001456 (SFD)a P.O. BOX 1504 No.. 001456
Building 78-105 CALLE ESTADO
.44-356 W. SM40wn th=t Dr. LA QUINTA CALIFORNIA 92253
Address
Owner
Mailing
BUILDING: TYPE CONST. VN OCC: GRP. R-3
Address 1001 Disicip St..'� 2700A.P. Number
City Zip ;�1.'�. f�0 Tel. R • .
flu.Legal Description
micl
Contractor.
Project Description 1
Address ... ....... _ .. .. .. � ..
146 MlitS Davao
...City . ... . .. Zip Tel.:..
fastlw 92053 340--5511
J State Lic. City -
& Classif. 842822 Lic. # 237
Arch.,'Engr.,...
Designer , *tA_
Sq. Ft. = X47
Size •,ice .
Newt Add ❑
Address Tel. .
340 S.* X1,1 .37877 .. .
City Zip State
Pali :��.. 92262 Lic. #
.,-.LICENSED CONTRACTOR'S DECLARATION,
I hereby affirm that I am. licensed under provisions of Chapter 9 (commencing with Section '
7000) of Division 3 of thye)Business and Professions Code, and my-license,is inrfull force and
> effect. t " A) Y�!"
i SIGNATURE / DATE
t .. OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated ValUatlo
reason: (Sec. 7031;5,Business and Professions Code: Any, city. or.,county .which requires' a
No.
Stories' -
Alter ❑
No. Dw.
Units
Repair ❑• Demolition ❑,
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
:.DivisionT3t 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 live hundred dollars:($500):-'
❑ I, as owner of the property;, or my employees with wages as their sole compensation, will
•PERMIT
- .-.• AMOUNT
PIan�Chk.'Dep.
Plai r Chk. Bal.
_
2.i2...24
:COr1St.
367.M
do the work, and the structure is not intended oroffered'for sale: (Seca 7044, Buisness 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,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.) '•' -_
❑ I, 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 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. for this reason
Mech.
%�sa
'Electrical
'
Plumbing
S.M.1.
Grading
Driveway Enc.
Date Owner
Infrastructure
rA fexmd z a. XJMXMMft
WORKERS' COMPENSATION DECLARATION
"-.1 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. I.Company
.. O Copy is filed with the city. ❑ Certified copy.is hereby furnished. ,.
TOTAL
A a� a
862. � d :. g�6.88
CERTIFICATE OF EXEMPTION FROM
,. WORKERS' COMPENSATION INSURANCE
REMARKS.
-
-
• (This section need not be completed it the permit is for one, hundred 'dollars ($100) - valuation
or 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—_L_' 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. -
- ZONE:' BY: '
Minimum Setback Distances: - - -
Front Setback4rom Center. Line
Rear Setback from,Rear.Prop. Line
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„Civil Code.).
Side Street Setback from Center'Line'
Side Setback from Property Line
Lender's Name
Lender's Address
FINAL DATE
INSPECTOR
'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,applicalion and state that the -above information is correct.
I' agree to comply'with all city and county ordinances and state laws relatingto. building
construction, and hereby authorize representatives -of this city 'to enter the above:
mentioned property for inspectionrpurposes. �% j�
r.rd !/
Signature of applicant f i f 1/': • J,, Date
. Mailing Address / .`
Issued by:
Validated by:
Validation:
'Date Permit '
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP./EQUIP.
DRINKING FOUNTAIN
SQ. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
I
IKITCHEN 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 ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
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./EQUIP.
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
PERMIT APPLICATION �� _ —. — • __.... .
City of La Quinta
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 o1 180 days.
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
(commencing with Section 7000) of Division 3o1 the Business and Professions Code, and my license is In full force
and effect.
License Class Lic. Number
Date Contractor
OWNER$UILDER 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 pursuanttothe provisions oltheContractor'sLicenselaw
(Chapter 9(commencing with section 7000) of Division Sof 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 ($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 riot 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. ll, 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.).
0 I, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec:
7074. Business and Professions Code: The Contractor's License Law does rot 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 self -insure, or a
certificate o1 Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800. Lab. Q.
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 Construction
ADDRESS
P.O. Box 173
CITY/C40MMLINIT Y/STATE/ZIP
Nestor; CA 92053
JOB SITE ADDRESS/SPACE
CITY/COM LONITY/STATE/ZIP - - - -
La. to CA 92253
Bole
PAG
PRC
C
mech. Fee 37.00
TWN
RNG
SE
S
TRACT
19903
LOT n
7
FM Fee 5.46'
MOO
SB
TRACT NAME
HORIZON PALMS
OWNER NAME (L. F. Mil General Management Corp. '
CONTMCTOR-FIRM NAME
J. L. Construction
ADDRESS
CITY/COMMUNITY/STATE/ZIP
PHONE F
LICHC .
with Ck=initzZ t Departnent
ARC/ENG FIRM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CITYICOMMUN ITY/STATE/ZI P
:Palm Springs, CA 92262.
PHONE . LICNC .
323-7877
USE OF PERMIT
Sin le Family Dwelling
BL
ZON,
FSB
'SSB
SSB -
RSB
OFC
ZONE ORD I
LOT SZ
END
SIDE
the permit is for one hundred (5100) 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: IL 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 thirty-six (36) feet high. (Chap 3.2, Grp 2, Art 2. Sec341, Title 8,
C.A.C.)
0 As owner -builder, 1 will not employ anyone to do work which would require a permit from the Division of
Industrial Safety, as rioted above, unless such person has'a permit to do such work from that division.
0 Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING AGENCY: I hereby aff imi that there is a construction lending agency for the performance
of the work for which this permit is issued (Sec. 3097, Civ. Q.
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
Print Applicant/Agent Name '401,V, <%
Date
APPL/PRMTfS>7- DATE
' 5-22=85
i
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
Elect, Fee 60.18
FM Fee 5.46'
plimbing Fee 85.00
Tnfrastructure
862.60
105.72 DEP. PAID
756.88
* 4greentint
with Ck=initzZ t Departnent
TOTAL
FEE
862.60
H11/4 7 LS 75
FINANCE VALUATION 77, 948.00