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05-2960 (SFD)-44 P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 12/06/05 Application Number: 05-00002960 Owner: Property Address: 78233 BIRKDALE CT JEROME SOBA APN: 770-280-025- - - Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 458069 Contractor: Applicant: Architect or Engineer: SOBA CONSTRUCTION CO, JEROM 7026 KOLL CNTR PRKWY, #211FrrY 8 2005 PLEASANTON, CA 94566 (925)426-3000 LiC. No.: OOR SQUARE FOOT Lic. No.: 466537 LAQUINTA FINANCE DEPT. ------------------------------------------------------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that Iam lice d under revisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business and Pro ssionals de, and giy License is in full force and effect. _ I have and will maintain a certificate of consent to self-insure for workers' compensation, as provided License Class: B L' ense N 466537 fore Section 3700 of the Labor Code, for the performance of the work for which this permit is %% issued. Date: i�^� Contractor: _ _ 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-BUILD R DECLARATION insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier STATE FUND Policy Number 0012912-2005 ' 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 toZbecosubjec to th 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 e ed to hew rs' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I s ith mpl h those provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by Q� - ' - -- f ` ��---- any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).: r Date: �� / ��S-Applicant: (_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the wnrk, 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 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.). (_ 1 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.). 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 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 to enter upon the above-mentioned property for, inspection purposes. r Date: -Signature (Applicant or AgenO: -- r-0; �LQPERMIT Application Number . . . . . 05-00002960 Permit . . . BUILDING PERMIT Additional desc •. . Permit Fee . . . . 1896.00 Plan Check Fee 1232.40 Issue Date . . . . Valuation . . . . 458069 Expiration Date . . 6/04/06 Qty Unit Charge Per Extension BASE FEE 639.50 359.00 ---------------------------------------------------------------------------- 3.5000 THOU BLDG 100,001-500,000 1256.50 Permit . . . ELEC-NEW RESIDENTIAL Additional desc . Permit Fee . . . . 233.13 Plan Check Fee 58.28 Issue Date . . . . Valuation •0 Expiration Date 6/04/06 Qty Unit Charge Per Extension BASE FEE 15.00 5358.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 187.53 780.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 15.60 1.00 15.0000 ---------------------------------------------------------------------------- EA ELEC TEMPORARY POWER POLE 15.00 Permit . . . GRADING PERMIT Additional desc . . Permit Fee . . . . 15.00 Plan Check Fee .00 Issue Date Valuation . . . . 0 Expiration Date 6/04/06 Qty Unit Charge Per Extension ---------------------------------------------------------------------------- BASE FEE 15.00 Permit MECHANICAL Additional desc '. Permit Fee . . . . 150.50 Plan Check Fee 37.63 Issue Date . . . . Valuation 0 Expiration Date 6/04/06 Qty Unit Charge Per Extension BASE FEE 15.00 - 5.00 9.0000 EA - *MECH FURNACE <=100K 45.00 5.00 9.0000 EA MECH B/C <=3HP/100K BTU 45.00 6.00 6.5000 EA MECH VENT FAN 39.00 1.00 ---------------------------------------------------------------------------- 6.5000 EA MECH EXHAUST HOOD 6.50 0 LQPERMIT Application Number . . . . . 05-00002960 Permit . . . PLUMBING Additional desc . Permit Fee 205.50 Plan Check Fee 51.38 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 6/04/06 Qty Unit Charge Per Extension BASE FEE 15.00 21.00 6.0000 EA PLB FIXTURE 126.00 1.00 15.0000 EA PLB BUILDING SEWER 15.00 2.00 7.5000 EA PLB WATER HEATER/VENT 15.00 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 1.00 9.0000 EA PLB LAWN SPRINKLER SYSTEM 9.00 10.00 .7500 EA PLB GAS PIPE >=5 7.50 1.00 15.0000 EA PLB GAS METER 15.00 -------------_--------------------------------------------------------------- Special Notes and Comments SFD 3538 SQ.FT. LIVING R-3 OCC. TYPE VN CONSTRUCTION. 2001 CODES.**PERMIT DOES NOT INCLUDE BLOCK WALLS, FENCES, SWIMMING POOLS, SPA, WATER FEATURES and BBQ'S** NOTE:COMPLIANCE WITH ALL FEDERAL & STATE LAWS, INCLUDING THE ENDANGERED SPECIES ACT OF 1973 IF APPLICABLE,IS REQUIRED. --------------------------=------------------------------------------------- Other Fees . . . . . . . . . ART IN PUBLIC PLACES -RES 645.17 DIF COMMUNITY CENTERS -RES 97.00 DIF CIVIC CENTER - RES 366.00 ENERGY REVIEW FEE 123.24 DIF FIRE PROTECTION -RES 97.00 DIF LIBRARIES - RES 225.00 DIF PARK MAINT FAC - RES 5.00 DIF PARKS/REC - RES 502.00 STRONG MOTION (SMI) -.RES 45.80 DIF STREET MAINT FAC -RES 15.00. DIF TRANSPORTATION - RES, 1098.00 Fee summary ----------------- Permit Fee Total Plan Check Total Other Fee Total Grand Total Charged Paid' 2500.13 .00 1379.69 500.00 321,9.21 .00 7099.03 500.00 Credited Due J .00 2500.13 .00 879.69 .00 3219.21 .00 6599.03 Building ' Address Owner C&4 4 4 a" P.O. BOX 1504 ,y Z 3 fJl iW,t� 78-495 CALLE TAMPICO b — , . LA OUINTA, CALIFORNIA 92253 Mailing eW,i,A4 State Lia 41D -5"3 7 8 City & Classif.Lic. # Arch., Engr., Designer a4x I/g� Addressel. S,4s_ c'� 7ZJ /71(?O! C�p Zip State itNPL) t 4 �C i �i" Lic. # a 2Z LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that he 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). O 1, 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 Profes- sions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or im- provement is sold within one year of completion, the owner -builder will have the burden of proving that he 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 Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law) ❑ 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKER'S COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company O Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less). 1 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 Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT.' If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. 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 city to enter the above-mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip WHITE = BUILDING DEPARTMENT APPLICATION ONLY BUILDING: TYPE �CONST.P. �� OCC. GR A.P. Number �L7o Legal Description Project Description ��L �C'�� t Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. _ Q� Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL 1711 REMARKS 11 2005 r ra.�ur ZONE: BY: Girt OF LA Minimum Setback Distances: FINANCE Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Validated by: Validation: Date Permit YELLOW = APPLICANT PINK = FINANCE CERTIFICATE OF COMPLIANCE Q�N�Fs�,o Desert Sands Unified School District y 47950 Dune Palms Road _< BERMUDA DUNES 0 COC RANCHO MIRAGE Date 11/2/05 La Quinta, CA 92253 �- INDIAN WELLS LMDESERT No. 27838 (760) 771-8515 d� P LA QUINTA 11�1O INDIO Owner Jerome A. Soba Construction Co. APN # 770-280-025 Address 7026 Koll Center Parkway, Suite 211 Jurisdiction La Quinta City Pleasanton Zip Permit # Tract # 28611 Study Area Type Single Family Residence No. of Units 1 Lot # No. Street S.F. Unit 1 .26 78233 Birkdale Court 5358 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments Lot # No. Street S.F. At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, residential additions under 5 00 square feet, detached awry structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile ho mes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $2.24 X 5,358 S.F. or $12,001.92 have been paid for the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued. Fees Paid By C/C-Diablo Valley Bank, Richard Herrera check No. 005237 Name on the check Telephone Funding Residential By Dr. Doris Wilson Superintendent . Fee collected /exLted Patr- is Barbuzza Payment Recd .` $0.00$12,001.92over/Unde%,Signature NOTICE: Pursuant to Government Code Section (d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees o r other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District(s) behalf, whichever is earlier. NOTICE: This Document NOT VALID if Duplicated Embossed Original -Building Department/Applicant Copy -Applicant/Receipt Copy -Accounting