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07-1955 (SFD)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description: Property Zoning: Application valuation: Applicant: . i07"=00001955 81853 RUSTIC CANYON DR 764-280-999-49 -300237- DWELLING - SINGLE FAMILY MEDIUM HIGH DENSITY RES 170639 4 BUILDING & SAFETY DEPARTMENT BUILDING -PERMIT Owner: SHEA LA QUINTA C/O JEFF MCQUEEN DETACHED 8800 N GAINEY.CENTER 350 SCOTTSDALE, AZ 852,8 Xrchilect or Engineer: h&>, C cw \suN- iLC.4. _2L401 Contractor: SHEA HOMES,.INC. 81260 AVENUE '62 LA QUINTA, CA 92 .(760)777-6005 Lic. No.: 672285 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 JUL 12.2007 CITY OF LA QUIM7q . _ FIIVAIurr Date: 7/65/07 LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7090) of Division,3 of the Business and Professionals Code, and my License is in full force and effect. _ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided LicenAp Claas: B License No.: 672285 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is 1` tractor: issued. 11L 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 OWNER -BUILDER DECLARATION insurance carrier and policy number are: 1 hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier AMERICAN HOME Policy Number 1247619 following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws, of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State - and agree that, if I should become subj ct to the workers' compensation provisions of Section License Law (Chapter 9 Icommencing 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 7631.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: 3700 of the labC e, IS dRh comply with those provisions. T 1 ate: icant: ' ( 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND'CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN - _ improvements are not intended or offered for sale; If, however, the building or improvement is sold within ' SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. one year o completion, the owner -builder will have the burden o 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 contractorls) licensed pursuant to the Contractors' State License Law.). ' 1 _ 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: LQPERMIT 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 hat the above infor anon is correct. I agree to comply with all cit*e: ounty ordinances sand state laws relate o 'he co op, and hereby authorize representatives of'l jy to enter upon the above -mention erty or pe ttcposes.. '' nature (Applicant or Agentl: V Application Number . . . . . 07-00001955 Structure Information Construction Type .. . . . . TYPE V - NON RATED Occupancy Type "DWELLG/LODGING/GONG <=10 Flood Zone NON -AO FLOOD ZONE Other.struct info CODE EDITION 2001 CBC FIRE SPRINKLERS - NO GARAGE SQ FTG 576.00 PATIO SQ FTG 177.00 DPTMBER OF UNITS 1 v 00. 1ST FLOOR SQUARE FOOTAGE 1943.00 Permit . ." BUILDING PERMIT Additional-desc . Permit Fee . . . . 888.00 Plan -Check Fee- 144.30 Issue Date Valuation, 170639. Expiration Date 1/01/08 ..Qty Unit Charge Per Extension BASE FEE 639.50 71.00 3.5000 THOU BLDG 100,001-500,000 248.50 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 70..50 Plan Check Fee 4.41 Issue Date Valuation. . . . . 0. Expiration Date 1/01/08 . 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 2.00 6.5000 •EA MECH VENT"FAN 13.00 1.00 6.5000 EA MECH.EXHAUST HOOD 6.50 ' Permit• ELEC-NEW RESIDENTIAL Additional desc . Permit Fee . . . . 94.53 Plan Check Fee 5.91 Issue Date Valuation 0 Expiration Date 1/,01/08 Qty• Unit Charge Per Extension BASE FEE 15.00 1943.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 68.01 576.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 11.52 LQPERMIT - - . Application Number 07-00001955 Permit PLUMBING Additional desc . Permit Fee 152.25 Plan Check Fee 8.95 Issue Date Valuation . . . . . . 0 Expiration bate.. 1/01/08 Qty Unit Charge Per. Extension BASF FFF.. .14.00 6.0000 EA PLB FIXTURE 84.00 - 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 5.06 .7500 EA PLB. GAS PIPE >=5 3.75 __•: 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. Expiration Date 1/01/08 Qty Unit Charge Per Extension BASE FEE 15:00 Special Notes'and Comments. SFD - LOT 49, PLAN 4520C, 1943 SF/ 255 SF CASITA,BOX BAY @ MBR. -.26 SF 4' GARAGE EXT - 88 SF.PERMIT DOES NOT INCLUDE BLOCK WALLS,POOL, SPA OR DRIVEWAY APPROACH. 75% REDUCTION TO PLAN CHECK FEE DUE TO MULTLIPLE ISSUANCE OF SAME PLAN TYPE. 2001 CBC, CMC, CPC, 2004 CEC, 2005 ENERGY CODES ------------------------------------------------------------------------------ Other Fee's . . . ART IN PUBLIC PLACES -RES .00 DIF COMMUNITY CENTERS -RES 74.00 DIF CIVIC CENTER - RES 995.00 ENERGY REVIEW FEE 14.43 DIF FIRE PROTECTION -RES 140.00 GRADING PLAN CHECK FEE .00 DIF LIBRARIES - RES- 355.00 DIF PARK MAINT FAC .-.RES 22.00 DIF PARKS%REC - RES 892.00 STRONG MOTION (SMI) - RES 17.06 LQPERDSTT Application Number 07-00001955 Other Fees . . . . ----- - --- ---------------- DIF STREET MAINT FAC -RES 67.00 DIF TRANSPORTATION - RES 1930.00 Fee summary Charged Paid Credited Due Permit Fee Total 1220.28 .00 .00 1220.28 Plan Check Total. 163.57 :00 .00 163.57 Other Fee Total 4506.49 .00 .00 4506.49 Grand Total 5890.34. 00 ' UU 5liyU . i4 LQPERMIT