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04-6543 (SFD)LOL 2004 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Xa - qo 4-44ull1t a9iy7- BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760).777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 Application Number . . . . 04-00006543 Date 12/01/04 Property Address . . . . . . 5-766-5—BALLYBUNION APN: 762-360-015- - - Application description DWELLING - SINGLE FAMILY DETACHED Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation ... .320430 Owner Contractor SOUTHERN HILLS DEVELOPMENT SOUTHERN HILLS DEVELOPMENT INC 55161 SOUTHERN HILLS 81070 CHANTICLEER DR LA QUINTA CA 92253 LA QUINTA 'CA 92253 (760) 771-3497 (760) 771-3497 WCC: EXEMPT WC: EXEMPT .05/31/05 CSLB: 838041 05/31/06 CCC: B ----=- Structure -Information 3578 SQ. FT. SFD ----- Construction Type . . . . . TYPE V - NON RATED Occupancy Type . . . . . . DWELLG/LODGING/CONG <=10 Flood Zone . . . . . . .. NON -AO FLOOD ZONE Other struct info CODE EDITION 2001 CBC # BEDROOMS 4.00 FIRE SPRINKLERS NO GARAGE SQ FTG 926.00 PATIO SQ FTG 970.00 NUMBER OF UNITS 1.00 1ST FLOOR SQUARE FOOTAGE 3578.00 ---------------------------------------------------------------------------- Permit . . . . . BUILDING PERMIT Additional desc Permit Fee . . . . 1413.00 Plan Check Fee 918.45 Issue Date . . . . Valuation . . . . 320430 Qty Unit Charge Per Extension BASE FEE 639.50 221.00 3.5000 THOU. BLDG 100,001-500,000 773.50 ---------------------------------------------------------------------------- Permit . . . . . ELEC-NEW RESIDENTIAL Additional desc Permit Fee . . 173.75 Plan Check Fee 43.44 Issue Date Valuation . . . . 0 Qty Unit Charge Per BASE FEE 3578.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 926.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 1.00 15.0000 EA ELEC TEMPORARY POWER POLE Extension 15.00 125.23 18.52 15.00 i k t I P.O. Box 1504 .4 • 78-495 CALLE TAMPICO T - LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's aling dress: VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 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 LiceQge is in full force and effect. _ }47— License Class I/ License No. i 3 Date" ,Z- 6F —Ao-- Contract _1 - OWNER -BUILDER DECLARATION I hereby affirm under penalty of p at 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 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 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 issued. My workers' compensation insurance carrier and policy number are: Carrier Policy Number 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, and agree that, if I should become sub'ect to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall forthwith comply with those pr i i ns. Date Z- Applican WARNING: FAILURE TO SECURE RKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUND 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, 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 construction, and hereby authorize representatives of this county t nter on the above -mention roperty for' spection purposes. z -J �Signature(ApplicantorAgentj`. t--~_-". 14' f' Page 2 Application Number . . . . . 04-00006543 Date 12/01/04 ---------------------------------------------------------------------------- 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 . . . . 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 6.5000 EA MECH EXHAUST HOOD 6.50 ---------------------------------------------------------------------------- •Permit . . . . . . PLUMBING Additional desc Permit Fee . . . . 191.25 Plan Check Fee 47.81 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 3.00 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 -------------------------------7-------------------------------------------- Special Notes and Comments 3578 sq. ft. SFD THIS PERMIT DOES NOT INCLUDE POOL & SPA BLOCK WALL OR DRIVEWAY APPROACH. 12/1/04 8:29:11 AM jjohnson ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ART IN PUBLIC PLACES -RES 301.07 DIF COMMUNITY CENTERS -RES 97.00 -DIF CIVIC.CENTER - RES 366.00 ENERGY REVIEW FEE 91.85 Page 3 Application Number . . . . . 04-00006543 Date 12/01/04 --------------------------------------------------------------------------'- Other Fees ... . . . . . . . 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 32.04 DIF STREET MAINT FAC-RES 15.00 DIF TRANSPORTATION - RES 1098.00 Fee summary ----------------- Charged ---------- ---------- Paid Credited Due Permit Fee Total 1925.50 -------------------- .00 .00 1925.50 Plan Check Total 1042.83 .00 .00 1042.83 Other Fee Total 2829.96 .00 .00 2829.96 Grand Total 5798.29 .00 .00 5798.29