 A.P. Number
Tel....,
3 • _800—.567"'50Legal Description,
Project Description RPr►r$rs M a IiIime
$A1 l
Tel. -
State Lic. City MG 1247
& Classif.$ 23Ty Lic4W22. # Sq. Ft. No.. No. Dw.
Size °M 43:.. .Stories . . Units
Arch:, Engr.,
' '.Designer New.*, Add ❑ Alter ❑ Repair ❑.->: Demolition ❑.
Address Tel.
3»7877 K° '
_.. _
City Zip - State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencingrwilh Section a —
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE v - _ ... -7 DATE
" OWNER -BUILDER DECLARATION ' . . '
I hereby affirm that I am exempt from the Contractor's License Law for the following.
Estimated Valuation
reason: (Sec: 7031.5;Business,and Professions Code:. -Any city,_or county which requires, a
WORKERS' COMPENSATION DECLARATION
.. 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 "
:
.the provisions of theContractor's. License .Law, Chapter 9' (commencing with.Section '7000) of
-"' • D&I'sion 3 or the'Susiness and -Professions Code, or that. he is exempt tberefrorA,• and the basis
_for the -'alleged exemption. Any violation or Section 7031.5. by any applicant for a permit
.
Rlan..ChK.. Dep. .
- subjects the'applicant to a'civil penalty of not mote -than five hundred dollars ($500). ` ' ' ' ".
. ❑ I, as owner of the property, or my employees with.wages as their sole compensation, wi11
Plan Chk..Bal. .
COr1St.,
do the work, and the structure is -not intended or offered for sale. (Sec. 7044,. Suisness and.
• Professions Code: ;The Contractor's License Law does not apply to an owner of property* who
Mech.
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., It, however, .the building '
'Electrical
of. 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.)' ..,. . ,
Plumbing
❑ I, as owner of the property; am exclusively contracting with licensed contractors to.con-
• strucl the -project -(Sec: - 7044; Business and Professions Code: The Contractor's License Law
does not apply to an owner or property who builds or improves thereon, and who contracts for
S•M.I. ..
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
_ 0 I am exempt under Sec..B. B. & P.C.-for this reason
Grading
Driveway Enc.
Date' Owner
Infrastructure4
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.)
Policy No. . ....Company . . ...
O.Copy is filed with the city.. ❑ Certified copy is hereby furnished.
'.
TOTAL
oro gn _ S3
'CERTIFICATEOFEXEMPTION 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 sous 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 :
BY:
-subject* to the' Workers' Compensation. provisions of the Labor Code, you must forthwith-
comply with such provisions or this permit shallbedeemed revoked.
,ZONE:
Minimum Setback Distances:' - -,
Front..Setback from.Center.Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback 6om 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 fYOm ,Property. Line
Lender's Name
Lender's Address
FINAL DATE
INSPECTOR
This is a building permit when properly filled out, signed and validated, arid is'subjectto =
expiration it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct:
Issued' b y
Date Permit .
I agree to comply with all city and county ordinances and state laws relating to building
-
construction, and hereby authorize representatives sof --this city to- -enter • the -above-.
mentioned property for inspection;purposes. .
Validated by:
ff '/ r
Signature of applicant Z A' : —DateF/
Mailing Address / ` ' ' _ 1
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT. p
BONDING
YARD SPKLR SYSTEM
FOR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP./EOUIP.
DRINKING FOUNTAIN
SQ. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
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./EOUIP.
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/INITIALS.
GARDEN WALL FINAL
LICENSED CONTRACTORS DECLARATI
(commencing with Section 7000) of Divi
and effect.
License Class Lic. Number
Date Contractor
OWNER -BUILDER DECLARATION: 1 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 (5500.):
0 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 properly 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. If, however, Me
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.).
0 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
builQs or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
0 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
0 Certified copy is hereby furnished.
0 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. It work has been suspended or abandoned for a period of 180 days.
CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE: This section need not be completed if
ON: 1 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 perlormance o1 the work for which this permit is
sion 3of the Business and Professions Code. and my license is in full force Issued. I shall not employany person inanymannerso asto beconve subject to the Workers'Compensation Laws of
California.
APPLICANT NAME (L. F. MI)JLOnnstruction
ADDRESS
P.O. Box 173
CITY/COMMUNITY/STATE/ZIP
Nestor, CA 92053
JOB SITE ADDRESSISPACE
CITY/CGMM UNITY/STATE/ZI P _
La• to CA 92253
Bol(
PAG
PRC
C
Elect, Fee 60.18
TWN
RIND
SE
s
19903
LOT
//1
with cinnyrnmit;y t De t
Moo
se
2 60
TRACT NAME _ HORIZON PALMS
OWNER NAPE Il. F. MI)
A. me al Management Corp. '
CONTRACTOR•FIRM NAME
J. L. Construction
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE .
LICNC .
ARC/ENO FIRM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CITY/COMMUN ITY/STATE/ZIP
:Palm rin s CA 92262
PHONE .
323-7877
LICNC .
USE OF PERMIT '
Sin le Famil Dwelling
BL
ZON.
'FSB
SSB
SSB
RSB
1
OFC
.—
ZONE ORD •
LOT SZ
-END
SIDE
L
It
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:
0 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 3.2, Grp Z Art 2. Sec341. Title 8.
C.A.C.) .
0 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.
0 Division o1 Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: 1 hereby affirm that there is a construction lending agency for the performance
o1 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-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.) agree to comply with all state laws and county ordinances relating to buidling .
construction, and authorize a lepresentative 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 QJ_ � - - DATE TE S.F.D.
Permit to construct 1247 sq. ft. of
livingarea and 433 . ft. of arage
as r a roved plans.
mech. Fee 37.00
Plan Check Fee 307.96
Const. Fee' 367.00
Elect, Fee 60.18
SMI Fee 5.46
.Pimbin Fee 85.00
Tnfrastructure
862.60 .
105.72 DEP. PAID
756.88
* a eem6nt
with cinnyrnmit;y t De t
TOTAL '.
FEE
2 60
H 1 1 3 0 J L D / 7 6 6 8 CK
nfuetiec VALUATION 77,948.00