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SFD (04-4078)• t�Gi�riV 1 P.O 78 LA A j,(;.ff 0 Rd,%9 2 CITY OF LAQUIW1 FINANCE DEPT. Application*Number . . Property Address . . . APN: Application description Property Zoning . . . . Application valuation . BUILDING & SAFETY DEPARTMENT (760).777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 ERMIT -- 1 04'0,0004078- Date 5/121/04 8116-0—NATIONAL DR 767-500-024- - - . DWELLING - SINGLE FAMILY DETACHED . . . LOW DENSITY RESIDENTIAL . . 342299 Owner Contractor NORMAN ESTATES II EHLINE COMPANY r C/O MEDALLIST GOLF DEVELOPMENT 55375 MEDALLIST DR' 501 NORTH AlA LA QUINTA CA 92253 JUPITER FL 3.3477 (760) 771-8130 WCC:. STATE FUND WC: 22900067.83 01/01/05 CSLB: 482086 11/30/05 CCC: B -------------------------- Structure Information ----------- 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 # BEDROOMS 4.00 FIRE SPRINKLERS NO GARAGE ,SQ FTG 843=.00 -_ PATIO SQ FTG 698.00 NUMBER OF UNITS 1.00 FIRST FLOOR SQ FTG - 3917.00 ' -------------------------- Permit . . . . . . ------------------------------------ BUILDING PERMIT ------------- Additional desc . Permit Fee . . 1490.00 Plan Check Fee 968.50. Issue Date . . . . Valuation 342299 Qty Unit Charge Per Extension' BASE FEE 639.50 243.00 3.5000 THOU BLDG 100,001-500,000 .8.50.50 ---------------------------------------7------------------------------------ Permit . . . ELEC-NEW RESIDENTIAL Additional desc Permit Fee . . . . 168.96 Plan Check Fee 42.24 Issue Date . . . Valuation . . 0 Qty Unit Charge Per Extension (f 4.4 P.O. Box 1504 ity VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing Address: Date: Architect or Engineer: Architect or Engineer's Address: Lic. No.: BUILDING 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 7000) of Division 3 of the Business and Professionals Code, and my Licenye is in full force and effect., �,, �� '%(4=)/ License Class ,cense No. _ _ Date __Cr5` _ actor _ c- ut P IFi C® " 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).): U 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 or 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.). U 1, 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 coniracts 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 WORKERS' COMPENSATION DECLARATION I hereby affirm. under penalty of perjury one of'the following declarations: I 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 Section 3700 of the Labor Code, for the performance of the work for which this permit is r—� ued. M wq ' co( nsation in ce carrier�r1�0.4 j�ymbe�r arder�l �'� olicy Number ei _ 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, arryyl� 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 provi*i'ofis. 7 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 applicafion. 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 info tion is 'ect. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorizer resentatives of this county to e r up a above-mentioned property for inspection purposes. ,"DateSignature (Applicant or Agent): Page 2. Application Number . . . . . 04-00004078 Date 5/1.2/04 Qty Unit Charge Per Extension BASE FEE 15.00 3917.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 137.10 843.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 16.86 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 --------------- ----------------------------------------------------------- Permit . . . . MECHANICAL Additional desc Permit Fee 109.50 Plan Check Fee 27.38 Issue Date. Valuation . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 2.00 9.0000 EA MECH FURNACE <=100K 18.00 2.00 9.0000 EA MECH B/C <=3HP/100K BTU 18.00' 8.00 6.5000 EA MECH VENT FAN 52.00 1.00 6.5000 EA MECH EXHAUST HOOD 6.50 ----------------------- Permit . . . ------------------------------------------------ . . PLUMBING ----- Additional desc Permit Fee . . . 187.50 Plan Check Fee 46.88 Issue Date . . Valuation 0 Qty Unit Charge Per Extension BASE FEE 15.00 19.00 6.0000 EA PLB'FIXTURE 114.00 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 Special Notes and -Comments SFD - TR 29657, LOT 49. PLAN 4A. PERMIT Page 3. Application Number . . . . 04-00004078 Date 5/12/04 ---------------------------------------------------------------------------- Special.Notes and Comments DOES NOT INCLUDE BLOCK WALLS, POOL, SPA OR DRIVEWAY APPROACH. - I --------------------------------- Other Fees . . . . --------------------------- ART IN PUBLIC PLACES -RES -------------- 355.74 DIF COMMUNITY CENTERS -RES 97.00 DIF CIVIC CENTER - RES 366.00 ENERGY REVIEW FEE 96.85 DIF FIRE PROTECTION -RES 97.00 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 34.22 DIF STREET MAINT FAC -RES.. . 15.00. DIF TRANSPORTATION - RES 1098.00 Fee summary Charged --------------------------- Paid Credited: Due Permit Fee Total 1970.96 ------------------------------ .00 .00 1970.96 Plan Check Total 1085.00 00 .00 1085.00 Other Fee Total 2891.81. .00 .00 2891.81 Grand Total 5947.77 .00 .00 5947.77