001450 (SFD)P.O. BOX 1504 No
Building 78-105 CALLE ESTADO 001450
_ Address 44-236 W. SLMdC*M G'e't Dr. LA QUINTA, CALIFORNIA 92253
Owner
xxteil A+
Mailing '
Address 101. BW
City
sssarx BUILDING: TYPE CONST. $i OCC: GRP.-
P f• &4te 2700 -- A.P. Number -
Zip ii cp:.� Tel.
1T800 - 367-- s4,. Legal Description '
Contractor
Project Description
+MM. *Rlyn
r.
J.L.
_
.....Address. .. ...:. -. .. . _
_ .. .......
� ; t m _ l ;:moi : ., .
P.O. BM 173
r -City-- ............
Zip..... ...
Tela
32053
340 -SM
State Lic.
City
• &.Classif: �
Lic. # ,�
Sq. Ft. Z 1. 47
No. No. Dw.
•
Size 1tQ:w
Stories Units
---Arch., Engr:. ...... ... .:
_
_.:Designer
1 _ilne� 1�sa�r�r_
New 04. • Add ❑
Alter ❑• Repair ❑ -Demolition ❑
Address
Tel.
.340 S.-11
32-°! .
.. ... .. ....
.. _
City Zip
State
.. .. ..
Palm 2262
Lic..#
LICENSED CONTRACTOR'S DECLARATION
am
I herebyaffirm that licensed under provisions of Chapter 9' (commencingwith Section
't
7000) of ivision 3 of thepButsiness and Professions. Code, and mlicense is i full force and
n
effect.. _.. Jr?�.. -f , -�.. .- _ f.?/ ./. i-
-
SIGNATURE a_/' ,r / " DATE
.. ...
.. .
..
OWNER --BUILDER DECLARATION
Estimated Valuation
..
I hereby affirm that I am exempt from the Contractor's License Law for the following
Code: An
'•�7r'
Q
reason: 70315,Business and Professions
Sec. .
, ( y'city or county which requires .a.:
. u:. permit to construct, attei; improve, demolish, or repair any structure, .prior to its Issuance also
.. -
-
.requires the applicant:/or such permit.to file a signed statement that he is licensed pursuant to
- PERMIT
. AMOUNT '-
the provisions o/ 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 o/ Section 7031.5 by. 'any applicant for 'a
Plan Chk.' Dep'.
..
permit
' subjects the applicant to a civil penalty o/ not more than live hundred dollars ($500).
Plal.
Plan OW Ba
_7
❑ I; as owner of the property, or my employees with wages as their sole compensation,, will
- _20i. .4
do the work; end 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 -such
.
or improves thereon and who' does work himself or through his, own,employees,
intended
Mech..
.
..
- 7
- provided that such improvements are.not or If, however, the building.
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.) .
' O 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. 1.
such projects with a contractors) licensed pursuant to the Contractor's License -Law.) -
Grading
..
• ❑ 1 am exempt under Sec.� B: & P.C. for this reason.
Driveway Enc.
Date Owner
Infrastructure,
WORKERS' COMPENSATION DECLARATION
hereby affirm that'l,have a certificate of consent to self -insure ; ora certificate of • '
orkI
Wer'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
S1�ii I!
CERTIFICATE OF EXEMPTION FROM
REMARKS.
WORKERS' COMRENSATION-INSURANCE
- (This section need not be completed i/ the permit is /or one hundred dollars ($100) valuation
- -
- - -
or iess.) _ .. _
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 ' ' owner
NOTICE TO APPLICANT: If, alter making this Certificate of Exemption - you should become
ZONE:
BY: -
subjectto the' Workers" Compensation provisions of the Labor Code, you must forthwith
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 V.
Side Street, Setback from 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 frorT.1 :Property, Line'
Lender's Name
Lender's Address
FINAL.DATE
INSPECTOR:
This isa building permit when properly filled out, signed:and validated; and is subject to
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'by:
Date Permit
Pagree 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 for inspection
r
property purposes.
Validated by:
Signature f!%`. 1- f x`
`
of applicant •. Date
• Mailing Address +`. ; ' f '
Validation:
City, State, Zip
HARD COPY '
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. @
CAR P. SO. FT.
WALL SO. FT. ®
SO. 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 APPJEOUIP.
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
AIECH.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 APPJEOUIP.
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 SIGNATURESIINITIALS,
GARDEN WALL FINAL
PERMIT APPLICATION
City o1 La Ouinta
Department of Building and Safety
This permit becomes void i1 work not commenced within 180 days from date o1 issuance, OR, If work has been suspended or abandoned for a period of 180 days
APPLICANT NAME (L, F. MI)
JL f3nnstruction
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
Icommencing 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 asto become subject tothe Workers'Compensation Laws of
and effect.
California.
License Class Lic. Number
Date Applicant
Date Contractor
NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you should become subject to the Workers'
OWNER BUILDER DECLARATION: I hereby affirm that 1 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 islicensedpursuanttothe provisions oftheContractor'sLicense Law
01 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) o1 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 strueture, 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 2 Art 2, Sec 341, Title 8,
subjects the applicant to a civil penalty of not more than five hundred dollars (5500.):
C.A.C.)
❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
❑ 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 of property who builds, or improves thereon, and who does such work himself or
O Division o1 Industrial Safety Permit No.
through his own employees. provided that such improvements are not intended or offered for sale. If, however. the
ADDRESS
building orimprovemntissold within oneyearofcompletion. the owner -builder will havethe burden of proving that
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
❑ I, as owner o1 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
,Contractor's License law.).
Lender's Address
❑ 1 am exempt under Sec. B. d P.C. (Attached Certificate).
I certify theft have read this application and state that the above information is correct. I agree to comply with all '
Owner
'City and county ordinances and state laws relating to building construction, and hereby authorize representatives
Date
of this county to enter upon the above-mentioned property for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
ZONE ORD 0
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. Q.
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
D Certified copy is hereby furnished.
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling .
O 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
Signature of Applicant or Agent Date
APPLICANT NAME (L, F. MI)
JL f3nnstruction
ADDRESS
P.O. Box 173
CITY/COMMpJMITY/STAT E/ZIP '
Nestor; CA 92053
JOB SITE ADORESS/SPACE
CITYICOMM UNtTY/STATE/ZIP -
La.Quinta CA 92253
BOK
PAG
PRC
C
mech. Fee 37.00
TWN
AND
SE
S
TRACT
19903
I LOj4
MOD
SS
.Plimbing Fee.. 85.00
TRACT NAME HOPJZC T PTT*Rc
OWNER NAME (L. F. MI)Gane • al Management Co
l7�iGi
CONTRACTOR -FIRM NAME
J.L. Construction
ADDRESS
ahove
CITY/COMMUNITY/STATE/ZIP
ahQm
PHONE 6 1
756.88
LICNC 1
* ggreentint
ARC/ENG FIRM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
• CITY/COMMUNITY/STATFIZIP
Palm Springs, CA 92262
PHONE 0 11 LICNC 0
862.60
323-7877
USE OF PERMIT
Single Familv Dwellin
BL
ZON.
'FSB
SSB
SSB
RSB
DEC
ZONE ORD 0
LOT SZ
END
SIDE
Print Applicant/Agent Name � h `V,5 0
APPL/PRMT� �' DATE i-85
S.F.D.
Permit to construct 1247 sq. ft.
of
livincr 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
Sm Fee 5.46
.Plimbing Fee.. 85.00
Tnfrastructure
862.60
105.72 DEP. PAID
756.88
* ggreentint
t Department
TOTAL
'FEE
862.60
M 1 1 0/ J L J / 7 6. 8 8 R
FINANCE VALUATION 77,948.00