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04-6173 (SFD)4 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: 6/03/05 Application Number: 04-00006173 Owner: Property Address: 81570 CARBONERAS CORAL OPTION I APN: 764-200-006-25 -316811- 79285 RANCHO LA QUINTA DR Application description: DWELLING - SINGLE FAMILY DETACHED LA QUINTA, CA 92253 Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 271596 4 A Contractor: Applicant: �rc`hitect or Engin/e�er� PPO. KBOX01716UCTI INC 0 S 205 )�i�J LA QUINTA, CA 9224 C917 S (760) 771-1941 Iy,QVINTA Lic. No.: 674074 Cli�roF EOEpT' • FINANC LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisio 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 Professionals Cod nd my Li ense is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License CI ss: L' se No.: 674 74 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. /DatO. A `r 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 -BUILDER 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 00003482004 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 to become subject to the 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 should become subject to the workers' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3;60 of the Labor Code, I sh thwith c p1 with t e provisions. 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).: et2.' �1 O plicant: 1 _ 1 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 Professions Code: The WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, ND 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 HUNDR 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.). APPLICANT ACKNOWLEDGEMENT (_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application, (_ 1 I am exempt under Sec. , B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City 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: tom' Lender's Address: Inc LQPERMIT 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 t. I agree to comply with all city and county ordinances and state laws relatingL19 wilding construction d hereb authorize representatives of this cc ty to mer upon the above-me6Ant): grope for inspec ' purposes. D Q �' ure (Applicant 0 LQPERMIT Application Number . . . . . 04-00006173 I Structure Information Construction Type . . . . . TYPE V - NON RATED Occupancy Type . . . . . . DWELLG/LODGING/CONG <=10 F1ood.Zone FLOOD ZONE AO Other struct info . . . . . CODE EDITION 2001 CBC # BEDROOMS 3.00 FIRE SPRINKLERS NO GARAGE SQ FTG 785.00 PATIO SQ FTG 686.00 NUMBER OF UNITS 1.0.0 . ---------------------------------------------------------------------------- 1ST FLOOR SQUARE FOOTAGE 3058.00 Permit . . . BUILDING PERMIT Additional desc Permit Fee . . . . 1241.-50 Plan Check Fee 806.98 Issue Date . . . . Valuation . . . 27.1596 Expiration Date 6/03/05 Qty Unit Charge Per Extension BASE FEE 639.50 172.00 ---------------------------------------------------------------------------- 3.5000 THOU BLDG 100,001-500,000 602.00 Permit . . . MECHANICAL Additional desc . Permit Fee . . . 83.50 Plan Check Fee 20.88 Issue Date . . . . Valuation . . 0 Expiration Date 6/03/05 Qty Unit Charge Per Extension BASE FEE 15.00 2.00 9.0000 EA MECH FURNACE <=100K 18.00 2.00 9.0000 EA MECH B/C <=3HP/100K BTU 18.00 4.00 6.5000 EA MECH VENT FAN 26.00 1.00 ---------------------------------------------------------------------------- 6.5000 EA MECH EXHAUST HOOD 6.50 Permit . . . ELEC-NEW RESIDENTIAL Additional desc . Permit Fee . . . . 137.7.3 Plan Check Fee 34.78 Issue Date . . . . Valuation . . . . 0 Expiration Date 6/03/05 Qty Unit Charge Per Extension BASE FEE 15.00 3058.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 107.03 I Application Number . . . . . 04-00006173 Permit . . . . . . ELEC-NEW RESIDENTIAL Qty Unit Charge Per Extension 785.00 .0200 ----------------------------------------------------------- ELEC GARAGE OR NON-RESIDENTIAL ---------------- 15.70 Permit -.PLUMBING Additional desc . .Permit Fee . . . . 166.50 Plan Check Fee 41.63 Issue Date . . . . Valuation . . . . 0 Expiration Date 6/03/05 Qty Unit Charge Per Extension BASE FEE 15.00 16.00 6.0000 EA PLB FIXTURE 96.00 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 8.00 .7500 EA PLB GAS PIPE >=5 6.00 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 . . 6/03/05 Qty Unit Charge Per Extension BASE FEE 15.00 ---------------------------------------------------------------------------- Special Notes and Comments SFD - LOT 25, PLAN 2B, 3058 S.F. PERMIT DOES NOT INCLUDE POOL, SPA, BLOCK WALLS OR DRIVEWAY APPROACH ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ART IN PUBLIC PLACES -RES 188.67 DIF COMMUNITY CENTERS -RES 97.00 DIF CIVIC CENTER - RES 366.00 ENERGY REVIEW FEE 80.70 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 27.54 DIF STREET MAINT FAC -RES 15.00 y LQPERMIT Application Number . . . . . 04-00006173 --------------------------------------------- Other-Fees . . . . . . . . . ------------------------------ DIF TRANSPORTATION•- RES 1098.00 Fee summary ----'------------- Charged Paid Credited Due Permit Fee Total ---------- 1644.23 ---------- .00 -------------------- .00 1644.23 Plan Check Total 904.27 750.00 .00 154.27 Other Fee Total 2701.91 .00 .00 2701.91. Grand Total 5250.41 750.00 .00 4500.41 MA LQPERMIT 1