001420 (SFD)Building
Address
Owner
'Mailing'
Address
City
44
P.O. BOX 1504 No. 001420
78-105 CALLE ESTADO
.44-265 E. SMY]MM CrOSt DriVMA QUINTA, CALIFORNIA 92253
01018=1 -'BUILDING: TYPE CONST. VW OCC'..GR . P.
f__
Zip Tel.
Contractor
Address
P.O. B= 178
-city .1Zlp Tel.'
Rest= smw *9202M. 340 -MU
A.P. Number
Legal Description
Project Description R3112M. MIMI
State Lic.
City
M41247
& Classif. . 442s=
Lic. #
Sq. Ft No No. Dw.
' (MR.- 433-
Arch.., Engr-.
Size - -Stories. -Units-
.Designer iwirlm
New'® Add 0, Alter 0. Repair O. Demolition . El
Address Tel.
340-A, FZ-0=1124-Dr. 323-7-877,
Cityip State
... pc-aM 92262 Lia .#
LICENSED CONTRACTOR'S DECLARATION,
I hereby affirm that I am lice /' qs�d,under provisions of Chapter 9 (commencing with Section
7111) of Division 3 of the Busines�sand Professions Code, and my license, is in full,fdrce.and
effect.
F DATE
OWNER -BUILDER DECLARATION'
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 703 1.5, Business. and Professions Code:. Any city or.counfy .which. requires, a
-0M,949.00
permit to construct, after, 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
7e
Divisldii'3 of the Business and Professions Code, or that.hb Is' exempt therefrom, and - the basis
for the 'alleged Any Section 7031.5 by. 'any for
n
PlaC,Chk. Delp. W5.72
exemption. violation of applicant permit
subjects the -applicant to a civil penalty of not more than five hundred dollars (S500).7-
Plan Chk. Bal....' M2..24
0 1, 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, Buisness and
67oo
Professions Code: The -Contractor's License. Law does 'not apply -to an owner of property whoCOf1St
*who
.
builds or improves thereon' and 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
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 ownerof the property, am exclusively contracting with licensed• contractors to con-
Plumbing' 85.00 -
Stru ct the project. (Sec. 7044, Business and Professions Code: The Contractor's -License Lew.
does not apply to an owner of property who builds or improves thereon, -and who contracts for
5-A6
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)-
Grading
0. Lam exempt. under Sec. B.-&.P.C;for this reason
Driveway Enc.
Date Owner
Infrastructure Dafemid m9mer t as oil�w
With anim— r—LW-01. nir
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I"ha%Ve 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., 0 Certified copy. is hereby furnished.
TOTAL 756 88
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This -section need not be completed if the permit is for one hundred dollars ($100) valuation
-orless.)
I certify that in the performance of thp 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 wner
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.•
-Minim.um-Setback Distances:
Front Setback from,Center Line
Rear Setback'from Rear Prop.. Line
CONSTRUCTION LENDING AGENCY -
'Si de Street Setback from.Cenier.Line,
I heieb affirm that there is a construction. lending agency for the performance of the
for which
work I ch this permit is issued. (Sec. 3097, Civil Code.)"
Side. Setback from Property Line
Lender's Name
.Lender's Address
'signed
INSPECTOR
This is a building permit when properly filled out, and validated, and is subject'to
..FINAL.,DATE
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
I agree to comply with all city4and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of. this city .to enter. the - above-.
mentioned property for inspectionpurposes. . . . I. . . I t .• .
Validated by:
Signature of applicant Dat /14)
Mailing ' ' Address
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. ®
CARP. SO. FT.
WALL SO. FT.
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
I 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 ® 1 V. 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
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 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
i�
PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
This permit becomes void 11 work not commenced within 180 days from date of Issuance. OR. If work has been suspended or abandoned for a period o1 180 days.
CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE: This section need not be completedif
'LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9
-(commencing with Section 7000) of Division Sof 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 o1 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 1. as owner of the property, or my employees with wages as Meir 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 riot 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. If, however, the .
building or improvemni is sold within one year of completion. Me 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
builds 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 1 have a certificate o1 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
APPLICANT NAME (L. F. MI)
JL C]nnstruf:,-tion
ADDRESS
P.O. Box 173
CITY/COMMUNITY/STATE/ZIP
Nestor; CA 92053
JOB SITE ADDRESSISPACE
CITY/COeM UNITY/STATE/ZI P
lia.Quinta, CA 92253
am
PAG
PRC
C
as per approved plans.
WMA
RNG
SE
S
TRACT
19903
LOT
Plan Check Fee
MOD
SB
Const. Fee
TRACT NAME
HORIZON PAIMS
OWNER NAME (L. F. MI) General Management Co
CONTRACTOiI-FIRM NAME '
J.L. Construction
ADDRESS
ablove
CITY/COMMUNITY/STATE/ZIP
PHONE •
5.46.
LICNC
.Plimbin Fee
ARC/ENG FIRM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CITY/COMMUNITY/STATE/ZIP
Palm rin s CA 92262
PHONE / LICNC •
323-7877
USE OF PERMIT '
Single Family Dwelling
SL
ZON..
105.72 DEP. PAID
FSB
Ssa
SSB
RSB
as = a eembnt
oFc
t Departnent
" ZONE ORD 0
LOT SZ
END
SIDE
the permit is for one hundred ($100) o. less. I certify the. In the performance o1 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 o1
California.
Date Applicant
NOTICE TO APPLICANT: 11, alter making this Certificate of Exemption, you should became 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 I 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 32, Grp Z Art 2. Sec 341, 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'lo do such work from that division.
0 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. 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. I agree to comply with all state laws and county ordinances relating to buidting
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/PNMT -
DATE-
S.T.D.
Pemit to construct
1247 sq. ft.
of
livincT area and 433
sq. ft. of gaage
as per approved plans.
mech. Fee
37.00
Plan Check Fee
307.96
Const. Fee
367.00
60.18
SMI Fee
5.46.
.Plimbin Fee
85.00
Infrastmicture
862.60
105.72 DEP. PAID
756.88
*Ilefe=ed payment
as = a eembnt
with Ccumini=
t Departnent
TOTAL '•
`FEE
862.60
FINANCE VALUATION 77, 948.00