001408 (SFD)a
Zip ...
.L
t •�
' Building
Address•-'
. Uor,5511
Owner
State Lic.
City
Mailing
.Issued:by:
Address
Lic. #'
City
No. Dw.
TA h1f
44
P.O. BOX 1504 No.
78-105 CALLE ESTADO
r1r. LA QUINTA, CALIFORNIA 92253
Zip Tel.
36813111.1-800-3
Contractor
Address . :.
P.O.'
BUILDING: TYPE CONST. VX ::OCC: GRP. R I
A.P. Number
Legal Description
Project Description kMM:-
City
Zip ...
Tel.'
.
92053
. Uor,5511
Side Street Setback from Centerline
State Lic.
City
INSPECTOR
.Issued:by:
& Classif.-1247
�
Lic. #'
Sq. Ft. No.
No. Dw.
Validation:
Size KRA Win Stories -
-Units -
Arch.iEngr:,--Add
.DesDesigner
New ❑ Alter ❑ .
Repair ❑• Demolition ❑-
p
Address
Tel.
q
171-7977
City
Zip
State
. .
_. Tal* i>
92262Lic.
#...
LICENSED CONTRACTOR'S DECLARATION
�I
—
hereby affirm that l am licensed under provisions of Chapter 9'(commencing with Section'
7000) of Divisiojn'36frtyghee Busttiness and Professions Code, -and my license is in fullforceYalnd i
effect. J/t J i S / .Tf.`• : / 1_3 •707 J
DATE.
.. _ .. .. ....
.- ... _
oWNER•BUILDER DECLARATION'.
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
Any
�w.'Qj q �qA
94
'
reason:,.(Sec. 7031;5,Business and Professions. Code: 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
i9 ,1 X00
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. that. he -is. exempl'theiefrom,' and the basis.
-- for the Any Section 7031.5 by 'any. for
Plan. Chk. Ddp.'. - -
-• 195.72.
alleged' exemption. violation of applicant.. a permit:
subjects the applicant to a civil penalty of not more than'five'hundred:dollars ($500). '•-
'O '
Plan Chk. Bal..
.
,
2024, 24
I, as owner,of the property, or my employees with wages;as their sole -compensation, will .
.
- do the work, and th6.str66ture is not intended oroffered for sale. (Sec. 7044,'Buisness and '•
ConM*.'_
3'7�0�
• .Professions Code: The Contractor's License Law does not. apply,to•an owner.of, property who.
,
builds or improves thereon and who does such work:.himself- or through 'his own employees,
' Mebh.
R
3
. ,provided: that such improvements -are_ not intended or offered, for sale. If, however; the. building
j .•00 .
or improvement is sold within one year of completion,- the. -owner -builder will have the. burden
Electrical-.�
• of proving. that he.did not build or improve,for.the purpose of sale.) ._ - -
,
.O I, as owner of the property, am exclusively contracting with licensed• contractors to con-
Plumbing '
85.00 "
struct the project. (Sec. -7044, Business and -Professions Code: The Contractor's 'License Law
does not to *an who builds improves thereon, for
S.M.I.'
-
• apply owner of property or and who contracts
- suchprojects with a contractors) licensed pursuant to the Contractor's License Law.) •
-
5..56
-
Grading
. ❑ I am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
Date owner
Infrastructure 19fa
t a$•i
WORKERS' COMPENSATION DECLARATION
I hereby affirm that -1 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 00 Company
' ld Copy is filed with the city., ,O,Certified copy is hereby.furnished.
CERTIFICATE OF EXEMPTION FROM
}{ WORKERS' COMPENSATION INSURANCE
(This lseclion need not be completed it the permit is -for one Ihundred'dollars ($100) valuation
.. or less.) ..
I certify that in the performance of thg 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, after making this. Certificate or 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. '
CONSTRUCTION LENDING AGENCY" .
(.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.)',
Lender's Name
Lender's Address
This'is a 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:
I agree to comply with all city and county ordinances and state.faws relating to'building'
construction, and hereby authorize representatives: -of this city to enter the' above
mentioned property for inspection:purposes. }#'
Signature of applicant Y 11
_ r` !i : r - :' Dat -Q k d Iy_
Mailing Address --
City, State, Zip r
HARD COPY
` .. �1� �'leissnreais$4csi?xagt t►1SM+sraf Tit�'t1'9�'
TOTAL
-5-REMARKS
ZONE:
BY:
Minimum Setback Distances:
Front Setback -from Center.Line
Rear Setback from Rear.Prop. Line
Side Street Setback from Centerline
Side Setback from.Property.Line
.FINAL DATE_
INSPECTOR
.Issued:by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEE'S
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SQ. 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.000L HOOD
SIGN
WASH ER(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, TEM/PERM
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
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
CNSPECTOR'S SIGNATURES/INITIALS.
GARDEN WALL FINAL
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
APPLICANT NAME (L. F. MI)
JL Clnnstruction
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed it
LICENSED CONTRACTORS DECLARATION: I hereby affirm that 1 am licensed under provisions of Chapter 9
the permit Is for one hundred ($100) o, less. l certify that in the performance of the work for which this permit is
(commencing with Section MOO) of Division 3of 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 theWorkers'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 oftheContra ctor'slicenseCaw
01 hereby certify that no excavation live (5) or more feet in depth into which a person is required to descend, will be
(Chapter 9(commencing with section 70DO) o1 Division 3 o 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 o1 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 ($500.):
C.A.C.)
O I, as owner of 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 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 o1 property who builds, or improves thereon, and who does such work himself or
O Division of Industrial Safety Permit No.
through his own employees, provided that such improvements are not intended or offered for sale. If. however, the
ADORESS
340 S. Farrell Dr. A212
building or improverrint 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 sate.).
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance
O 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.).
7004. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
Lender's Name
builgs or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the
SSB
Contractor's license Law.).
Lender's Address
O 1 am exempt under Sec. B. 8 P.C. (Attached Certificate).
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
Date Owner
of this county to enter upon the above-blentioned property for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate o1 consent to sell-insure,'or a '
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
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
APPLICANT NAME (L. F. MI)
JL Clnnstruction
ADDRESS
P.O. Box 173
CITY/COMMUNITY/STATE/ZIP
Nestor, CA 92053
JOB SITE AODRESSiSPACE -
CITY/C06111AUNITY/STATE/ZIP - - -- - -
La. to CA 92253
BOK
PAG
PRC
J C I
I
TWN I
AND J
SE
s
TRACT
19903
LOT
Elect- Fee 60.18
MOD
Ste
.21urrbing Fee 85.00
TRACT NAME _ ON HORIZPALMS
HORIZON
OWNER NAME (L, F, MI)
Maamigement Corp.'
COIRRACTOR-FIRM NAME
J.L. Construction
ADDRESS
ahimm
CITY/COMMUNITY/STATE/ZIP
PHONE a
756.88
LICNC I
* ggreenitint
ARC/ENG FIRM NAME
Michael Buccino Assoc.
ADORESS
340 S. Farrell Dr. A212
CITY/C01101MUNITY/STATE21P
Palmrin s CA 92262
PHONE frLICNC
323-7877
8 2.6Q
USE OF PERMIT '
Sin le Family Dwelling
BL
ZON,
•FSB
SSB
SSB
RSB
DEC' -
ZONE ORD •
LOT SZ
'END
SIDE
Signature of Applicant or Agent Date
Print Applicant/Agent Name eq 1
1
APPIMT�5 2-2=85
S.F.D.
Permit to construct 1247 sq. ft.
of
livinq area and 433 sq. ft. of
age
as Per approved Plans.
Mech. Fee 37.00
Plan Check Fee 307.96
Ctinst. Fee 367.00
Elect- Fee 60.18
SME Fee 5.46
.21urrbing Fee 85.00
Tnfrastructure
862.60
(105.72)DEP. PAID
756.88
* ggreenitint
with Oo=mity t De
t
TOTAL
FEE
1
8 2.6Q
A l l L 1 7 L L / 7 61 6 115 U
/. GIAI A AIP& VALUATION 77,948.00 '