001427 (SFD)P.O. BOX 1504 N Q',
Building 78 105 CALLE ESTADO
Address "05 E. SMXIMM., Creft Dr. LA QUINTA, CALIFORNIA 92253
Owner - •. ........ ... ... ... ,.._. _
Mailing
Address .1(1) fni I TPA, 1t 3M. Stif Na 2'7M
City Zip 9"g Tel.
Contractor
i. L. istvmlitiml
Address
BUILDING: TYPE CONST._ • OCC: -GRP.. .r% 3
A.P. Number
Legal Description
Project Description, A�.�5$ -Palm
3C.�:dA d:[Liid1S 113
--
City-.. Zip - . .. Tel.'
Ines 92053 34 512. "
State Lic. City
& Classif..'. 442822 Lic. # 237 Sq. Ft. UVA 1247 No: No. Dw.
• -'• Arch., Engr.;.... ...... .. .. , .. .....
Size _ -Stories - Units -
Designer :Newjl" - Add ❑'. Alter ❑::. Repair ❑ :Demolition ❑!
Address
Tel.
►lye
—ICS L / ��V�
CityJ
Zip
State
�i
` "26
Lic. #
,.
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I amtlicensed under provisions of Chapter -9 (commencing.wilh Section
' 4 _
7000) of Division 3'of the'Business and Professions'Code;•and my license.is in full force and • '
effect._.
a
/•1 1%d s .
..
SIGNATURE �.s• ._ * ... .: DATE
... ., . _ .. ,
” OWNER(BUILDER DECLARATION Y.„
Estimated Valuation .
I hereby affirm that I am exempt from the Contractor's License Law for the following
Q AA A
reason: Sec. 7031.S,Business and Professions Code: An. cit or count which requires a
. (. Y Y Y':. q
- - ` a�+20,.�V
"
perniR to construct, alter, improve, demolish, or repair any structure, prior.to its issuance also
.. -� +r•. '-
+e requires the. applicant for such, permit to file a signed statement that he is licensed pursuant -to
'PERMIT •- - AMOUNT „
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 theSection 7031.5 by :any for �'
g9 '
Plan Dep. 4. � �. �•• '
alleged exemption: .Any violation of applicant a permit
' subjects the applicant to a civil penalty of not more than five'llundred dollars ($500).
as
,105.7..fi�6..
Plan Chk. Bal. .202.24
. ❑.I, 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
v
Const.- 3150703—
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,"Mach
such.
provided that such improvements are not .intended or offered for sale., If, however, the building
. n�f
I.I
or improvement is within .on e year of completion,' the owner -builder will have the -burden
Electrical -�
...: of proving that he did not build,or improve for the, purpose of,sale.) " , _ _ . - ..
- .
O I, as owner of the property, am exclusively contracting with licensed -contractors to.con-
Plumbing
00
• Strutt- the project. (Sec. 7044,. Business and. Professions Code: The Contractor's License Law,�e..
- _ -
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
❑ 1 am exempt under.Sec.. B: ti P.C. for this reason- '•
Driveway Enc.
Date owner
Infrastructure tt ad i+t
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to'self-ihsu're, or a'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., . ❑. Certified copy is hereby 'fu rnished..
TOTAL 862.60
CERTIFICATE OF EXEMPTION FROM .''
:REMARKS '
WORKERS' COMPENSATION INSURANCE
(This section need not be,completed if the permit is for one hundred dollars ($100) valuation
or less.) .. .. .... _ ... - .. _. ..
.. _
certify that in the performance of thg 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, alter 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. -
Minirrlum�Setback Distances:
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 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. -4
'
ISSued.by: Date Permit
I agree to comply with all city -and county ordinances and state laws relating to buildings
construction,• and hereby authorize representatives -of this city. to •enter: the above.`
mentioned property for inspecttiigp.put poses. t 7.
�.
Validated by:
• Signature of applicant fll /.� r Date
Mailing Address r
validation:
City, State, Zip
,� HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. p $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL S0. 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.0OOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SQ. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
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 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
INSULATIOWSOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURE 1INITIALS
GARDEN WALL FINAL
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'COMPENSATIONINSURANCE: This section need not be completed it
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9
,(commencing with Section 7000) of Division 3of the Business and Professions Code, and my license is in full force
and effect.
License Class Lic: Number
Date Contractor
OWNER -BUILDER DECLARATION: 1 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 per mit 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 3of 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 o1 not more than five hundred dollars
0 1, as owner o1 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 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 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 1, as owner o1 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.).
❑ I am exempt under Sec. B. 8 P.C. (Attached Certificate).
Date Owner
WORKERS' COMPENSATION DECLARATION: 1 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. 38(X1. Lab. C.).
Policy No. 'Company
O Certified copy is hereby furnished.
0 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/COMMUNITY/STATE/ZIP
Nestor; CA 92053
JOB SITE ADDRESS/SPACE
do
CITY/COMML1NITY/STATE/ZIP
La.Quinta, CA 92253
BOK I
PAG
PRC I
C I
TW"
R14G
SE
S
TRACTlOT/�
19903
L/�(
Flect- Fee 60.18
MOD
SB
TRACT NAME
HORIZON PALMS
OWNER NAME (L. F. MI) Gsneral Management Corp. '
CONTRACTOWFIRM NAME '
J.L. Construction
ADDRESS
abcme
CITY/COMMUNITY/STATE/ZIP
PHONE .
105.72 DEP. PAID
LICNC .
ARC/ENG FIRM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CITY/COMMUNITY/STATE/ZIP
Palm SDrincts, CA 92262
PHONE a LICNC e
323-7877
USE OF PERMIT
Single Fami1v Dwelling
SL
60
ZOIC,
'FSB
SSB
SSB "
RSB
OFC
ZONE ORD 0
LOT SZ
END
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. 1 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:
0 I hereby certify that no excavation live (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, Sec 341• Titleff.
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 noted 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 affirm that there is a construction lending agency for the performance
o1 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: 1 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 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/PRMTTE
5-2"-85
S'F.D.
Pennit to construct 1247 sq. ft.
of
living area and 433 sq. ft. of oratge
as per approved Pfans.
Mech. Fee 37.00
Plan Check Fee 307.96
Const. Fee 367.00
Flect- Fee 60.18
:MT Fee 5.46.'
.Plimbing Fee 85.00
Tnfrastructure *
862.60
105.72 DEP. PAID
756.88
* ggreenitint
with Ommmity t Department
TOTAL
•
FEE2
60
H 1 1 4 J 7 L / j& 8 8 CK
r. VALUATION 77,948.00