001449 (SFD)P.O. BOX 1504 0'0 1 4 9
Building 78-105 CALLE ESTADO
Address c LA QUINTA,.CALIF.ORNIA 92253
Owner
:'mate 'i __-�,aar.ww+b• flnsw�Q
Mailing '
BUILDING:. TYPE CONST. V � OCC: GRP.,.
Address 101 ELShap St.. .te 2700A.P. Number.
City Zip it3 Tel. ^
ffWD�3�:it Legal Description
Contractor Project Description R�W,.20
Address
a4�' .t Rill i� 3al �.
P.8_ 173
City .. Zip . Tel..... .
92053 340-5511
State Lia City
7
& Classif.. 4422 Lic. # . 237. Sq. Ft. No. No. Dw.
Arch.; Engr., __ Size • G Sto 433 .. ries Un - .
its
DesignerNew 9: Add ❑ Alter ❑ Repair ❑. Demolition ❑, .
_ .As
Address Tel.-
4 AMA. _ . X21„,. A
CityZip State "
Lic. #Palm
. ._
,.LICENSED CONTRACTOR'S. 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 licenseLiisyin full-force and
effect. +
. rfr 1.1 r `1 J.� a t 1. � if. •�0.f - ... ... .'. ..._..
It (DATE
OWNER BUILDER DECLARATION ,� Estimated Valuation
ni
hereby affirm that I aexempt from the Contractor's License Law forthe following
reason: (Sec..7031.5,Business and -Professions Code: -Any, city -or county which requires .a • !Aa X10
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•Jicensed 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 thathe is exempt. therefrom; . and. the' basis,• - -
.for the. alleged exemption. Any violation of Section 7031.5 by 'any applicant for 'a permit .Plan Chk. "Dep. - 100.72 ,
'subjects the'applicant'to a'civil penalty or not more'than five hundred dollars'(S 500)." - '
O:I, as owner of the property, or my employees with wages as theirsole,compensation„Plan Chk. Bal..
wit{
do the work, and the structure is not intended or offered for.sale: (Sec. 7044,•Buisness andCOnSt. .
• 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, Meth.
.provided that such. improvements are not intended or offered for sale. If, however,,thebuilding-:'. _
or improvement is sold within one year of completion;.the owner-builder- will have the burden Electrical
of 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'J. C; AA
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec.. B. & P:C. for this reason
Driveway Enc.
Dale ownerInfrastructure
. _ ... .... .ase*� _ ___ _ # air__ _ •
WORKERS' COMPENSATION DECLARATION
I' hereby affirm that I have a' certificate of consent Ao self-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 71;9 AQ
• CERTIFICATE OF EXEMPTION-FROM REMARKS
WORKERS' COM P ENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (S 100) • valuation
or less.) .. ..
I certify that in the performance of the work for which this permit is issued, I shall not t
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 ZONE:+ BY:
subject' to the 'Workers' Compensation provisions 'of theLabor Code, 'you must forthwith.- Minimum_ Setback'Distances:
comply with such provisions or this permit shall be deeme_ d'r_evoked.
Front Setback.from Center.Line
_ . Rear Setback from Rear. Prop. Line
CONSTRUCTION LENDING.AGENCY Side-Street Setback from reenter 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 from, Property Line
Lender's Name
Lender's Address
This is. a' building' permit when properly filled out, signed and validaled,'and"is subject to : FINAL DATE INSPECTOR
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and stale that the'above information'is correct. ISSued.by Date Permit' .
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 inspectio
n (purposes. { J r - Validated by:
Signature of applicant.
/ / t re / _ Date
Mailing Address �.i r r" % f 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. 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.IEQUIP.
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ec
HOUSE SEWER
REMARKS:
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEEPERMIT
FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEEPLUMB. 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.IEQUIP.
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
APPLICANT NAME (L. F. MI)
JL (Yinstruction
ADDRESS
P.O. Box 173
CITY/COMMUNITY/STATE/ZIP
Nestor; CA 92053
JOB SITE ADDRESS/SPACE
PERMIT
APPLICATION
City of La omnia
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. .
TWN
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
the permit is for one hundred ($100) o, less. I certify that in the performance of the work for which this, permit is
(commencing with Section 7000) of Division 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 as to 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 Certificate 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
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 of the Contractor's License Law
101 hereby certify that no excavation five (5) or more feet in depth into whicha person 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 of 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 Z Art 2, Sec 341. Title B.
subjects the applicant to a civil penalty of not more than five hundred dollars (5500.):
C.A.C.)
O 1, as owner o1 the property, or my employees with wages as their 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 o1
structure is not intended or offered for sale (Ser 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 of properly who builds, or improves thereon, and who does such work himself or
0 Division of Industrial Safety Permit No.
through his own employees, provided that such improvements are not intended or offered for sale. It, however, the
,
building or improvemnt is sold within one year of completion, the owner -builder will have the burden of proving that
Date Applicant
he did not build or improve for the purpose of sale.).
CONSTRUCTION LENDING AGENCY: 1 hereby affirm that there is a construction lending agency for the performance
❑ 1, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec.
of the work for which this permit is issued (Sec. 3097, Civ. C.).
7044. Business and Professions Code: The Contractor's License Law does rat apply to an owner of property who
lender's Name
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
SSB •
Contractor's License Law.).
Lender's Address
O 1 am exempt under Sec. B. & P.C. (Attached Certificate).
1 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 hereby authorize representatives
LOT SZ
of this county to. enter upon the above-Imentioned property for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure,"or a '
END
certificate of Workers' Compensation Insurance . or a certified copy thereof (Sec. 3800. Lab. C.)•
Signature of Applicant or Agent Date
Policy No. Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify l have read this application and state that
o Certified copy is hereby furnished.
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
❑ Certified copy is filed with the City Building inspection Department or City Department.
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.
Date Applicant
APPLICANT NAME (L. F. MI)
JL (Yinstruction
ADDRESS
P.O. Box 173
CITY/COMMUNITY/STATE/ZIP
Nestor; CA 92053
JOB SITE ADDRESS/SPACE
CITY/COMr i INITY/STATE/ZIP
La. to CA 92253
BOK
PAG
PRC I
C
TWN
RNO
SE
S
Const. Fee 367.00
LO%Q�i'
Elect, Fee 60.18
MOD
Tluffbi= Fee. 85.00
19903
Tnfrastructure
862.60
ISS
I
TRACT NAME HORUO T PJ Mc
/�
OWNER NAME (L. F. MI) (neral Management Co '
CONTRACTOWFIRM NAME
J.L. Construction
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP '
PHONE it
- TOTAL
FEE
LICNC
2.60
ARC/ENG FIRM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CITY/COMMUNITY/STATE/ZIP
Palm Sminas. CA 92262
PHONE 4 LIC14C #
,
323-7877
USE OF PERMIT
Single Fard1v Dwelling
BL
ZON.
FSB
SSB
SSB •
RSB
OFC
ZONE ORD #
LOT SZ
END
SIDE
Signature of Applicant or Agent
Print Applicant/Agent Name
7
Date
A
APPLNRMT ?_1
DATO 5-2-2=85
'
SX. D.
Permit to construct 1247 sq. ft.
of
living area and 433 sq. ft. of garage
as per approved plans.
mech. Fee 37.00
Plan Check Fee 307.96
Const. Fee 367.00
Elect, Fee 60.18
SW Fee 5.46.
Tluffbi= Fee. 85.00
Tnfrastructure
862.60
105.72 DEP. PAID
-756.88
t
* acrreembint
t Department
- TOTAL
FEE
2.60
A 1 1 6 6
FINANCE
[S /5&88 CK
VALUATION 77,948.00