001419 (SFD)TAti�t44
T
P.O. BOX 1504 No. 0014.9
Building44 245 E. S Dr. LA QUINTA CALIFORNIA92253
• Address -
Owner
Gawra mmawwww w'7 BUILDING: TYPE CONST. OCC..GRP.•-' . M'
Mailing... �. .
Address I . fbi"Go A.P. Number
City Zip Tel.
ffCM1".%;. Legal Description "
Contractorct Description*
_ .. .. Proje -
Address. .
14-6 Mdt3l aasidez*ial novel
P.O. B=�!
City Zip .. - . Tel.....
'92053 340-►55
State Lic. City
& Classif, Lic. # Sq. Ft.-DW X47 No. No. Dw.
" Size -tri . 43 - Stories Units "
.Arch:, Engr:,
Designer. " NewX3 Add .0 Alter ❑; Repair ❑ .. • Demolition ❑.
r m
Address Tel.
City Zip State _ ......
.- 9Q
LICENSED.CONTRACTOR'S DECLARATION • "
hereby affirm that I.am licensed under provisions of Chapter'9'(commencirig with;Section - r
7000) of Division 3 of the Business arid; Professions Code, and my license is'in full force and a.
effect:. i
SIGNATURE - r ° 1 s DATE
•
OWNER-BUILDER DECLARATION' Estimated. Valuation �k
I'hereby affirm.that I am exempt from the Contractor's License Law for the following
.reason: (Sec..7031.5,Business.and Professions- Coder Any city or counjy .which requires 'a - d
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 AMOUNT
.the provisions of the Contractor's License Law, Chapter. 9 (commencing with Section 7000) of •
DitiWon: 3 of the .Business and Profession's 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 Plan.Chk.' Dep. • ' - aria
subjects the applicant to-a civil penafty'ol not more than live hundred dollars ($500).2L'
Plan Chk: 'Bal. p
[1I, as owner-of the property, or my employees with wag or sole compensation,,will e
do the work, and the structure is not intended or.offeied for sale. (Sec:+7044, Buisness and : COr1St' ,
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,p
provided thal'such'improvements are.not intended. or offered for sale. If,,.however, the building .Mach. - 3LL gay`#Fd0
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.) 1... -
❑ 1, as owner of the property, am exclusively' contracting with licensed contractors to con- Plumbing MAO
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.L. - - 5' 46 '•
- such projects with a contractor(s) licensed pursuant 4o theContractor's License Law.) -
. .. ❑ I am exempt under Sec. B. t. P.C. for this reason' Grading .
Driveway Enc.
Date owner Infrastructure 13aVMCft ZU j,;
t � C0WrA=ty U,t ;:It I AAXVZ ' -
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 • - -
❑ Copy.is filed,with the city. 0 Certified copy is hereby furnished. '
_ TOTAL . 75..$8
CERTIFICATE OF EXEMPTION FROM
REMARKS.
WORKERS'. COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dollars ($100) valuation ' • - •`
or less.) .. .. _
» I certify that in the performance of the work forwhich 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 of Exemption -you should become ZONE: BY: -
subject' to 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
r . CONSTRUCTION. LENDING AGENCY 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, from•Property Liffe .
Lender's Name
Lender's Address
This DATE INSPECTORThis is a'building permit when"properly filled out, signed and validated, and is subject to .
expiration if work thereunder is suspended for 180 days.: -
Lcertify that l have read this application and state 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 inspection,p"urpots s. f Validated by:
Signature of applicant Ffi /.` J!! l.`a !.... Date,• /1 >ty
Mailing Address . _ tr + yrr Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. S0. FT.
POR. SO. FT. ®
GAR. S0. FT. ®
CARP. SO. FT. @
WALL SO. FT. ®
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
t
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.IEOUIP.
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 ® 1 Vi c
SEWAGE DISPOSAL
SO.FT.GAR ® 3144c
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 APP.IEOUIP.
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
J
.r
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 of 180 days.
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
LICENSED CONTRACTORS DECLARATION: 1 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 Contractors License Law
(Chapter 9(commencing with section 7000) of Division 3o1 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 (MOO.):
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 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. It, 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.).
0 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 rat apply to an owner of property who
builQs or improves thereon, and who contracts for such projects with a contractors) 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 1 have a certificate of consent to self -insure, or a
certificate of Workers' Compensation Insurance , or a certilied 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
APPLICANT NAME (L. F. MI)
JL Construction
ADDRESS
P.O. Box 173
CITY/COMMUNITY/STATE/ZI P
Nestor; CA 92053
JOB SITE ADDRESS/SPACE
CITY/COMMUNITY/STATE/ZIP
La.Quinta, CA 92253
Bolt I
PAG
PRC
.,IT*"
mech. Fee 37.00
RNo
SE
s
TRACT
19903
LOTMOD
Plect. Fee- 60.18
SB
TRACT NAME
HORIZON PALMS
OWNER NAME (L. F. MI) Caneral Management Corp.'
CONTRACTOR -FIRM NAME
J.L. Construction
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
PHONE.
105.72 DEP. PAID
LICHC .
ARC/ENG FIRM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CIT'/COMMUNITY/STATE/ZIP
Palm Sprincts, CA 92262
PHONE
323-7877
LICNC r
'
USE OF PERMIT
Single Familv Dwelling
BL
ZON.
'FSB
SSS
SSB
'RSB
OFC
ZONE ORD /
LOT SZ
I -END
SIDE
the permit is for one hundred ($100) 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 asto become subject to the Workers' Compensation Laws of
California.
'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 2. 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 rated 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: 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. 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
APPLMRMT TE
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
Plect. Fee- 60.18
Mff Fee 5.46.
.Plurrbing Fee 85.00
862.60
105.72 DEP. PAID
756.88
*Deferred payment as = ggreendmt
t Department
TOTAL
FEE
2.60
H11 / 7 L 5 /j&88 CK
FINANCE VALUATION F7548.00