001481 (SATT)Building
Address 7CJ-4
Owner
Mailing
Address
7 ftFs�
City
1AJU
Contractor
Address
Tjt�l 4
P.O. BOX 1504 N o . 14 81L
78-105 CALLE ESTADO
%3r 2*r, pa&ng Cjj'Clp LA QUINTA, CALIFORNIA 92253
]BUILDING: TYPE CONST. V 4 OCC. GRP. R 3
Number
Tel.
1-30—367—:2.111- Legal Description
Project Description z1Zt9s TIatg
City ye
JZIp Tel.
State Lic. City
& Classif. f .;2 Lic. # 237
Arch., Engr.,
Designer
Address Tel.
340 S. Farrell St. 323'- ii
City Zip State
Pal-l"I Sminge 1 92262 Lic. #
LICENSED CONTRACTOR'S DECLARATION
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
effect.
SICNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's LJcense Lew for the following
reason; (Sec. 7031.5,Buslness and Professions Cade: Any cfty or county which requires a
permit to construct, Alter, improve, demolish, or repale any structure, prior to its issuance also
requires his applicant for such permit to file a signed stataman! that he is licensed pursuertf to
111e ptavisfons of the Contfactor's License Law, Chepfer 9 (cpmmancfng 60h Section 7000) of
D(visfon 3 of the Business andProfeWons Cade, or that he is exempt lheretmm, 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 (S500).
❑ 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, Bussness and
Professions Cade; The Contractor's License Law does not apply to an owner of property who
builds or lmprovas thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for safe, It, however, the building
or improvement is sold within one year of completion, the owner-bullder 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
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' 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 -Owner
NOTICE TO APPLICANT: If, alter making (his Certificate of Exemption you should become
subject to the Workers' Compensatlon provisions of the Labor Cade, you must forthwith
comply with such provisions or Wfrls permit shall be deemed 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 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 lead this application' and slate that the above information is correct_
I agree to comply with all oily and county ordinances and state laws relating to building
construction, and hereby authorize representatives Hof this city to enter the abotte.
mentioned property for Inspection purposes.
Signature of applicant Date
Mailing Addres4
City, State, Zip
Sq. Ft, W G 12-47
Size C
New EEC Add ❑
No.
Stories
No. Dw-
Units
Alter ❑ Repair ❑ Demolition El
Estimated Valuation
$ 771,948.00
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
COnSt.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
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:
Validati
HARD CO
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBING FEES
1ST FL. SQ. FT. @
2ND FL. SQ. FT. @
POR. SQ- FT. @
GAR- SO. 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
LAUNDRYTRAY
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.
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/<c
HOUSE SEWER
GAS PIPING
EE
PERMIT FEE
PERMIT FEE
TOTAL FEES MICRO FEE
FDB
MECH.FEE
PL.CK.FEE 7
ONST. 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.IEQUIP.
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 Oulnta
Department of Building and Safety
This permit becomes void if work not commenced within 180 days from dale o1 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 7000) of Division 3of the Business and Professions Code, and my license is in full force
and effect
License Class
Lic Number
OaiP Contractor r
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 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.7D44, 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 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 safe )
❑ 1, as owner of the property, am exculsively contracting with licensed contractors to construct the project (Sec
7041. 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.0 (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
❑ 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/STATEMP
Nestor, CA 92053
JOB SITE ADDRESS/SPACE
CITY/COMA UNITY/STATF/ZIP
La Quinta, CA 92253
em
PAG
PRC C
TWN
RNG
SE
S
TRACT
19903
Lpi�/
MOD
SB
TRACT NAME HORIZON PALMS
OWNER NAME (L. F. MI) General Management Corp.
CONTRACTOR -FIRM NAME
J.L. Construction
ADDRESS
aboyn
CITY/COAAMUN ITY/STATE/ZIP
PHONE a
LICNC
ARC/ENG FIRM NAME
Michael Buccim Assoc.
ADDRESS
340 S. Farrell Dr. A212
Cm/COMMUN ITY/STATEIZIP
Palm rin s CA 92262
PHONE 0
LICNC N
323-7877
USE OF PERMIT
Single Familv Dwellin
BL
ZON,
FSB
I SSB
SSB
RSB I
I
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 (S1D0) 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
Dale Applicant
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 permit shall
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ f 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 2 Art 2, Sec341, Title B,
C.A.0 )
❑ 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 of Industrial Safety Permit No
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 Addiess
I certify that I have read this application and stale 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 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 buldling
construction, and authorize a representative of the City of La Ouinta Department of Building and Safety to enter
upon the properly for which I have applied for this permit for the purpose of making inspections
Signature of Applicant or Agent
Print Applicant/Agent Name ( I e j L1p I
Date
APPLIPRMT
DATE
5-2-2-85 S.F.D.
Permit to construct
1247 sq. ft. of
living area and 433
sq. ft. of garage
as per approved plans.
Mech. Fee
37.00
Plan Check Fee
307.96
Fge
367.00
60.18
5.46
Pliwrhina Fee
85.00
Infrastnictum
862.60
105.72 DEP. PAID
756.88
*
4qreerrd3nt
with OprivitinjiZz
t Department
TOTAL •
FEE
862.60
AiiV1 5 75688 V
FINANCE VALUATION 77,948.00