001443 (SFD)Building
Address
Owner
Mailing
Address
City
Zip Pt/1e�/13 Tel
. T_1r._ t9'�!s+al�trxae�S
ddress .
P.O. 193
P.O. BOX 1504 NO. 0-01443
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project. Description 1T4wfymWA Vknl vm
'City
Zip
Tel•..
RFa
4i _ ��
r��i
•
State Lic.
& Classif. 442822
City
Lic. # 237
Sq. Ft.DW., 3247
No. No. Dw.
Size iM 43:x......
-Stories ...: .. Units ...
Arch:, -Eng r., ..
" Designer(y,�p{��q�q ��,, �.,�
New 8' Add ❑ - ,Alter 0,''-. Repair ❑ Demolition ❑
Address
Tel.
344 S. Fw=a .
..323-7977
_ ..
CityZip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I herebbaffirm,thatr,l�am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of;,tp Business and Professions Code, and my license is in fulLforce anis -
effect... (
A
a '
• "� _•
SIGNATURE %' f "' .f' DATE
OWNER -BUILDER DECLARATION
•Thereby affirm that I am exempt from the Contractor's License Law -for -the following
reason: -(Sec. 7031.5,Bu00
slness and Professions Code: Any city or county •which requires 'a ' •
"
Estimated Valuation
_
-
Qb '$`
`J
_
- PERMIT'
AMOUNT
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 df'the Business and Professions Code, or thabhe'is exempt therefrom, and the basis -
for. the alleged exemption:. Any violation of Section 7031.5 by Any .applicant fora- permit
-subjects the applicant to•a civil penaltyofnot more than five' hundred.dollars ($500). . ' '
f7 I, as owner of the, property, or my employees with wages as their sole compensation, will..
• Plan Chk. Dep.
Plan Chk: Bal. . -
.. '
242.24do
CiOf1§t.
-•. ''1 ..�1�
the work, and the structure is not intended or offered for•sale. (Sec. 7044, Buisness and
Professions. Coder The Contractor's License Law does. not, apply.to an, owner of.property who
- •MeCh.
,
` .. 11, -
. ,. builds, or fmpioves .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 or completion,- the owner -builder will, have the burden
_of proving that he did not build or improve for the purpose_of sale.) � . I .. ..
Electrical
Plumbing
- •' ' -a� '
❑ I, as owner of the property, am exclusively contracting with licensed contractors to.con-
struct the project. .(Sec. 7044, Business and 'Professions Code: The Contractors License Law
does not apply to an owner o! property who builds .or 'improves thereon, and who contracts for
- -such projects with a contraclor(s) licensed pursuant to the Contractor's License Law:)
. O I am exempt under Sec. 8.-8 P.C. for this reason
• S.M.I.
.. -
Grading'
Driveway Enc.
Date owner
Infrastructure
ice`-, .� •g -
WORKERS' COMPENSATION DECLARATION
I hereby affirm'that I 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
O Copy is filed with the city.. 0 Certified copy is hereby furnished.
TOTAL
756.88.
_
' CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(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 th? 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 'Worke'rs' 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 Setback from Center Line
Rear Setback from Rear Prop. Line
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.) .
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 if work thereunder is suspended for 180 days."
I certify that I have read this application and state that the above information is correct. h
agree to comply with all,tclty and county ordinances and state laws relating -to buildings'
construction, and hereby authorize representatives -of. this city to enter the above-
mentioned property for inspection purposes. fJ t
Signature of applicant �I .l s'' :: Date^ J ,
Issued,by:
Validated by:
Date Permit '
Mailing Address. �"' P r
Validation:.
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEE;
IST FL. SO. FT. ® $
2ND FL SQ. FT.
POR. SO. FT. ®
GAR. SQ, FT. ®
CARP. 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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
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. (off c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/<c
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./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 SIGNATURESANITIALS
GARDEN WALL FINAL
_ `I ._ . _. _ .. . _ _ . --
LICENSED CONTRACTORS DECLARATI
(commencing with Section 7ODD) of Divi
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
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 o1 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 improvemni 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 1, 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 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.).
O 1 am exempt under Sec. B. & P.C. (Attached Certificate).
Date Owner
WORKERS' COMPENSATION DECLARATION: I hereby affirm that 1 have a certificate of consent to sell -insure, or a
certificate o1 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
PERMIT APPLICATION
City of La Oulnta
Department of Building and Safety
This permit becomes void i1 work not commenced within 180 days from date of issuance. OR, if work has been suspended or abandoned for a period o1 190 days.
CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE: This section need not be completed it
ON: I hereby affirm that I am licensed under provisions of Chapter 9 the permit Is for one hundred ($100) o. less. I certify that in the performance of the work for which this permit is
sion 3 of 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 lothe Workers'Compensation Laws at
California.
APPLICANT NAME (L. F. MI)
JL Clnnstruction
ADDRESS
P.O. Box 173
CITY/COMMUNITY/STATMIP
Nestor; CA 92053
JOB SITE ADDRESS/SPACE
-`V
CITYI'COMMUNITY/STATE/ZIP
La. to CA 92253
BOK ]
PAG
PRC
C
TWN
RNG
SE
S
TRACT
Lo�
M Fee 5.46
Moo
SB
Tnfrastructure *
862.60
f '
105.72 DEP. PAID
.756.88
* a eem�nt
TRACT NAME VORIZIO T PT
i�M^lY�.L
tM'„^�ag7eIYp,.nt
OWNER NAME (L. F. MI) .[1
aaLIl�
`�11GJ. 1-JGLL Y1 Corp.
CONTRACTO I -FIRM NAME
J.L. Construction
ADDRESS
abimm
CITY/COMMUNITY/BTATE/ZIP
PHONE a
LICNC .
ARC/ENG FIRM NAME '
Michael Buccing Assoc.
ADDRESS
340 S. Farrell Dr. A212
CITY/CMMUN ITY/STATE/ZIP
Palm Springs, CA 92262
PHONE LICNC 0
323-7877
USE OF PERMIT
Single FamilyMelling
BL
ZON,
FSB
SSB
SSB
RSB
OFC
ZONE ORD #
LOT SZ
END
SIDE
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 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 B.
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: I 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. I agree to comply with all state laws and county ordinances relating to buidling .
construction, and authorize a representative 61 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
nnn nyym.uv nyc�n namc (/ a/���
'Date
AtMT # ` ` DATE 22=85
S:F.D.
Permit to construct 1247 sq. ft.
of
,livingarea and .433 . ft. of
age
as approved plans.
mech. Fee 37.00
Plan Check Fee 307.96
Const. Fee 367.00
Elect, Fee 60.18
M Fee 5.46
21imbing Fee 85.00
Tnfrastructure *
862.60
105.72 DEP. PAID
.756.88
* a eem�nt
with riorammity t De
t
TOTAL •
FEE
.862.60
H 1 1 / L L / 5 is 8 8 KK
CINAN< F VALUATION 77,948.00