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04-7119 (SFD)t. i T4hf 4 4auiKYa P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760),777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 Application Number . . . . .04-00007119 Property Address . . . . . . 57605 BALLYBUNION APN: 762-330-014- - - Application description . . . DWELLING - SINGLE FAMILY Property Zoning LOW DENSITY RESIDENTIAL Application valuation . . . . 316193 Owner ------------------------ Contractor Date 11/08/04 DETACHED SOUTHERN HILLS DEVELOPMENT SOUTHERN HILLS DEVELOPMENT INC 55161 SOUTHERN HILLS 81070 CHANTICLEER DR LA QUINTA CA 92253 LA QUINTA CA 92253 (760) 771 -3497 - WCC: EXEMPT WC: EXEMPT 05/31/05 CSLB: 838041 05/31/06 CCC: B . -------------------------- Structure Information ------------------------- Construction Type . . . . . TYPE V - NON RATED Occupancy Type .. . . . . DWELLG/LODGING/LONG <=10 Flood Zone- __--.-�. NON -A0. FLOOD ZONE Other struct info CODE EDITION 2001 CBC FIRE SPRINKLERS NO GARAGE SQ FTG 970.00 PATIO SQ FTG 996.00 NUMBER OF UNITS 1.00 --------------.--------------------------------------------------------°------ _ FIRST FLOOR SQ.FTG 3512.00 Permit . . . . BUILDING PERMIT Additional desc Permit Fee 1 1399.00 Plan Check Fee 909.35 Issue Date . . . . Valuation . . . . 316193 Qty Unit Charge Per Extension BASE FEE 639.50 217.00 3.5000 THOU BLDG 100,001-500,000 759.50 ------------------------------------------------------------ Permit . . . . . . MECHANICAL --------------- Additional desc Permit Fee . . . . 132.50 Plan Check Fee 33.13 Issue Date Valuation . . . . 0 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 6.00 6.5000 EA MECH VENT FAN 39.00 1.00 6.5.000 EA MECH EXHAUST HOOD 6.50 .,` P.O. Box 1504 • 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: 04- 11 1 q Date: /1- %a'G4 Applicant: Applicant's Mailing Address: ArdhitecMor En inqe���� Architect or Engineer's Address: ic. No.: 14':�> 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 Licep�e is in full force and effect. �nse Class _� A icense No. ��O V`C • r OWNER43UILDER 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 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: 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' comInnsation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensatioV { surance carrier and policy number are: Carrier licy Number _ ertify that, in the performance fiisi=7 work rc this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Californa that ' u d me subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those pr WARNING: FAILURE TO SECURE WORKEP C 1C PMSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOU Nl OLLARS ($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 S fety for permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, an 'A erson 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 appl' nt, 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 relat to the work being erfo Ilowing issuance of this permit. 2. Any permit issued as a result of this application becomes n I and void i is mmenced within days from date of issuance of such permit, or cessation of work for 180 days will subject permit to can tion. I certify that I have read this application and state that the above info ation orrect. a to comply with all city nd county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to er upo th o entioned property for ins ection purposes. ate�'��T Signlure (A pplicant or Agent): -1 Page 2 Application Number 04-00007119 Date 11/08/04 ------------------------------------------------------ Permit . . . . . . --------------------- ELEC-NEW RESIDENTIAL Additional desc . . Permit Fee . . . . 157.84 Plan.Check Fee 39.46 Issue Date Valuation 0 Qty Unit Charge Per Extension BASE FEE 15.00 3512.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 122.92 996.00 ..0200 ELEC.GARAGE OR NON-RESIDENTIAL 19.92 ---------------------------------------------------------------------------- Permit. . . . . . . PLUMBING Additional desc Permit Fee . . . . 191.25 Plan Check Fee 47.06 Issue Date . . . . Valuation 0 Qty Unit Charge Per Extension BASE FEE 15.00 20.00 6.0000 EA PLB FIXTURE 120.00 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 3.0.0 . 1.00 9.0000 EA PLB LAWN SPRINKLER SYSTEM 9.00 9.00 .7500 EA PLB GAS PIPE >=5 6.75 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 Qty Unit Charge Per Extension BASE FEE 15.00 . ---------------------------------------------------------------------------- Special Notes and Comments SFD - LOT 42, PLAN 6 3512 SF. PERMIT DOES NOT INCLUDE BLOCK WALLS, POOL, SPA OR DRIVEWAY APPROACH ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ART IN PUBLIC PLACES -RES 290.48 DIF COMMUNITY CENTERS -RES 97.00 DIF CIVIC CENTER - RES 366.00 ENERGY REVIEW FEE 90.94 DIF FIRE PROTECTION -RES 97.00 GRADING PLAN CHECK FEE 00 DIF LIBRARIES - RES 225.00 Page 3 Application Number . . . . . 04-00007119 Date 11/08/04 --------------------------------------------=------------------------------- Other Fees . . . . . . . . . DIF PARK MAINT FAC - RES 5.00 DIF PARKS/REC - RES 502.00 STRONG MOTION (SMI) - RES 31.61 DIF STREET MAINT FAC -RES 15.00 DIF TRANSPORTATION -.RES 1098.00 Fee summary ----------------- •Charged ---------- Paid Credited Due Permit Fee Total 1895.59 -------------------- .00 ---------- .00 1895.59 Plan Check Total 1029.00 .00 .00 1029.00 Other Fee Total 2818.03 .00 .00 2818.03 Grand Total 5742.62 .00 .00 5742.62 CITY OF LA QUINTA SUB -CONTRACTOR LI T I JOB ADDRESS PERMIT NUMB ' 'ER OWNER) �`�1c` �- BUILDER t This form shall be costed on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work tki� inh nnv r.hnnnPs to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance it in permit. For each applicable trade, all information requested below must be completed by applicant. n File" is not an accep a eresponse. of bud P 9 P ............. . ..::::::::::.......:..... .Bus, . , ... _ ......... .. ,._...... _ . _ _.... .. _ ,.,__�____..,_.u.__�....�.,.r...�..�...�.,..e _ _ .. __City _ Hess c . Name -s) B,c L'censeNu ber 1x xxxx) ExP- Date 1xx xx/xx) Carrier NameComPanY 1e.9. Cal omP!1e.9.A Policy NumberClassification at Varies) Exp.. Date xx/xx/xx1StateFund License Number xxxx1 Exp. 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