001458 (SFD)�-� P.O. BOX 1504 N o .
Building44-396 W. MAM D's LA QUINTA, CALIFORNIA92253
Address - •-
Owner _
Wiza bunmimalt cbm.R3
Mailing BUILDING: -TYPE CONST: V 17Q OCC: GRP.
Address Mgt�M�qt_ kda 270 A.P. Number
City Zipter" Tel.
Description
Le al
tl��_.,s__`. s•,,,....�a � amts. 4�[lA�._7@�Svr;JfcA 9
Contractor
r . Address.. qq.�•�
Y P.O. 6rr3..
City Zip Tel. "
$3" 42053 3451.
State Lic. " City
i4 & Classif. g4U22 Lic. #
Arch., Engr.,
Designer Mrbiml BXViM ASS•
Address Tel.
Project Description Tbrimm palm
UG Chita ftswMHAI, wml_
M 1247
Sq:`Ft. No. No. Dw.
Size M A33 • Stories Units
New C31'
Add ❑ Alter ❑ Repair ❑ Demolition ❑'
. �M 1s.. � :•
.323-7877.
' City
Zip
State
Lic. #
i LICENSED CONTRACTQR'S DECLARATION,
' I hereby affirm•that I am licensed under provisions of Chapter.9 (commencing with Section, '
s -
• 7000) of Division 3 of the Business and ProfessionCode, and my license is in fullrforce and
effect. Al
'( SIGNATURE i/f t /f . Y, ! I , J I d J DATE'.
.... .. -. .. _ _
OWNER -BUILDER DECLARATION 1 ' 7 11
I
... .
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
Q �f � �0
$
reason: (Sec. 7031..5, Business and Professions Coode: An cit y q
. y or count which re vires a .:
- "` - S ,
permit to construct, atter, 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--.lice'nsed pursuant to
... PERMIT - - -
the provisions o/ the Contractor's License Law, Chapter 9 (commencing with Section, 7000) of
.:r,� ..•. •, -
Division 3 of the Business'and Professions Code, or- that. he is 'exempt therefrom, and the basis'
for the. Any -,Section 7031.5 by 'any for
«�
Dep. -
alleged- exemption. violation of applicant a permit
subjects the applicant to a civil penalty o/ not more than -five hundred dollars ($500).'. -
.Plan�,Chk.. , . , .05.7%6•
..�- .q.` '
Plan Chk. Bal.
p. 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 forrsale. (Sec. 7044, Buisness'ands�
•
�ir=33�f11 '
Const. � - '
• Professions Code: The Contractor's License Law- does not .apply to an owner,of property 'who '.
�. f e.NV
builds. or improves thereon and - who does such work himself. or through his own employees,
- Mech.
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 '
Electrical - g
18
o(. proving that he did not build or improve /or the purpose of sale.) , -
:i0• i
- O I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing 85.00
• - 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: " '•'• 5.46
. such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
. ❑ I am exempt under Sec. -B. 8• P.C. for this reason
... .
Driveway Enc.
Date owner.
Infrastructure- Defesixid pwaymt as agmwimpit
vdkb fes. DmI. Elizeebw' .
WORKERS' COMPENSATION DECLARATION
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. ' .Company
. ❑ Copy.is filed with the city. . ❑ Certified copy is hereby furnished:
TOTAL M.60 I 756AS
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
- (This section need not be completed if the permit is' /or one .hundred dollars '($100) valuation
- -
or less:) - -- -• -
I certify that in the performance of thg work for which this permit is issued, 1 shall not
-
_ - employ any person imany 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
• ZONE: - BY:
subject to ' the ' Workers' 'Compensation provisions ' of the" Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. - -
- -
M'Inlmum Setback Dl Stances: - -
Front Setback.from Center Line
Rear Setback from,Rear.Prop. Line
CONSTRUCTION LENDING .AGENCY
Side Street'Setback from Center Line
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
Setback f rom.Property Line
Lender's 'Name
Lender's Address
FINAL DATE ' INSPECTOR
This is a building permihwhen properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that l have read this •application.and.state that the above information is correct,.-
ISSUed'bq: Date Permit .
I agree to comply with all :city and county ordinances and state laws ielating to building
construction, and hereby authorize representatives .of this city to enter the above-:
' mentioned property for inspection purposes. " f
Validated by:
,% ,.f-/ '
% r r� r ! x
Signature of applicant fX : Date
Mailing Address " " j" !
Validation:
City, State, ZiP F
i�..
Rte:....
.. ,. .. .. - • _
HARD COPY
+�
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
FOR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. FT.
SQ 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.000L 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. ® 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 ® 3/4c
HOUSE SEWER
REMARKS:
VENTILATION
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
PERMIT APPLICATION
City of La Duinta
Department of Building and Safety
This permit becomes void if work not commenced within 180 days from date o1 issuance. OR, If work has been suspended or abandoned for a period of 180 days.
CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE: This section need not be completed if
LICENSED CONTRACTORS -DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7DDO) o1 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 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 o1 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 1. 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, avid who does such work himself or
through his own employees, provided that such improvements are not intended or offered for sate. If, 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 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 rat apply to an owner of property who
buitgs or improves thereon• and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License Law.).
❑ 1 am exempt under Sec. B:& 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 Omstruction
ADDRESS
P.O. Box 173
CITY/COMMUNITY/STATE/ZIP
Nestor; CA 92053
JOB SITE ADDRECSISPACE
CITY/COMMUNITY/STATE/ZIP -
La.Quinta, CA 92253
BOK
PAG
PRC
I C
Mech. Fee 37.00
Twit
aNG
SE
S
TRACT
LOT '7
cmT Fee 5.46.
MoD
SB
19903
1
112
.1
756.88
TRACT NAME _ HORIZON P MS
Val tMan^�
OWNER NAME (l. F. MI) GanertL
10.
agement Corp • '
CONTRACTOR -FIRM NAME
J.L. Construction
ADDRESS
cbcve
CITY/COMML1NITY/STATE/ZI P
PHONE •
LtCNC .
ARC/ENG FIRM NAME
Michael Buccino Assoc.
ADDRESS - .
340 S. Farrell Dr. A212
CITY/COMMUNITY/STATE/ZIP
Palm Sprin s CA 92262
PHONE LICHC F
323-7877
USE OF PERMIT '
Sin le Fand1v Dwelling
BL
ZON.
'FSB
SSB
SSB
RS8
f
OFC
ZONE ORD a
LOT SZ
END
SIDE
D
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: 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:
❑ 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 Z Art 2. Sec 341, 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.
❑ Division o1 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. Q.
Lender's Name
Lender's Address
1 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 Dale
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify 1 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 o1 the. City of La Ouinia 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
Ai/,�/.5�?
APPL/PRMTt y } "''� DATE
5-2-2-85
S.F.D.
Permit to construct 1247 sq. ft.
of
living area and 433 sq. ft. of gaage
as pgr approved plans.
Mech. Fee 37.00
1 -an Check Fee 307.96
Const. Fee 367.00
Elect- Fee 60.18
cmT Fee 5.46.
.21imbing Fee 85.00
*
862.60
105.72 DEP. PAID
756.88
* agreamfint.
t De t
TOTAL .
'FEE
862.60
A11 / 6 D [ S / jIS88 R
VALUATION
FINANCE )]F948.O0