001454 (SFD)P.O. BOX 1504
No. 001454
Building 78-105 CALLE ESTADO
Address 44-316 W S=d= CreSt Dr. LA QUINTA, CALIFORNIA 92253
OwnerammmiM_
�UMMIML • BUILDING: TYPE CONST. V N OCC: GRP. R 3
Mailing
Address IMIc.. Sifte 2700 A.P. Number
City Zip Oji J,/ '� Tel.
{i�,• 1:$367--5054 Legal Description
Contractor Project Description � Wim'
JAL cJ^[mtrMUM
Address 146 Mdta X 81 IJ�q�1.
P.O. BC 173.
City Tio - Tel.
)30-9"W 92053
State Lic. City 340-5511
& Classif. wjl� Lie. # Sq. Ft. U47 No. No. Dw.
Size CSR 433 Stories Units
Arch:, Engr.,
Designer Xtchft3 $WCJM ASWC. New Add ❑ Alter ❑-. Repair ❑ Demolition ❑
Address ����pp�� Tel. g.� yyry.���yy
.. 30 . s7. ft�U • • 3 • f 977. _
City Zip State
X312 'gor"-wis ' 92 Lic: #
_ LICENSED CONTRACTOR'S DECLARATION t
I hereby affirm -that I am licensed under provisions of Chapter 9 (commencing with Section +
70 OO) of Division 3 of {{the Business and Professions Code, and my license is in fullforce and.
effect.
SIGNATURE .4 t t G �r > - 9 DATE
OWNER -BUILDER DECLARATION r' .
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuationt? A♦f� RA
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a. S ! i+9411.00
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also AMOUNT
requires the applicant for,such permit to file a signed statement that.he is licensed pursuant to PERMIT -
the provisions of the Contractor's License Law, Chapter 9. (commencing ,with Section 7000) of - -
Division'3, of the' Busiress 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 Plan Chk. Dep. - 105.72
subjects the applicant to a'civil penalty of not more than five hundred dollars ($500)2- ' Plan Chk. Bal. 4L7�.�2�
❑ I, as 3 owner of the property, or my employees with wages as their sole compensation, will - y A
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Bussness and Const. 00
Professions Code: The Contractor's License Law does'not apply,lo an owner of property who
builds or improves thereon and who does such work himself or through his own employees, Mech. �p1%
provided that such improvements are not intended or offered for sale. If, however, the building 37 .ti 0
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical WAS
of proving that he did not build or improve for the purpose of sale.) . ..
❑ 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.I.'5.46j `
such projects with a contractor(s) licensed pursuant to the' Contractor's License Law.)
Grading
❑ I am.exempt under Sec. 8. t. P.C. for this reason
Driveway Enc.
DateOwner Infrastructure Mfe=ed 1avi�.as ammemimt
. tA3 ! w - T%11 Lr�ay.
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to selfAnsure, 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. ❑ Certified copy is hereby furnished.
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.)
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 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. '
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, 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 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 representatives -of this city to enter the 'above-.
mentioned property for insp}e)ction purposes.
r
Signature of applicant / 7 !'!ri 1 a !n Date
Mailing Address ✓ r �_ r
City, State, Zip
HARD COPY
TOTAL 862.60
REMARKS
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line '
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CARP. SQ. FT.
WALL SQ. FT.
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM C
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
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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
APPLICANT NAME (L. F. MI)
JL Clnnstruction '
ADDRESS
P.O. Box 173
CITY/COMMUNITY/STATE/ZI P
Nestor; CA 92053 --
JOB SITE ADDRESS/SPACE -
CITY/CO NfuNITY/STATE/ZIP
La . Quinta, CA 92253
8"
PERMIT APPLICATION
City of
La Oulnta
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.
RHO
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section (reed not be completed if
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 7000) of Division 3of the Business and Professions Code, and my license Is in full force
issued. I 0all not employany person Inanymannersoesto become subject to the Workers' 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 ofthe Contractor's License Law
01 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, w ill be
(Chapter 9(commencing with section 7000) of Division 3 of 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 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 Z 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 o1 the property, or my employees with wages as their sole compensation, will do the work, and the
O As owner -builder, 1 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 of Industrial Safety Permit No.
through his own employees, provided that such improvements are not intended or offered for sale. If. however. the
SSB
building or improvemnt is sold within one year of completion. theowner-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
0 1, 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. Q.
7044. Business and Professions Code: The Contractor's License Law does not apply to an owner o1 property who
Lender's Name
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
END
Contractor's License Law.).
Lender's Address
0 1 am exempt under Sec. B. & 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-mentioned property for inspection purposes.
WORKERS' COMPENSATION DECLARATION: 1 hereby affirm that I have a certificate o1 consent to self -insure, or a
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. C.).
Signature o1 Applicant or Agent Date
Policy No. Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify l have read this application and state that
0 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
*applied
upon the property for which 1 have for this permit for the purpose of making inspections.
Date Applicant
Signature of Applicant or Agent Date
APPLICANT NAME (L. F. MI)
JL Clnnstruction '
ADDRESS
P.O. Box 173
CITY/COMMUNITY/STATE/ZI P
Nestor; CA 92053 --
JOB SITE ADDRESS/SPACE -
CITY/CO NfuNITY/STATE/ZIP
La . Quinta, CA 92253
8"
PAG
PRC
I C
TWN
RHO
SE
s
199 03
LID
Elect- Fee 60.18
MOD
I S
-Plimbina Fee- 85.00
TRACT NAME HORIZON PALM
OWNER NAME (L. F. MI) Gare al Management Co'
CONTRACTOR -FIRM NAME '
J.L. Construction
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
PHONE .
' 756.88
LICNC .
* ggreentint
ARC/ENG FIRM NAME '
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CITY/COMMUNITY/STATE/ZIP
Palm sr)rincrs, CA 92262
PHONE a;1 LICNC •
323-7877
TOTAL 7-T
FEE
USE OF PERMIT
single Family Dm1lin
BL
ZON.
FSB
SSB
SSB
-RSS
OEC
ZONE ORD •
LOT SZ
END
SIDE
-Print Applicant/Agent Name
4 Ll S�
APPLMRMT 5 - DATE
5-2-2=85
S.T.D.
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
Qmst. Fee 367.00
Elect- Fee 60.18
M Fee 5.46
-Plimbina Fee- 85.00
Tnfrastructure
862.60
105.72 DEP. PAID
' 756.88
* ggreentint
with Ccnminit2Z t Department
TOTAL 7-T
FEE
862.60
A 1 1/ 1 D L 5 % 5& 8 8 CK
FINANCE VALUATION '77, 948 .00