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05-4136 (SFD)_10 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description Property Zoning: Application valuation: \ Applicant: U05-00004136 1 46662'BRADSHAW TR 643-170-999-62 -31348 - DWELLING - SINGLE FAMILY LOW DENSITY RESIDENTIAL 173868 Tav1440" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT OOwner: Q PH RANCH LLC 70 HIGHWAY 111 STE 200 DETACHED �'C� LA TA, CA 92253 Cnr^_ 1 1pOS rchitect or Engineer: C . �J -1-1 0 ----------------- 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 is in full force and effect. License Class: B LicenseNo.: 482086 Date: Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 Contractor's 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).: 1—) 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 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.). ( �) 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 ark exempt ynder Sec. , B.&P.C. for this reason 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: MM Lender's Address: A LQPERMIT � vEH NE COMPANY 5 75 MEDALLIST DR QUINTA, CA 92253 (760)771-8130 Lic. No.: 482086 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 ------------------ WORKER'S COMPENSATION DECLARATION Date: 9/15/05 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 STATE FUND Policy Number 1814972 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 su¢j�ect to the workers' compensation provisions of Section 3g09 Df the I �g^^+= I�h Ilf&tftJyi'th,comply with those provisions. 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 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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 an county - dinances and state laws relating to building construction nd hereby authorize representatives of this ounty to t upon th ove.mentioned pn 11 p yoses. ature (Applicant or Agent): Application Number . . . . . 05-00004136 ------ Structure Information. 2800 SQ.FT. SFD MODE- B-1 ----- Construction Type . . . . . TYPE V - NON RATED Occupancy Type . . . . . . DWELLG/LODGING/CONG <=10 Flood Zone . . . . . NON -AO FLOOD ZONE Other struc_t info . . . . . CODE EDITION 2001 CBC # BEDROOMS 3.00 FIRE SPRINKLERS NO GARAGE SQ FTG 504.00 PATIO SQ FTG 288.00 NUMBER OF UNITS 1.00 ---------------------------------------------------------------------------- -1ST FLOOR SQUARE FOOTAGE 2800.00 Permit . . . BUILDING PERMIT Additional desc . Permit Fee . . . . 898.50 Plan Check Fee 146.01 Issue Date Valuation . . . . 173868 Expiration Date 3/14/06 Qty Unit Charge Per Extension BASE FEE 639.50 74.00 3.5000 --------------------------------------------------- THOU BLDG 100,001-500,000 ------------------------- 259.00 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 101.50 Plan Check Fee 6.35 Issue Date . . . . Valuation . . . . 0 Expiration Date 3/14/06 Qty Unit Charge Per Extension BASE FEE :15.00 3.00 9.0000 EA. MECH FURNACE <=100K 27.00 3.00 9.0000 EA MECH B/C <=3HP/100K BTU 27.00 4.00 6.50,00 EA MECH VENT FAN .26.00 1.00 6.5000 ---------------------------------------------------------------------------- EA MECH EXHAUST HOOD 6.50 Permit Additional desc . Permit Fee . . . . Issue Date . . . . Expiration Date . Qty Unit Charge 2800.00 .0350 LQPERMIT ELEC-NEW RESIDENTIAL 138.08 Plan Check Fee Valuation 3/14/06 Per BASE FEE ELEC NEW RES - 1 OR 2 FAMILY 8.63 0 Extension 15.00 98.00 Application Number . . . 05-00004136 Permit . . . . . . ELEC-NEW RESIDENTIAL Qty Unit Charge Per Extension 504.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 10.08 1.00 15.0000 ---------------------------------------------------------------------------- EA ELEC TEMPORARY POWER POLE 15.00 Permit . . . PLUMBING Additional desc . Permit Fee . . . . 174.75 Plan Check Fee 11.44 Issue Date . . . . Valuation . . . . 0 Expiration Date 3/14/06 Qty Unit Charge Per Extension BASE FEE 15.00 17.00 6.0000 EA PLB FIXTURE 102.00 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 .00 3.0000 EA PLB GAS PIPE 1=4 OUTLETS .00 11.00 .7500 EA PLB GAS PIPE >=5 8.25 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 Expiration Date 3/14/06 r Qty Unit Charge Per Extension .BASE FEE 15.00 ---------------------------------------------------------------------------- Special Notes and Comments SFD - LOT ,6f PLAN B1, 2800 SF. PERMIT DOES NOT INCLUDE BLOCK WALL , POOL,SPA OR DRIVE WAY APPROACH.75% REDUCTION TO PLAN CHECK FEE DUE TO MULTIPLE ISSUANCE OF SAME PLAN TYPE ---------------------------------------------------------------------------- Other Fees . . . . . . . ART IN PUBLIC PLACES -RES .00 DIF COMMUNITY CENTERS -RES 97.00 DIF CIVIC CENTER'- RES 366.00 ENERGY REVIEW FEE 14.60 DIF FIRE.PROTECTION-RES 97.00 GRADING PLAN CHECK FEE .00 DIF LIBRARIES - RES 225.00 LQPERMIT -• A.4 LQPERMTT Application Number . . . . . 05-00004136 ---------------------------------------------------------------------------- Other Fees . . . . . . . DIF PARK MAINT FAC - RES 5.00 DIF PARKS/REC - RES 502.00 STRONG MOTION (SMI) - RES 17.38 DIF STREET MAINT FAC -RES 15.00 DIF TRANSPORTATION - RES 1098.00 Fee summary Charged Paid Credited Due Permit Fee Total 1327.83 .00 .00 1327.83 Plan Check Total 172.43 .00 .00 172.43 Other Fee Total 2436.98 .00 .00 2436.98 Grand Total 3937.24 .00 .00 3937.24