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SFD (04-5099)U S ' BUILDING & SAFETY DEPARTMENT "� w4 P.O. Box 1.504 (760).777-7012 OFTt�9 78-495 CALLE TAMPICo FAX (760) 777-7011 ® A;TALIFO92253 INSPECTION REQUESTS (760) 777-7153 BU -II DING PERMIT JUL 2 8 2QQ V Applicatio QUl"T� 04 OQOO-5`0:9_9= Date 6/25/04 Property 'A , dre56315 MOUNTAIN VIEW APN: 762 -4107018 -..- Application description . . DWELLING --SINGLE FAMILY DETACHED Property Zoning . LOW DENSITY RESIDENTIAL Application valuation 365747 Owner Contractor SRHI TOLL-BROS, INC. C/0,RIELLY HOMES INC.. 73121 FRED WARING DRIVE, #100 3 CORPORATE PLAZA DR 210 , PALM DESERT CA 92260 NEWPORT BEACH CA 92660 G. WCC: LIBERTY MUTUAL WC: WA26DO04723013 09/01/04 CSLB: 777699 04/30/06 CCC: B ----------------------- -- Structure Information` --7-7 -------------------- Construction-Type . . .. . . TYPE V - NON RATED Occupancy Type. . . . . . . DWELLG/LODGING/LONG <=10 Flood Zone NON -AO FLOOD ZONE Other struct.info.. . CODE EDITION 2001 CRC FIRE SPRINKLERS NO ..GARAGE SQ FTG 785:.00 PATIO SQ FTG 1058.00 NUMBER -`OF UNITS 1.00 FIRST FLOOR SQ FTG .4162.00 ---------------------------------------------------------------------------- Permit BUILDING,.PERMIT` Additional desc Permit Fee. 1570.50 Plan Check.Fee 1020.83 Issue Date Valuation 365747 Qty Unit Charge Per Extension BASE FEE- 639.50* 266.00 3.5000 THOU BLDG 100,001-500,000 931.00 Permit MECHANICAL Additional desc 'Permit Fee . . ,139.00 Plan -Check Fee 34.75 Issue Date . . Valuation 0 Qty Unit Charge Per Extension P.O. BOX 1504 � • w VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Date: Applicant: Applicant's Mailing Address: chitect Architect ic. No.: or Engineer: or Engineer's Address: 13UILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 700)) of Division 3 of the Business and Professionals ode, and my Licensed m full force and effect. G� License Class ' I S License No.--/ 1—__611e ontrector OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he 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).): ( j 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 th3 work himself or herself or through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvemen 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.). (, 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.). U I am exempt under Sec. , BA P.C. for this reason Date - Owner WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 1 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 issued. I have and will maintain workers' compensation insurance, as required by Sectign 3700 of the Labor Code, for the performance of the work for which this permit is issuee,d. My o��ttccers'��ompegsation instance carrier and o' number are: - Cartier L�Ja.�tii %�'Vl/Jlie 1 ol4r icy Number w� 6 D oO'f 7L3 0/3 _ I certify at, 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 3700 of the Labor Code, I shall forthwith comply with those provisions. /ate i=ce ¢ Applnt WARNING: FAILURE TO SECURE WORKERS' COMPENSATION 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. 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 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, indemnity 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 building construction, and hereby authorize representatives of this county to enter upon the abov tinned property for inspection purposes. �Bate�9 ignature (Applicant or Agent): 44 Page 2 Application Number 04-00005099 Date 6/25/04 Qty Unit Charge Per Extension - BASE FEE 15.00 4.00 9.0000 EA MECH FURNACE <=100K. 36.00 4.00 .9.0000 EA MECH B/C <=3HP/100K•BTU 36.00 7.00 6.5000 EA MECH VENT FAN 45.50 1.00 6.5000.EA MECH EXHAUST HOOD 6.50 ---------------------------------------------------------------------------- Permit ELEC-NEW RESIDENTIAL Additional desc Permit Fee 176.37 Plan Check Fee 44.09 Issue Date Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 4162.00 .035.0 ELEC NEW RES - 1 OR 2 FAMILY 145.67'• 785.00 .0200 ELEC-GARAGE OR NON-RESIDENTIAL 15.70 Permit . . . PLUMBING Additional desc Permit Fee 235.50 Plan Check Fee 58.88 Issue Date . . . . Valuation 0' Qty Unit Charge Per r Extension BASE FEE 15.00 27:00 6.0000 EA PLB FIXTURE 162.00 1.00 15.0000 EA PLB BUILDING. SEWER 15.00 1.00 7..5000 EA PLB WATER HEATER/VENT 7.50 1.00 3.0000 EA 'PLB WATER INST/ALT/REP 3.00 1.00 9.0000 EA PLB LAWN SPRINKLER SYSTEM 9.00 12.00 .7500 EA PLB GAS PIPE >=5 9.00 1.00 15.0000 EA PLB GAS METER 15.00 ---------------------------------------------------------------------------- Permit . . . . . GRADING PERMIT Additional desc Permit Fee 15.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0. Qty Unit Charge Per Extension BASE FEE 15.00 --------- ------------------------------------------------------------------ Special Notes and Comments SFD - LOT 18 PLAN CABRILLO • SB 4162 S.F. i Page 3 Application Number . . . . 04-00005099 Date 6/25/04 Special Notes and,. Comments PERMIT DOES NOT INCLUDE BLOCK WALL, -- POOL, SPA -OR DRIVEWAY APPROACH., ----------------------------------------------------------------------------- Other Fees ART IN PUBLIC, PLACES -RES 414.36 DIF COMMUNITY CENTERS -RES. 97.00 DIF CIVIC CENTER -RES 366.00. ENERGY REVIEW FEE 102.08 DIF FIRE PROTECTION -RES" 97.&0 GRADING PLAN CHECK FEE 00 'DIF LIBRARIES -. RES 225.00 DIF PARK MAINT FAC,- RES 5.•00 DIF PARKS/REC - RES 502.00 STRONG MOTION (SMI) - RES 36.57 DIF STREET MAINT FAC, RES 15.00: DIF TRANSPORTATION - RES 1098.00 Fee summary Charged Paid Credited Due .Permit Fee"Total 2.136.37 .00 ..00 2136..37 Plan Check Total 1158.55 .00 .00 1158.55 Other Fee/total 2958.01 .00 .00 2958.01 Grand Total 6252.93. .00 .00 6252.9"3