001435 (SFD)w4t�/ 4 6(4iq� (49waj
Building
Address 7!` —305 F. &R lsest RM.rE. Dr.
Owner
Gdk_,M1
mailing
Address -tool 2
City Zip ;"j � � c� Tel.
Contractor
J.T
Address
Zip I Tel.
State Lic. City
& Classif. 442322 Lic. #
Arch., Engr:,
Designer
Address I Tel,
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
P
Cityzip State
FVIM 5'riro:w [9226? Lic. #
LICENSED CONTRACTOR'S nFCLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
of fact.
Sir N A ru a DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: fSec. 7031.5,Buskwss and Prolassions Code; Any city at county which requires a
permit to construct, eller, fmprove, demolish, or repair any structure, prior fo ifs Issuance also
requlfeS the applicant f-r such Permit to file a signed Statement Ihaf he ie llcensed purruanf in
the provisions of the Contracior'a License Law, Chapter 9 (Conananaely with seetlun 7000) of
Division 3 of the Business and Professions Code, or tharhe is exempt therefrom, and the bases
for the alleged exemption. Any violation of Section 7037.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars (85001.
D 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 w offered for sale. (Sec. 7044, Bui5ne35 and
Prolessions Cade: The Contractor's License Law does not apply to art owner of property who
builds or Improves. thereon and who does such work himseff or through his gwn employees,
Provided that such improvements are rrbt Intended or offered for sale. !f, however, the building
or imprairwrlerit is sold wlfhln one year of completion, the owne,1111Uar wig 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 ProfesEws, 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.)
❑ 1 am exempt under Sec. B, & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I 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 Coder:)
Policy No Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(ihis section need not be completed if the permit is for one hundred dollars (S100) valuation
or Tess.)
I Certify that in the performance of the work for which this permit is issued, I shall not
employ any parson in any manner so as to become sutiject to the Workers' Compensation
Law$ of California.
Date Owner
NOTICE TO APPLICANT: If, alter 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 palmR shall be daemcd revoked.
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.)
Lender's Name
Lender's Address
This is a building parmit when propetly 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.
I agree to comply with all City and county ordinances and state laws relating to building
construclion, and hereby authorize representatives -of this city to enter the. above -
mentioned property for inspection purposes.
t;
Signature of applicant Dale
Mailing Address
City, State, Zip
No. 001,435
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number
Legal Description
Project Description fiOdC77X1T1r�T
146 C:::x`. 1.
Sq. Ft. �,�, � `7 No. No. Dw.
Size -'ki Stories Units
Newer] Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation 77,
PERMIT AMOUNT
Plan Chk. Dep. 105,72
Plan Chk. Bal. 202,24
COnst. IF7,00
Mech. 37,00
Electrical
Plumbing q5
S.M.I.
Grading
Driveway Enc.
Infrastructure ,7; , at.1.5 Pex 81MEerftt
th by :^fi'F?1. Dim C3{b=.
TOTAL n*26 _
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
HARD COPY]
T
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBING FEES
1ST FL. SQ. FT. ®
2ND FL. SQ. FT.
POR. SQ. FT.
GAR. SQ. FT. ®
CAR P. SQ. FT. ®
WALL SQ. FT. @
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION
$
UNITS
YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
$
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
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, TEM/PERM
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.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/ac
HOUSE SEWER
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
ROCKSTORAGE
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES[IHITIALS
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, it work has been suspended or abandoned for a period of 180 days.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 70DO) of Division 3 of the Business and Professions Code, and my license is in lull force
and effect
License Class Lic. Number
pate 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 requlfes a permit to
construcl, alter, improve. demolish, ar 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 p r ovisions of IheContraetor's License Law
(Chapter 9 i c o m mencing with section 7000) of Division 3 of the B us I ness and Not Essig ns Code) of that he is e K emp I
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 properly, 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
WOW his own tmployees. provided that such impravements are not intended or offered for sale. It, however, the
huilding or improvemnl is sold within o nc year of complelio a, 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 properly, am exculsively contracting with licensed contractors to construct the project (Sec
7044, Business and Professions Code: The Contractor's License Law does riot apply to an owner of properly 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 6 P.C. (Attached Certificate).
Date. Owner _
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell -insure, or a
certificate of Workers' Compensation Insurance , or a certified copy thereof (Sec. 3800 Lab C.).
Policy No. Company
D Certified copy is hereby furnished.
❑ Certified copy is filed with the City Building Inspection Department or City
Date Applicant
Department.
APPLICANT NAME (L. F. MI)
JL Construction
ADDRESS
P.O. Box 173
CITY/COMMUNITY/STATE/LIP
Nestor, CA 92053
JOB SITE ADDRESS/SPACE
CITY/COMMLONITY/STATE/ZIP
La. to CA 92253
60K
PAS
PRC
C
TWN
FIND
SE
S
19903
L%is
MOD98
TRACT NAPE
HORIZON PALMS
OWNER NAME (L. F. M1) Ganeral Management Corp.
CONTRACTOR -FIRM NAME
J.L. Construction
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
PHONE a
LICNC 0
ARC/ENG FIRM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CITY/COMMUNITY/STATE/ZIP
Palm Springs. CA 92262
PHONE a
LICNC N
323-7877
USE OF PERMIT
Single Family Dwelling
eL
ZON,
Fee
SSe
SSe
RSe
OFC
ZONE ORD a
LOT SZ
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
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: 11, 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 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, Title 8,
C.A.C.)
❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of
Industrial Safely, as noted above, unless such person has a permit to do such work from that division.
❑ Division of Industrial Safety Permit No
Dale 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 stale 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
Prim ApplicantlAgenl Name (Y} fV a 15
Date
APPIJPRMT001385
DATE
i=85
S.F.D.
Permit to construct
1247 sq. ft.
of
living area and 433
sq. ft. of garage
as per approved plans.
h. Fee
37.00
Plan Check Fee
307.96
Const. Fee
367.00
Elect, Fee
60.18
I Fee
5.46
Plumbing Fee
85.00
862.60
105.72 DEP. PAID
756.88
*npferred paymmt
as = agreemftnt
with rr_ym_mif;V
t Department
TOTAL ■
FEE
1
862.60
All�S 5 23 75&88 V
FINANCE VALUATION 77, 948.00