001422 (SFD)Building
Address
Owner
Mailing
Address
City
Contractor
Address, .
P.O. BOX 1504 No. 001422
78-105 CALLE ESTADO
€LA QUINTA, CALIFORNIA 92253
'CAM crant Dr
ZipTel.
9681.Eire
P.O.
173 _
. Zip - _. - Tel.
BUILDING:- TYPE•CONSTY N OCC: GRP. � 3
A.P. Number
357 5054 Legal Description
Project Description + «t31Ma
r .. ,_.,..... 146 Urdts rW&tL-a Davelcmimt=,
a
State Lic.
& Classif.:. 42
City
Lic: #
23%- • ,T V
.7
Sq. Ft. No. No. Dw.
size. 433 Stories Units
-
Arch., Engr., ..
_
Designer Awhael" ala.
Newer; Add.❑. Alter ❑ Repair ❑ "° ' . 'Demolition
Address
Tel.
_
_.. 340. S: -ACM-11 Ms
323-7877..:
,.
City
Zip
State
. PAM 90c--'
92,262
.. I
~
LICENSED cONTRA�CTOR'S DECLARATION, • "-
I hereby affirmah iil am licensed under provisions of Chapter9 (corimmencing;wlth Section
7000) of Division3,Of,the Business and Professions. Code, and'my license is inf1 force.and -
.. effect. -- .?,Of,
'siil�t ll3 ti•..t. �'A !x:1�<r; f�.
'
1
„ _
_SIGNATURE f. e / 1 DATE
OWNER -BUILDER DECLARATION A•
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 /or suchpermitto file a signed statement that he, is licensed pursuant to
the provisions • o/ the Contractor's License Law, Chapter 9 (commencing with Section • 7000)ol:.�.
'DivWon'3 of'the'Buslness'and'Professions Code, or that. he is ekempt therefrom, and the basis'•
for the alleged exemption. Any violation o/ Section 7031.5 by 'any. applicant /or a. permit
subjects the applicant'to a civil penalty of not more than five hundred' dollars ($500).•
., ❑ I, as owner of the property,, or my employees with wages as their sole compensation, will
do the.work, and the structure is not intended or offered for sale. (Sec: 7044, Buisness and
Professions C.ode: The Contractor's License_Law does not apply to an *owner of, property who
- .builds or improves thereon and who does .such. work himself or through his own employees,
- provided that' such improvements, are not intended or .offered for sale.. If, however, they building ,
or improvement is sold. within one year o/ completion, the owner -builder 'will have the. burden
' of. proving that he, did not build or Improve for the purpose of sale.)
EStlmated Valuation pq
C wiiPil
- - ':' AMOUNT
_ PERMIT - ,
-
-
Plari Chk. .Dep.- gobe►.
Plan Chk. Bal. 202.24.
COf1St.��
- .5649
Mech: - y+� �+?t
3 J AS "
Electrical 6!y Yf.K.6fb `
Plumbing .
-- ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License -Law
does bot<apply to an owner o/ property who builds or Improves thereon, and who contracts dor
-such projects with a contractor(s)licensed pursuant to the Contractor's License Law.)
0.l am exempt under Sec..B. B. & P:C. for this reason
_
Grading
Driveway Enc.
Date ' owner
Infrastructure Daft, !7ammlit W » acreignmt
WORKERS' COMPENSATION DECLARATION
hereby "affirm that I have 'a certificate of consent *to self -insure, or,a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800; Labor Code.)
-
Policy No. Company
❑ Copy is filed with the city. .O Certified copy is hereby furnished. ..
TOTAL. T3«is
REMARKS
CERTIFICATE OF EXEMPTION FROM
WORKERS'. COMPENSATION INSURANCE
:(This section need not be completed if the permit is for one hundred dollars ($.100) valuation
or less.) - . ... .. , .
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, after making this Certificate of Exemption you should become'
subject to :the Workers' Compensation provisions of-'1he 'Labor Code, you must forthwith
' comply with such provisions or this permit shall be deemed revoked.
.
.ZONE: - BY:
Minimum Setback Distances:
Front Setback from Center. Line "
Rear Setback,from Rear Prop: Line
- ,CONSTRUCTION LENDINGAGENCv-
I hereby affirm that there is a cbnstruction lending agency for tfie performance of the
.work for which this. permit is issued. (Sec. 3097; Civil Code.) . ' ..
Side Street Setback -from Center Line
Side Setback from Property Line,
Lender's Name
Lender's Address
' . FINAL DATE INSPECTOR _
• 'This is abuilding permit when properly filled out, signed and validated, and is 'subject to
expiration if 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 laws relating to'building
construction, and hereby authorize irepresentatives pf this city to enter the above-.
mentioned property for inspection` purposes. ;' s _
Signature of applicant i �✓�f:''�f a 1 Date
Mailing Address 7 1
ISSued'by:� Date .- Permit. .
- - -
Validated by'
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL SQ. FT. ®
POR. SO. FT. ®
GAR. SQ. FT. ®
CAR P. S0. 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 APPJEQUIP.
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.
SQ. FT. ®c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
I 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 APPJEQUIP.
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 SIGNATURES/lb ITIALS
GARDEN WALL FINAL
PERMIT APPLICATION _ ...., _ ..... _ _ �-. _� . .. ....._ _ „_,_ - . _.... -- --- • —... . _ _ _ _ _,
•/ City of La Ouinta
Department of Building and Safety
This permit becomes void it work not commenced within 180 days from date of issuance. OR, if work has been suspended or abandoned for a period of 160 days.
CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE: This section need not be completed if
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 700) 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 of 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.):
O 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. if, however, the
building or improvemnt is sold within one year of completion, the owner -builder will have the burden of provind that
he did not build or improve for the purpose of sale.).
0 1, as owner o1 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 I have a certificate of consent to sell-insure,'dr a
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. Q. -
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/CDMMUNITY/STATE/ZIP -
Nestor, CA 92053
JOB SITE ADDRESS/SPACE '
livincr area and 433 sq. ft. of garage
CITYICOMMUNITY/STATE/ZIP
La. to CA 92253
BOK
PAIS
PRC
I C
TWN
FINIS
SE
s
TRACT
19903
LOTMOO
SM Fee 5.46.
SB
TRACT NAME
HORIZON PALMS
Corp.OWNER NAME (L. F. MI) Gw erraal Maemient C
LG/
CONTRACTOR -FIRM NAME J.
J . L . Construction
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
PHONE a
LICNC a
with, CrurminitzZ t Department
ARC/ENG FIRM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CITY/COMMUNITY/STATE/ZIP
Palm Sprinas CA 92262
PHONE a
LICNC a
323-7877
USE OF PERMIT '
Sin le Famil" Dwellin
BL
ZON.
FS8 11
SSB
SSB I
RSB
OFC
ZONE ORD a
LOT SZ
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 as to become subject to the Workers' Compensation Laws of
California.
Date Applicant
NOTICE TO APPLICANT: 11. 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:
O 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 thirly-six (36) feet high. (Chap 12, 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 noted above, unless such person has a permit to do such work from that division.
0 Division o1 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. 3D97, Civ. C.).
Lender's Name
Lender's Address
1 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
APPLNRMT, -
5-2-2--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
Eftect. Fee 60.18
SM Fee 5.46.
-.21imbiug Fee 85.00
Tnfrastructure
862.60
105.72 DEP. PAID
756.88
* agreembint
with, CrurminitzZ t Department
TOTAL
FEE
862 60
N 1 1 4 U 7 L / (a 6 6 UK
'--FINANCE VALUATION 77, 948.00