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04-6516 (SFD)015 N !,�QUWC41J. 1�n hNIABUILDING &SAFETY DEPARTMENT P.O. B6x 50.yofi��(760)' 777-.7012 �tpg 9 �IAI� qN-;P718,4 J� LLE TAMPIC.O FAX (760) 777-701'1: A,U NTA, CALIFORNIA 92253 INSPECTION REQUESTS (760).777.-7153: BUILDING PERMIT Application Number 04ti00006516� Date 10/16/04 Property .Address X7,8656 BOTTLE'BRUSH' DR APN-: 646--311-035-35- -000000- Application description DWELLING-- SINGLE FAMILY. DETACHED Property. Zoning MEDIUM.DENSITY RES Application -valuation 118710 Owner Contractor PACIFIC HOMES. IN CALIFORNIA OWNER P..0. BOX.. 1023 LA QUINTA CA 92253 ---- Structure Information SINGLE.FAMILY,DWELLING•' : ----- -Construction. Type .:. TYPE.. V- -.N0 N.,RATED Occupancy Type.. DWELLG/LODGING/CONG <=10 Flood Zone NON -AO :FLOOD .ZONE . Other stru.ct'info CODE EDITION ..2001 CBC #.BEDROOMS 00' FIRE SPRINKLERS. NO GARAGE SQ FTG 470.00.. PATIO SQ FTG47.00 NUMBER OF UNITS '- 1 .`0 0. FIRST 'FLOOR SQ FTG : 1805.00 Permit BUILDING PERMIT .Addi:t.i brig l..d.e s:c.; Permit Fee .706:00 -Pian Check Fee :. 458.90 Issue Date Valuation .118710 Qty` Unit Charge Per Extension BASE: FEE 639.'50 19.00 3.5000 THOU BLDG 100,001-5.00,00.0 66.50. -------------------.-------------------.-------------------------------------- Permit:. MECHANICAL Additional desc Permit Fee 65.50 Plan Check Fee 16.38 Issue Date Valuation 0 Qty Unit Charge,' Per Extension BASE 'FEE 15.00 1.00 9:000.0 EA MECR FURNACE <=100K 9.00 1.00 9..0000 EA MECH B/C <=3.HP/100K BTU ...9.00 4. 00. .6,.;:-500-0 EA ME.CH VENT . FAN . 26.00 1:.00 '6.5000 EA MECH EXHAUST HOOD 6.50 Permit ELEC-NEW RESIDENTIAL Additional desc r P.O. Box 1504 WC4 VOICE(7-60) 777=791.2. 78-495 CALLS TAMePcoFAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (76.0)'777-71.53 BUILDING & SAFETY DEPARTMENT Application Number: O Al- 661(( Date: Applicant: Architect or Engineer:: Applicant's Mailing Address: 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 (comrnericing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class License No. Date Contractor OWNER -BUILDER DECLARATION I hereby affirm'under penalty of perjury that I am exempt from the Contractors`. State license Law th for e fobowing reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a pert, mft to construct alter, improve. demolish, or repair any sbtx tLw% 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).7 (, I. as owner of the property, or my employees with wages as their sole compensation, will do the work, and fie structure Is not intended or offered for -sole (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 tiumsetf or herself or through his or her own employees. provided tihat the improvements are not Intended or offered for sale. N, however, the buliding or improvement is sold within one year of completion, the owner -bolder will have the burden of proving -that he or she did not build or imprwe.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 properly who builds or Um Improves thereon. and who contracts for a projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). U 1 am exempt under Sec. " -.B.& P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION 1 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 forwhich this permit is issued. . _ 1 have and win maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which We permit Is Issued. My workers' compensation insurance carmen and policy number are: Carrier Policy Number _ I certiy:that, In the performance of the work "for which this: pemhit is issued, I shall not empty any person in arty. mw~so as to become subject to the workers' compensation laws of California: and agree that, if I should become subject lothheworkers'•.compensation provisions of Section 3700 of the Labor Code, l shag foNrwilh comply with those provisions. Date Applicant WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 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 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY 1 hereby affirm under penalty of perjury that there is a construction lending agency for the.perfomnance of the work for which this permit is issued (Seo. 3097, Civ. C.). Lender's Name Lenders 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.behaH 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, indemnity and' hold harmless the City of Lad]uinta, 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 nun and void lf work is riot commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to canceration. I certify that 1 have read this application and state that the above information is correct. I agree to comply with in city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above4nihfioned property for inspection purposes. Date Signature (Applicant or Agent): ;.r Page 2 Application Number . . . . . 04-00006516 Date 10/16/Q4 Permit Fee . . . . 102.58 Plan Check Fee . . 25.65 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE' FEE 15.00 1805.00 .0350 ELEC NEW.RES - 1 OR 2 FAMILY 63.18 470.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 9.40 1.00 15.0000 EA ELEC TEMPORARY POWER POLE 15.00 ---------------------------------------------------------------------------- Permit . . . . . . PLUMBING Additional desc Permit Fee . . . . 129.00 Plan Check Fee 32.25 Issue Date . . . . Valuation . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 10.00 6.0000 EA PLB FIXTURE 60.00 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 ------------------------------------------------'---------------------------- 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 1805 S.F.. SFD PERMIT DOES NOT INCLUDE BLOCK WALL, POOL/SPA OR DRIVEWAY APPROACH =----------------------------------------=------------ ------7 --------------- Other Fees . . . . . . . . . ART IN PUBLIC -PLACES -RES .00 DIF COMMUNITY CENTERS -RES 97.00 DIF CIVIC CENTER - RES 366.00 ENERGY REVIEW FEE 45.89 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 11.87 a Page 3 Application Number . . . . . 04-00006516 Date 10/16/04 ----------------------------------------------------------'------------------ Other Fees . . . . . . . . . DIF STREET MAINT FAC -RES 15.00 DIF TRANSPORTATION - RES 1098.00 Fee summary ----------------= Charged ---------- Paid ---------- Credited ---------- Due ---------- Permit Fee Total 1018.08 .00 .00 1018.08 Plan Check Total 533.18 250.00 .00 283.18 Other Fee Total 2462.76 .00 .00 2462.76 Grand Total 4014.02 250.00 .00 3764.02 o4- X5116 /� P.O. BOX 1504 APPLICATION ONLY Address Building7 9 ']>�//J, 90S / 78-495 CALLS CALIFORNIATAMPIO Addie �� V ��J(� (CK/ {� LA QUINTA, ORNIA 92253 LICENSED CONTRACTOR'S DECLARATION I hereby affir at License r revisions of Chapter 9 (commencing with Section 7000) of Diviessions Code, and my license is in full force and effect. SIGNATOR 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 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 mroves 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). ❑ 1, 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 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 ❑ 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). 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.. 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 Estimated Valuation PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback fromCent( Rear Setback rfrf om Rear,F 111% Side �tieet-Setback from Side Slack from�Prope FINAL DATE- Issued ATE Issued by: Date G,A Validated by: Validation: WHITE = BUILDING DEPARTMENT YELLOW = APPLICANT PINK = FINANCE AMOUNT BUILDING: TYPE CONST. OCC. GRP. A.P. Number 12t e /('�",+ Mailin Add ess , (®� Legal Description wL ✓�/acpq CW6 Project Description City Zi Tel. " Contractor aG o Address City Zip Tel. Sq. Ft.No. No. Dw. Size �� Stories Units State Lic. & Classif. `� �-5 -,7—A- 1 City Lic. # �� Arch., Engr., Designer Ne Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affir at License r revisions of Chapter 9 (commencing with Section 7000) of Diviessions Code, and my license is in full force and effect. SIGNATOR 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 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 mroves 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). ❑ 1, 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 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 ❑ 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). 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.. 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 Estimated Valuation PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback fromCent( Rear Setback rfrf om Rear,F 111% Side �tieet-Setback from Side Slack from�Prope FINAL DATE- Issued ATE Issued by: Date G,A Validated by: Validation: WHITE = BUILDING DEPARTMENT YELLOW = APPLICANT PINK = FINANCE AMOUNT Date 11/4/04 No. 26601 Owner Pacific Homes in Califomia Address City Zip CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune Palms Road La Quinta, CA 92253 (760) 771-8515 APN # ��FIF,pSC` O BERMUDA DUNES r Cr RANCHO MIRAGE INDIAN WELLS tt PALM DESERT LA QUINTA OINDIO 646-311-035 Jurisdiction La Quinta Permit # Tract # Study Area Type Single Family Residence No. of Units 1 Lot # No. Street S.F. Unit 1 78656 Bottle Bursh Dr 1805 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 garagestcarports, covered patios/walkways, 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 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 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 CC/1 st Bank - Dick Scott Check No. 73405 Name on the check Telephone Funding Residential By Dr. Doris Wilson Superintendent Fee collected /Aexempt ZSMcGilvrey Payment Recd 1$0.00 $4,043.20 Over/Under Signature c NOTICE: Pursuant to Government Code Section 66020(d)(1), this willZ!,, you that the 9G 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