04-5599 (SFD)1;�_-
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number . .
Property Address . . .
APN:
Application description
Property Zoning . . . .
Application valuation .
Owner
POWER FINANCE
P.O. BOX 1573
LA QUINTA Vr,� 922r
04-00005599 ,`Date 11/18/04
78625 BOTTLE BRUSH DR --
646-312-012-62 -000000-
DWELLING — SINGLE FAMILY DETACHED
MEDIUM DENSITY RES
113084
Contractor
--------------------------
ADDINGTON, DAVID
4zJJ760 HERMITAGE DRIVE
DIO CA 92201
U
"JANO 2005 Tn�CNCSTATE
0:
FUND
2290019787
01/01/05
QUINTACS�LB:
682901
12/31/05
FINANCE DEPT. COC
: B
------ Structure Information
1085 SQ. FT. SFD
-----
Construction Type . .
. . . TYPE V - NON RATED
Occupancy Type . . .
. . . DWELLG/LODGING/LONG <=10
Flood Zone . . . . .
. . . NON -AO FLOOD ZONE
Other struct info . .
. . . CODE EDITION 2001 CBC
# BEDROOMS
3.00
FIRE SPRINKLERS NO
GARAGE SQ FTG
470.00
PATIO SQ FTG
.47.00
NUMBER -OF UNITS
1.00
FIRST FLOOR SQ FTG
1805.00
----------------------------=-----------------------------------------------
Permit . . . . . .
BUILDING PERMIT
Additional desc
Permit Fee . . . .
688.50 Plan Check Fee
447.53
Issue Date
Valuation . . . .
113084
Expiration Date
5/18/05
Qty Unit Charge
Per
Extension
BASE FEE
639.50
14.00 3.5000
THOU BLDG 100,001=500,000
49.00
----------------------------------------------------------------------------
Permit . . . . . .
ELEC-NEW RESIDENTIAL
Additional desc . .
Permit Fee . . . .
102.58 Plan Check Fee
25.65
Issue Date . . . .
Valuation . . . .
0
Expiration Date
5/18/05
Qty Unit Charge
Per
Extension
BASE FEE-
15.00
1805.00 .0350
ELEC.NEW RES - 1 OR 2 FAMILY
63.18
t
r0 Ilk-
P.O.
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: U44 ,599 Date:
Applicant:
Applicant's Mailing Address:
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 License . . full force and effect.
License Classy FS License No. L O
/Date Co 0 Contractor
OWNER -BUILDER DECLARATION
1 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).):
(_,) 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.).
(_) 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:
,1 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
5 is ed. My ers' corr�ensation insurance carrier an policy numb rare A
�CarAer 'Ww.c�, !_Policy Number Ci O f� '7 % TJ 7
_ 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 workers'
compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
bate 4 Applicant
t
WARNING: FAILURE TO SECURE WORK S' COMPENSA119COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL 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.
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 Ouinta, 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'nspection purposes.
r6ate7 I & U Signature (Applicant or Agent):
t
Application Number
. . . . . 04-00005599
Page 2
Date 11/18/04
Qty
Unit Charge
Per
Extension
470.00
.0200
ELEC GARAGE OR NON-RESIDENTIAL
9.40
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
5/18/05
Qty
Unit Charge
Per
Extension
BASE FEE
15.00
---=------------------------------------------------------------------------
Permit .
. . . . .
MECHANICAL
Additional
desc
Permit Fee
. . . .
65.50 Plan Check Fee
16.38
Issue Date
Valuation
0
Expiration
Date
5/18/05
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
4.00
6.5000
EA MECH VENT FAN
26.00
1.00
6.5000
EA . MECH EXHAUST HOOD
6.50
----------------------------------------------------------------------------
Permit .
. . . . .
PLUMBING
Additional
desc
Permit Fee,
135.00 Plan Check Fee
33.75
Issue Date
. . . .
Valuation'
0
Expiration
Date
5/18/05
Qty Unit Charge
Per
Extension
BASE FEE
15.00
11.00
6.0000
EA- PLB FIXTURE
66.00
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.
6.00
.7500
EA PLB GAS PIPE >=5
4.50'
1.00
15.0000
EA PLB GAS METER
15.00
--------------------------------------------=-------------------------------
Special Notes and Comments
1805 SQ. FT. SFD. THIS PERMIT DOES NOT
.INCLUDE POOL & SPA, BLOCK WALLS AND
S
4
Fee summary
-----------------
Permit Fee Total
Plan Check Total
Other Fee Total
Grand Total
Charged Paid
1006.58' .00
523.31 250.00
2561.05 .00
4090.94 250.00
Credited Due
.00
Page
3
Application Number . . . .
. 04-00005599 Date
11/18/04
------------------------------------------=---------------------------------
Special Notes and Comments -
3840.94
DRIVEWAY APPROACH.
----------------------------------------------------------------------------
Other Fees . . . . . .
. ART IN PUBLIC PLACES -RES
.00
DIF COMMUNITY CENTERS -RES
97.00
DIF.CIVIC CENTER - RES
366.00
ENERGY REVIEW FEE
44.75
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
COVE PRECISE PLAN FEE
100.00
STRONG MOTION (SMI) - RES
11.30
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
1006.58' .00
523.31 250.00
2561.05 .00
4090.94 250.00
Credited Due
.00
1006.58
.00
273.31
.00
2561.05
.00
3840.94
Ti44
PO. BOX 04
Building 78-495 CALL
ICO
Address LA QUINTA, C O
'
RNIA92253
Owner t) r A
mailing -
Address P�
7
Address
& Classif. I Lic. #
tngr.,
Designer
Designer WY �
Address Tel.
City Zip State
6'2Z5_3 Lic. #
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 rive hundred dollars ($500).
O 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 Profes-
sions Code: The Contractor's License Law does not apply to an owner of property who builds
ort mproves 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 or sale).
O 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 or property who builds or improves thereon, and who contracts for such
projects with a contractor(s) licensed pursuant to the Contractor's License Law)
O 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKER'S COMPENSATION DECLARATION
I 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. O 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).
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 Workers' Compensation Laws of
California.
Date Owner
NOTICE TO APPLICANT.' It, 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
n c�--
It A-'
0Z/-SSq%
APPLICATION ONLY
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number ��L 3CZ_—CAL
Legal Description Lot -4 G2 0 C. M -i ` t t
Project Description
Sq. Ft. `
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
` AMOUNBO
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
1111
EL ITY I.A UINT
FI DICE DEPT.
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE_
Issued by:
Validated by:—
Validation:
YELLOW = APPLICANT
INSPECTOR
Date Permit
PINK = FINANCE
Tract # Study Area
Type Single Family Residence No. of Units 1
Lot # No. Street
Unit 1 78625 Bottle Brush
Unit 2
Unit 3
Unit 4
Unit 5
S.F. Lot # No.
1805 Unit 6
Unit 7
Unit 8
Unit 9
Unit 10
Street S.F.
Comments Overpayment of $253.12 issued as refund & to be mailed to Power Finance address above.
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 accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile ho
ales. it has been determined that the above-named owner is exempt from paying school fees at the 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 1,805 S.F. or $4,043.20 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 CCNalley Independent Bank -Amanda Velez Check No. 319831
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempte y Sha n McGilvrey • Payment Recd 253.12
32 Over/Under
L
Signature
NOTICE: Pursuant to Government Code Section 66020(d)(1), tht 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
arose amounts are paid to the District(s) or to another public entity authorized to collect them on the DtstrWs) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated h
Embossed Original -Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting ,0 "
\O
C1 Tasting englnears - U.S. Labs I 1 'resting Engineers - Inland Empire k'Testing Engineers - Palm Springs
N 7895 Convoy Court, Suite 18 41146 Elm Street, Suits A 820 Resoaroh Drive, Suite 2
San Diego, CalNomis 02111 Murrlota, California 92562 Palm Springs, California 92262
Phcna:(858)715-5800 Phone=(951)677-0366 Phone=(760)325-8378
Fax: (866) 715-5810 Fax. (951) 677.6761 Fax; (760) 325.7480
NUCLEAR FIELD VENSIT'Y TEST SHEET
Project Natna; –7L,iT
Contract No,, r Pt,ge —of —.
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