05-2150 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
A
Pr
A
A
T,4ult 4 44u&rw
-05-00002150
,52380 AVENIDA MONTEZUMA
773-241-028-19 - -
NTIAL
IAL
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I "reby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
ection 70001 of Divisio 3 of the Business and Professionals Code, and�1 Li a se is in full force and effect.
License Class: A //f /// License Ng/� Ig�O
� Dater Contractor: j /fir..
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
thai she or she 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).:
1 _) 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, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
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 or she did not build or
improve for the purpose of sale.).
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
( 1 I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY '
I hereby affirm under penalty of perjury 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:
LQPERI%1IT
Owner:
SHIVELY JEFFERY J
52810 AVENIDA MONTEZUMA
LA QUINTA, CA 92253
Contractor:
SHIVEY CONSTRUCTION INC
WCC: CLARENDON INS
WC: 07KROO16704
CSLB: 440810
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
JEFF
07/15/05
07/31/06
Date: 6/03/05
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
�1( issued.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier B Policy Number - - - - - - - - - - - - - --
_ 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,
and agree that, if I should become subject to the workers' compensation provisions of Section
�4700 of the Labor Co* I shall forthwith comply those provisions.
a -D te: l< Applicant.
WARNING: FAILURE TO SECURE WORKERS' CfJMPtNSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under'or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
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 bui ding construction, and hereby authorize representatives
of t� un y to enter upon the above-mentioned pro rty for ins 'dh purposes.
O - Signature (Applicant or Agen
Application Number . . . . . 05-00002150
Permit . . . BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . . 252.00 Plan Check Fee 163.80
Issue Date . . . . Valuation . . . . 25000
Expiration Date . . 11/30/05 .
Qty Unit Charge• Per Extension•
BASE FEE 45.00
23.00 9.0000 THOU BLDG 2,001-25,000 207.00
----------------------------------------------------------------------------
Permit . . . MECH POOL
Additional desc . .
Permit Fee . . . 26.00 Plan Check Fee 6.50
Issue Date . . . . Valuation . . . . 0
Expiration Date'. 11/30/05
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 11.0000 EA MECH FURNACE >1OOK 11.00
----------------------------------------------------------------------------
Permit . . . ELEC POOL PERMIT -RES
Additional desc . .
Permit Fee . . . . 45.00 Plan Check Fee 11.25
Issue Date . . . . Valuation . . . . 0
Expiration Date 11/30/05
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL 30.00
----------------------------------------------------------------------------
Permit PLUMBING
Additional desc .
Permit Fee_ 33.00 Plan Check Fee 8.25
Issue Date Valuation . . . . 0
Expiration Date 11/30/05
Qty Unit Charge Per Extension
BASE FEE 15.00
2.00 6.0000 EA PLB FIXTURE 12.00
1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00
1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00
----------------------------------------------------------------------------
Special Notes and Comments
POOL & SPA ONLY. ALARMS/BARRIERS SHALL
LQPERMIT
Application Number . . . . . 05-00002150
-----------------------------------------------------
Special Notes and Comments
----------------------
BE IN PLACE PRIOR TO PRE -PLASTER
INSPECTION. EQUIPMENT ENCLOSURE NOT
INCLUDED IN PERMIT.
Fee summary Charged Paid
-------------------------------------
Credited
--------------------
Due
Permit Fee Total 356.00 .00
.00
356.00
Plan Check Total 189.80 .00
.00
189.80
Grand Total 545.80 .00
.00
545.80
LQPERMIT
(° 11
04
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0) 0)
,n
(° `_1
5'-0" HIGH
BLOCKIUALL
* DATUM PONT
EXISTING CURB
AND GUTTER
PANEL
-3'-0" M.I.
GATE
-5'-0" HIGH
BLOCK WALL
(FINISHED FLOOR BE 1
A$OVE DATUM POINT
TT AT TOP OF
CURB AT CENTERLINE OF LOT.)
THE DEVELOPER/C.ONiRAGTOR/OWNER 18 RESPONSIBLE FOR T+ -E VERPICA?ION
CF EXISTING CURB (OR EDGE OF 87 T PAVING IF NO CURB EXIST8) LOCATION
FI00I'1 PROPERTY LINIEW UATI-I THE PUBLIC WORKS DEPARTMENT. /
/
/
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aA
51 TE FLAN NORTH
Sl.iALE: '/$II -11-0"
SHEET INID X 5
1
51TE FLAN
CSN
GENERAL NOTES
2
FOUNDAT I ON FLAN
3
FLOOR FLAN
4
ELEVATIONS
5
SECTIONS
LA QUINTA, CA 92253
ROOF FLAN
R.C.
ROOF FRAMING FLAN
0
TITLE -24 REQUIREMENTS
e
ELECTRICAL FLAN
10
MECHANICAL FLAN
INFORMATION
OWNER:
JEFF SNIvELY
41-625 EGIEGTRIG 51., SiE. F-2
PALM DESERT, GA 92260
LEGAL DESCRIPTION:
L07 N0. 19
CPN": 113-241-033
PROJECT ADDRESS:
52-380 AVE. MONTEZUMA
LA QUINTA, CA 92253
ZONE:
R.C.
OCCUPANCY:
SINGLE FANaLY
TYPE VNON—f2A7ED
AREA TA5ULATION6
1RE5I1)-ENCE
2,158 SQ.FT.
CzARAC�cE/I'1ECH•
534 SQ.FT.
COVERED PA?10
314 SQ.FT.
TOTAL STRUCTURE 3160(o SQFT.
TOTAL SITE 1,620 SOFT.
TOTAL LOT COVERAGE 41.3%
AVENIDA JUAREZ
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AVENIDA MADERO
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NORTH
V I C I N I T%*T'� M A f N.T.S.
CITY OF LA QUJj�ITA
BUILDING & SAFETY DEPT,
APPROVE®
FOR CONSTRUCTION
DATE G f 0s
SOUTH WEST CONCEPTS
PROGRESSIVE DESIGN CONCEPTS
• Architectural Design
• Residential and Commercial
• Planning and Development
78-120 Calle Estado, Ste. 206
La Quinta, CA 92253
Office (760) 564-4707 Fax (760) 564-4955
www.swconcepts.com
PROJECT TITLE
Jeff Shively
Construction
52-380 Avenida Montezuma
La Quinta, California 92253
Date/ Description
Number 0 05.05.04
Aproved By
Project Maneger
Date: 06/02/2004
f t_