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05-3254 (AR)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Tiht " BUILDING & SAFETY DEPARTMENT BUILDING PERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/19/05 Application Number:5-0000�3ti25'4 Owner: Property Address: 7.56'5 BALLYBUNION SOUTHERN HILLS DEVELOPMENT APN: 7.62-330-015- - -ie 55161 SOUTHERN HILLS Application description: ADDITION - RESIDENTIAL [ �-----��iII' LA QUINTA, CA 92253 Property ZoningLOW DENSITY RESIDENTIAL I Application valuation: 44273 III I AUG .r; 2005 L Contractor: Applicant: Architect or Engine r: CITY OF LA QUINTA SOUTHERN HILLS DEVELOPMENT INC L� FINANCE DEPT. 78150 CALLE TAMPICO STE 101 'LA QUINTA, CA 92253 (760)771-3497 Lic. No.: 838041 ----------------- 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 Professio Is Cod f'dnd my License is in full force and effect. License Class: B Licen 838041 Date ' 2 ontractor: - OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury t t 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 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 1$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. 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.). (_) 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.). ( ) 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.I. Lender's Name: Lender's Address: F LQPERMIT --------------- - - - WORKER'S 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 issued. My workers' compensation insurance carrier and policy number are: Carrier EXEMPT Policy Number EXEMPT 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 wor rs' compensation laws of California, and agree that, if I should becom :subject a work ompensation provisions of Section 2 3700 the Labor Code, I shall or wit omply wi th a provisions. Applicant: WARNING: FAILURE TO SECURE W RS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMI 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 building c nstruct rn and hereb thorize representatives of this county to enter the above-mentioned property f i pec purpose -7 -off" op Dat Signature IA-glicant or Agent).' Application Number . . . . . 05-00003254 Permit . . . BUILDING PERMIT Additional desc . . Permit Fee . . . . 382.00 Plan Check Fee 248.30 Issue Date . . . . Valuation . . . . 44273 Expiration Date 2/15/06 Qty Unit Charge Per Extension BASE FEE 252.00 20.00 ---------------- 6.5000 m THOU BLDG 25,001-50,000 130.00 . . . ELECT - ADD/ALT/REM Additional desc . . Permit Fee . . . . 42.09 Plan Check Fee 10.52 Issue Date . . . . Valuation . . . . 0 Expiration Date 2/15/06 Qty Unit Charge Per Extension BASE FEE 15.00 774.00 ---------------------------------------------------------------------------- .0350 ELEC NEW RES - 1 OR 2 FAMILY 27.09 Permit . . . GRADING PERMIT Additional desc . Permit Fee 15.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 2/15/06 Qty Unit Charge Per Extension ----------------------------------------------------- BASE FEE ---------------------- 15.00 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 33.00 Plan Check Fee 8.25 Issue Date Valuation . . . . 0 Expiration Date 2/15/06 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00 ---------------------------------------------------------------------------- 9.0000 EA MECH B/C <=3HP/100K BTU 9.00 Permit . . . PLUMBING Additional desc . Permit Fee . . . . 61.50 Plan Check Fee 15.38 LQPERMIT Application Number . . . . . 05-00003254 Permit . . . . . . PLUMBING Issue Date . . . . Valuation . . . . 0 Expiration Date . . 2/15/06 Qty Unit Charge Per Extension BASE FEE 15.00 5.00 6.0000 EA PLB FIXTURE 30.00 1.00 7.5000 EA PLB WATER HEATER/VENT 7.50 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 2.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 6.00 ---------------------------------------------------------------------------- Special Notes and Comments casita addition 774 sq. ft. August 19, 2005 11:45:25 AM jjohnson ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ENERGY REVIEW FEE 24.83 Fee summary Charged Permit Fee Total 533.59 Plan Check Total 282.45 Other Fee Total .24.83 Grand Total 840.87 LQPERN1IT Paid Credited Due .00 .00 533.59 .00 .00 282.45 .00 .00 24.83 .00 .00 840.87 SAM City of .La Quilita . Building U Safety. Division Permic # P.O. Box 1504, 78-4 95 Calle Tampico -71 l La Quinta, CA 922S3 - (760) 777-7012 Building Permit Application and Tracking Sheet Project Address:4 ONvner's Name: � AG�� j�t�arR, A. P. Number: 6 - 3� _ Address: r scription: 0 3 '"4 Z /q % City, ST, Zip:or:W 7/H 1`` A Ur Telephone: 7f -(go �el6c �!( �Gp �t .E DProject Description: , zip: LA!�lrf�t-fi�.See- A7 /9 C -7e rStatc phone: : Constu #(Occupan 6tion Type: c} �Project type �caretcone • New AAItc Alter Repair c D cmo Ltc `Z`T.. # Joits:Stories:meoCContact Personrem Al,&Jer - Sq. Ft.: Telephone # of Contact Person: 7�0 - 4186� 44590 Estimated Value of Project: �6 APPLICANT: DO NOT WRITE. BELOW THIS UNE "Illy tl Submittal Req'd Rec'd TRACKING PER�IiT VETS ZPlan Sets ocss'a� Plan Check submitted Item Amount Structural Calcs. Reviewed, ready or corrections �( Plan Check Deposit Truss Calcs. Called Contact Pe Plan Check Balance It 24 Cates.. Plans picked'up t I Construction Flood plain plan SI Plans resubmitted ALeehanical Grading.plan 2" Review, ready or correctionsf sue Electrical Subcontactor List - Called Contact Pers I:lutnbing Grant Deed Q Plans picked up TJ S:hI.L H.O.A. Approval Plans.resubmitted Grading IN HOUSE:- '"' Review eadc for correctioIssuet Developer Impact Fee Planning Approval Called Contact Person �� i� A.LP.P. Pub. Wks. Appr Date of permit issue �. School Fees 7•otal Permit Fees e ! l o 'zi�4 f4p pCoif-0