001532 (SFD)Building
Address 79- 310 N.
Owner
Mailing
Address 1oo1 uahup St.
City I Zip
Contractor
Address
W
T4hf 4 P.O. BOX 1504 No.
78-105 CALLE ESTADO
Rif%p ilrlAQUINTA,CALIFORNIA 92253
BUILDING: TYPE CONST. S' 1' OCC. G
Suite 2750 A.P. Number_
Tel.
1—BM--36 7-50,5] Legal Description
J.L. 0:mzt�``ii>.
City Zip Tel.
Igesd r 920573 340- ,.513.
State Lic. City
& Classif. �42^22 Lic. # 237
J
Arch., Engr.,
DesignerMichael ct Assoc.
Address Tel.
flarrell . 23-78 7
City Zip State
.i S 1 92262 Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) t. of Division 3 of.the Business and Professions Code, and my license is in full farce and
affec
SIGNATURE DATE
OW#EWBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the fallowing
reason: (Sec. 7031.5.Bus less 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 ($500).
❑ 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, Bulsness 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 improvement 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.)
❑ I, 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.)
❑ 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 Code.)
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
fltus section need not be completed if the permit is for one hundred dollars ($100) valuation
Of Jess.)
I certify that In the performance of thg work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
DateOwner
NOTICE TO APPLICANT: ff, alter making this GedfTrcats of Exemption you should become
subjecl to the Workers' Compensation provislons of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed rnvaked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state lhat the above information Is correct,
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby au haize representatives of this city to enter the above.
mentioned properly for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
001532
P 3
Project Description
lkwimn Palirai
146 Zhits „.aa c 7tt3 1 ■
T.M 1247
Sq. Ft.` 433
Size
No. No. Dw.
Stories Units
New Ek Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
105■72
Plan Chk. Bal.
202.24
Const.
367.r-*
Mech.
37.130
Electrical
6t_1.12
Plumbing
85.00
S.M.I.
5.45
Grading
Driveway Enc.
Infrastructure
Defer t7@ ,.
t as acnmemrmt
With cbun,
!$l. uixect=-
TOTAL
r ']
756.532
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
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBING FEES
1ST FL. SQ. FT. ®
2ND FL SQ. FT. @
POR. SO. FT. ®
GAR. SQ. FT. ®
CARP. SQ. FT. ®
WALL SQ. FT.
SO. FT. p
ESTIMATED CONSTRUCTION VALUATION
$
UNITS
YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK
POWER OUTLET
ROOF DRAINS
I
I
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 14/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
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
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP-
REIN F. 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
I NSU LATIONISOU N D
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S S IG N ATU R ESUN ITIA LS
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 of Issuance, OR, If work has been suspended or abandoned for a period o1 180 days
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 Prolessions Code, and my license is in full force
and elfect.
License Class
Lic Number
)ate Contractor
OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the
lollowing reason (Sec 7031.5, Business and Prolesslons Code: Any city or county which requires a permit to
construct, alter- improve. demolish, or repalr any structure, prior to ils issuance, also requires the applicant for
such permit to life a signed statement that he Is licensed pursuant to the provisions of the Contractor's License Law
(Chapler 9 (commencing with section 7000) of 0ivWon 3 at the Business and Professions Coda) or Ill at he is exempt
lherelroin and the basis for the alleged exemption. Any vtofation of Section 70311 by any applicant Idr a permit
subjects the appficanf to a civil penally of not more than IN hundred dollars (Mm.):
o I. as owner of the property, or my employees with wages as their sole compensation, will do the work, and the
afrudufe is not intended or offered for safe (Sec.7044. Business and Professions Code: The Cunlractor's License
Law does not apply 10 an owner oI property who builds, or improves thereon, and who does such work himself or
through Ms own empfoyees. provided that such Improvements are not intended or off Bred far Sale.11, however, the
building a improvemnI is sold within one year of completion, lheowner-bufee r will have the burdefi of proving that
he did not build or improve for (he purpose of sale.).
❑ I, 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.)
❑ 1 am exempt under Sec . B. 8 P.C. (Attached Certificate)
Dale 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.
Dale Applicant
APPLICANT NAME (L. F. MI)
JL Construction
ADDRESS
P.O. Box 173
CITY/COMMUNITY/STATE/ZIP
Nestor, CA 92053
JOB SITE ADORESSSPACE
CITYiMCCIM IUNITY/STATEIZIP
La inter CA 92253
BOK PAG
PRC C
TWIN
RING
SE
S
TRACT
19903/t,'/
LOT_
moo
SB
TRACT NAME HORIZON PAIMS
OWNER NAME (L. F. MI) General Management Corp.
CONTRACTOR -FIRM NAME
J.L. Construction
ADDRESS
above
CITY/COMMUNITY/STATE/ZIP
ahpze
PHONE.
LICNC e
ARC/ETiC FIRM NAME
Michael Buccino Assoc.
ADDRESS
340 S. Farrell Dr. A212
CITY/COMMr1N ITY/STATE/ZIP
Palm rings CA 92262
PHONE a
323-7877
LICNC IF
USE OF PERMIT
Sin le Family Dwelling
BL
ZON,
FSB SSS
SSB RSB
OFC
ZONE ORD a
LOT SZ
END
SIDE
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed it
the permit is for one hundred ($100) o, less 1 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 o1
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:
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 32, Grp 2 Art 2, Sec341. Title8,
C.A.0 )
❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division o1
Industrial Safety, as noted above, unless such person has a permit to do such work Irom that division
❑ Division of Industrial Safety Permit No
Date
Applicant
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency lorthe performance
o1 the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
I certI fy that I have read this application and slate 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 fnentioned 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 of the City of La Ouinla Department of Building and Safety to enter
upon the property foT which I have applied for this permit for the purpose of making inspections.
Signature of Applicant or Agent Date
Print Applicant/Agent Name
APPVPRMT001185
DATE
2-85 S.F.D.
Permit to construct
1247 sq. ft. of
living area and 433
sq. ft. of garage
as per a roved lans .
Mech. Fee
37.00
Plan Check -Fee-
307.96
Mnst. Fee
367.00
Elect. Fee
60.18
cM
5.46
$5.00
Infrastructiare
862.60
105.72 DEP. PAID
756.88
*
s pex agreen�nt
with Cmminity
t Pm-artinent
TOTAL ■
FEE
62.6Q
AIL1i: ! 7 5 & 8 8 V
VALUATION 77,948.00