001455 (SFD)r
Building
Address
Mailing
Address
City
y
P.O. BOX 1504 No.. 001455.
78-105'.CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. V NOCC'.:GRP: .P .
In . 04 t4. +ems'9
*4*Mft '7ffrft A.P. Number
TEC
a , "3£9%' Legal,Description
Contractors P
Address.. ... .. .. .
v., Project Descr pt on
-]A6 - 07A -ft MSOMAJAI DMI*
City. _ . Zip Tel..
> _ 92053 340-5511
State LIC. �`� ___ City 124.E
& Classif. -. 442 Lic. # 237 Sq. Ft. No.
Size 433 • • Stories
Designer XXIM _ New Or . Add Alter ❑ Repair O
".
Address Tel.
U U1,.1q_.��
City Zip State .. ..
No. Dw.
Units
Rda. S;m0lap.. 92262
_
" _ LICENSED CONTRACTOR'S DECLARATION .
hereby affirm that I am licensed under provisions of Chapter°g (commencing with Section
• 7000) of Division.3 of the "Bu/si``ness and Professions Code; and -my license -is in full fore and
effect. .. .. -i' /O � ..i' , r 9.S .
SIGNATUR-Kik.!' v. + =,+ r.-� -`/ ,N DATE
-_'•
_
_-
' "OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractods-License Law for:the following
_ reason:- (Sec. 7031 ,5,Business and Professions Code: Any city or-. county. ,which requires' a
Estimated Valuation
'
•"
.. PERMITS• •
-
•. •• --
-'
" permit. to "construct, alter, improve, demolish, or repair any structure, prior do -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. hd-is -exempt fherefrorri, and the basis*
for the alleged exemption. Any -violation of Section' 7031.5 by 'any applicant for a - permit
-
:'.Plan: Chk. Dep�.-.:. •
-
• ' subjects the applicant to a civil penalty of not more'than five hundred'dollars ($500).
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; Buisness and
Professions Code: The Contractor's License Law does'not apply-to,an owner.of,property who
Plan Chk. B'al. .
Const. ,
builds or improves thereori 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
�.
'MeCh,
- Electrical -
-
or •improvement 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,). -
Plumbing
0 I, as owner of the property, am exclusively contracting with licensed contractors to con-
- struct the project: (Sea:•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.
- such projects with a,contractor(s) licensed pursuant to the Contractor's License Law.) -
• 0 I.am.exempt.under Sec. B. & P.C: for this reason
Grading
Driveway Enc.
Date owner
Infrastructure
Dafe=ed &aym
WORKERS' COMPENSATION DECLARATION
"hereby affirm that.] have a certificate of consent to self -insure, ora certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
0 Copy is filed with the city. 0 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
•orrless.) - - -
�p. I certify that in the performance of the work for which this permit is issued, l shall not '
employ any person in any manner so as to become'subject to'the Workers' Compensation
Laws of California.
Date Owrier
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:
certify that I have read this application and state, that the above information is correct..
I agree to comply with' alt.citygand county ordinances and state laws'relating to building
construction, and hereby authorize representatives of this city' to enter• the above
mentioned property for inspection, purposes.
Signature of applicant? Date f �t
Mailing Address
City, State, Zip
HARD COPY
Demolition 0
AMOUNT -
105072
2�p€02.22�4
10
' 367V .
.s K237 • A�.
85.00
5.46
t .as eqnsnant
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
IST FL. SO. FT. Qa $
2ND FL. SO. FT. �a�
POR. SO. FT. @
GAR. SO. FT. @
CAR P. SO. FT. i??
WALL SO. 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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EOUIP.
LAUNDRYTRAY
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/a 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 APP./EOUIP.
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/INITIALS,
GARDEN WALL FINAL
Ne
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: I hereby affirm that 1 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 h e is licensed pursuant to the provisions of the Contractors license law
(Chapter 9(commencingwith section 70001 of Division 3of theBusiness and Professions Code) or that he is exempt
therefrom and the basis for the alleged exemption. Any violation o1 Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty o1 not more than five hundred dollars ($500.):
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 Contractors 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. fl, 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.).
O 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 tat apply to an owner o1 property who
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
O 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 self -insure, or a
certificate of Workers' Compensation Insurance . or a certified copy thereof (Sec. 3800. Lab. C.).
Policy No. 'Company
O Certified copy is hereby furnished.
O Certified copy is filed with the City Building Inspection Department or City Department.
Date Applicant
APPLICANT NAME (L. F. MI)
JL CnnStruction
ADDRESS
P.O. Box 173
CITY1COMMLWITY/STATE21 P
Nestor; CA 92053
Joe SITE ADDRES:SISPACE
CITY/Co MMUNITYISTATE/ZIP
La. to CA 92253
BOK
PAS
PRC
C
TvvN
RNO
SE
S
19903
LD%O�
Plan Check Fee
Moo
Const. Fee
-TRACT NAME HORIZON PALMS
OWNER NAPE (L, F. Y1) (wneral Management Co
CONTRACTOF"IRM NAME
J.L. Construction
ADDRESS
above
CITY .OWUNITY/STATE/ZIP
PHONE •
5.46.
; LICNC •
.Plurrbi= Fee
ARC/ENG FIRM NAME
Michael Buccino Assoc.
ADDRESS '
340-S. Farrell Dr. A212
CITY/COMMUNITY/STATE/ZIP
Palm Suirinas, CA 92262
PHONE • LICNC •
862.60
323-7877
USE Of PERMIT '
Single Familv Dwelling
81.
756.88
ZON,
*
FS8
SSB
SSS
RSB
OFC '
ZONE ORD 1
TOTAL
'FEE
LOT SZ
2.60
END I
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: 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:
O 1 hereby certify that no excavation five (5) or more feel 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 Z An 2, Sec 341, Title 8.
C.A.C.)
O 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.
O Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: 1 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. l 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
APPL/PNMT
DATE
Permit to construct
1247 sq. ft.
of
livincr area and 433
sq. ft. of garage
as per appirwed.plans.
miech. Fee
37.00
Plan Check Fee
307.96
Const. Fee
367.00
Elect - Fee
60.18
5.46.
.Plurrbi= Fee
85.00
Tnfrastructure
862.60
105:72 DEP. PAID
756.88
*
a eanfint
t De
t
TOTAL
'FEE
2.60
A 1 1 / S
FINANCE
D zs 75&88 CK
VALUATION 77,948.00