001426 (SFD)ell"
I
Building
Address
_Owner
I Z;TM77 Alw".L,
Mailing
Address
City
Contractor
Address. -
P -0- BM 173
City
am N
State Lic.
& Class.if.
Arch.., Engr., -
Designer Will
P.O. BOX 1504 No.. 001426
78-105 CALLE ESTADO
L Dr. LA QUINTA, CALIFORNIA 92253
0 BUILDING: -TYPE CONST. OCC'..GRP.-.* R 3
1700 A.P. Number
Tel. -7—
Legal Description
54
Project Description
-146 -Miits Residoftial DWR.
-I Tel.
I City
Lic. #
28222V
Sq. Ft. bC 1247
Size - - JTM 433-
Newr' 'Add 0
No. No. Dw.
Stories Units
Alter El Repair 0 -Demolition 0
Address
Tel.
340 S. -FarzeU Dr.
323-7877
City • Zip
State
.92262-
Lic. # -
LICENSED CONTRACTOR'S DECLARATION
J hereby affirm that I iWicensed under provisions of Chapter 9 -(commencing with Section
7000) of Division 3 of the Business and Professions Code' and my license is in full for6e'and
effect.
SIGNATURE. _41 .1 DATE
OWNEFCBUILDER DECLARATION .1 . .. **-, , .
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec_ 7031.5,Busines�s- 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'thi) BLisihe§s and Pr6fessioni Code, or-that.h6 is exempt therefrom, -.and the basis
'for the alleged. exemption. Any violation of Section .7031.5 by *any applicantr'for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
0 1 as owner I the property, or. my employees with.wages'as their sole compensation, will
pK6
Estimated Valuation .
PERMIT-, AMOUNT
'
PlanChk. Dep.', 105.72.
Plafi:chk. Bal.'. 202.24
Const , 367.00
do iwork, 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
-Wn6ullds. or improves thereon and who does such work- himself or. through his own employees,
provided that su !t 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 improye-for the. purpose of sale.)
Mech.'-. 37.00'.
Electrical
-Plumbing 85.00
0 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 '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. & P.C. for this reason
S.M.I. MIS.
Grading
Driveway Eric.
• Date Owner
Inf-rastructure.. Mnf a Ted raymu& as I w agwwmt
ith M. ft-ogl. •Dal. V MW
WORKERS' COMPENSATION DECLARATION
I hereby affirm' that I have a certifidate of consenf to 'self -insure, ora certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
pany
0 Copy is filed with the city. .0 Certified copy is hereby furnished.
TOTAL 862.60 755.88
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
oriess.)
. I certify that in the performance of thp 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 �'_ _-Own6r
NOTICE - TO APPLICANT., If, after making this Ceifificate of. Exemptionyou should become
subject' to thd' Workers' Compensation provisions of 'the Labbr Codii,' you must - forthwith
comply with such provisions or this permit shall be deemed revoked.
ZONE: BY:
Minimum Setback Distances:
—Front Setback,f rom. Center Line
Rear Setback from Rear Prop.. Line
CONSTRUCTIONLENDING AGENCY
I
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
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.
FINAL DATE INSPECTOR -
I certify that I have read this application,and state that the above information is correct.
I agree to 6omply'with all'city and county ordinances and state laws relating.to building
construction, hereby authorize,/representatives -of this city to enter the above-.
mentioned property for inspection purposes.
'
Signature of applicant Date 1
Mail.ingAdd.ress
Issued by:' Date Permit
Validated by:
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES �.
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FLSO. 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 S0. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN
SO 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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
-
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.
SO. 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
SO.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
M=CH.FEE PL.CK.FEE
CONST. FEE JELECT.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 APPJEOUIP.
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
PERMIT APPLICATION
City of La Ouinta
Department of Building and Safety
This permit becomes void it work not'commenced within 190 days from date of issuance; OR. If work has been suspended or abandoned for a period of 190 days
APPLICANT NAME (L. F. MI)
JL Construction
CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE: This section need not be completed it
LICENSED CONTRACTORS DECLARATION: 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
(commencing with Section 7000) of Division 3 o 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 to the Workers'Compensation Laws of
and effect.
California.
License Class tic. 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
s
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, will 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, lalsework, 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) teat high. (Chap 3.2, Grp 2, Art 2, Sec 341. Titlea,
subjects the applicant to a civil penalty of not more than five hundred dollars ($500.):
C.A.C.)
0 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
❑ As owner -builder, I 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
❑ Division of Industrial Safety Permit No.
through his own employees, provided that such improvements are not intended or offered for sale. If, however, the
ADDRESS
building orimprovemntissold within oneyearofcompletion, the owner -builder will have the burden ofprovingthat
Date Applicant
he did not build or improve far the purpose of sale.).
CONSTRUCTION LENDING AGENCY:- I hereby affirm that there is a construction lending agency for the performance
O I, as owner of 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. C.).
7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
Lender's Name
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
Lender's Address
❑ 1 am exempt under Sec. B. 8 P.C. (Attached Certificate).
I certify theft have read this application and state that the above information is correct. I agree to comply with all '
Owner
'city and county ordinances and state laws relating to building construction, and hereby authorize representatives
Date
of this county to enter upon the above=mentioned property for inspection purposes.
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a
ZONE ORD .
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3600. Lab. C.I.
Signature of Applicant or Agent Date
Policy No. Company
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify l have read this application and state that
❑ 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 Ouinla Department of Building and Safety to enter
upon the property for which I have applied for this permit for the purpose of making inspections.
Date Applicant
Signature of Applicant or Agent Date
APPLICANT NAME (L. F. MI)
JL Construction
ADDRESS
P.O. Box 173
CITY/COMMUNITY/STATE/ZIP
Nestor; CA 92053
JOB SITE ADDRESS/SPACE
living area and 433 sq. ft. of garage
CITY/COMMLINITY/STATE/ZIP
La . QWnta, CA 92253
Bolt -
PAG
PRD
I D
TWN
RND
sE
s
TRACT
19903
LOT
LOT
cMT Fee 5.46
MOD
Sa
,
TRACT NAME
HORIZON PALMS
OWNER NAME IL. F. Mn Caneral Management Corp.
CONTRACTO111-FIRM NAME
J.L. Construction
ADDRESS
ahimm
CITY/COMMUNITY/STATE/ZIP
abqm
PHONE a
;
LICNC
ARVENG FIRM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CI11Y/COMMUNITY/STATE21 P
Palm.Sprincrs, CA 92262
PHONE • LICNC •
323-7877
USE OF PERMIT
Single Fc -mil Dwelling
BL
ZON.
'FS8
SSB
SSB
RS8
DEC
ZONE ORD .
LOT SZ
END
SIDE
Print Applicant/Agent Name A6 /1
APPUPRMT PR5 DATE
Un 11 5-2-2=85
S.T.D.
Pexmit to construct 1247 sq. ft.
of
living area and 433 sq. ft. of garage
as r approved plans.
mech. Fee 37.00
Plan Check Fee 307.96
Const. Fee 367.00
60.18
cMT Fee 5.46
--PlanbiM Fee 85.00
e
862.60
105.72 DEP. PAID
756.88
* ggreembint
t Department
• TOTAL .
FE
862.60
A 1 1 4 4 .5 2 37 5 ---£it
::PINONCE VALUATION 77,948.00