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04-4277 (SFD)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number Property Address APN: Application description Property Zoning . . . . Application valuation . BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760).777-7012 ` FAX (760) 777-7011 INSPECTION .REQUESTS (760) 777-7153 T- '04700-004277 -'04,-00.004277 Date 5/17/04 CALLE•. COLIMA 774-133-013-1 -000000- . . . DWELLING - SINGLE FAMILY DETACHED . . . COVE RESIDENTIAL . . . 104822 Owner Contractor ------------------------ ------------------------ GEORGE SCHENKMAN OWNER Structure Information Construction Type TYPE V -,NON RATED Occupancy Type .,DWELLG/LODGING/CONG <=10 Flood Zone .--NON-AO FLOOD ZONE Other struct info CODE EDITION 2001 CBC # BEDROOMS .3.00 FIRE SPRINKLERS NO GARAGE SQ FTG 492.00, PATIO SQ FTG 73.00 NUMBER OF UNITS 1.00 FIRST FLOOR SQ FTG 1647.00 ---------------------------------------------------------------------------- Permit . . . . . . BUILDING PERMIT Additional desc Permit Fee . . . . 657.00 Plan Check Fee 177.05 Issue Date . . . . Valuation . . . . 104822 Qty Unit Charge Per ,. Extension BASE FEE 639.50 5.00 3..5000 THOU BLDG.100,001-500,000 17.50 ---------------------------------------------------------------------------- Permit . . . . . . MECHANICAL Additional desc Permit Fee . . . . 52.50 Plan Check Fee 13.13 Issue Date . . . . Valuation 0 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 2.00 6.5000 EA MECH VENT FAN 13.00 P.O. Box 1504• �� VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 922534 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: O'S(—AJ277 CApplicant:3yGQOr 'Applicant's MailingAddress: S,nqo viN�A , Ca- . Q Date: 5-1 ?•D it Architect Architect or E gineer'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 is in full force and effect. License Class License No. Date' Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that 1 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).): U 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-bui(der will have the burden of proving that he or she 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 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.). U I am exempt under Sec. , BA P.�f for this reason 4 Date f4jZ) 7 0/ WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of 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 / Policy Number r. 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 beco a subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provis' ns. rDate d121.0 --Applicant WARNIN : FAILURE TO SECURE WORKERS' PENSATION 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. 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 V1 45 n Lender's Address / �' C SCt� I ° s 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 co ply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county t r upon the a ove- ntion property for inspection purposes. Date V %� Signature (Applicant or Agent): Application Number . . . . . 04-00004277 Page 2 Date 5/17/04 Qty Unit Charge Per Extension 1.00 6.5000 EA MECH.EXHAUST HOOD 6.50 ---------------------------------------------------------------------------- Permit . . . . . . ELEC-NEW RESIDENTIAL Additional desc . . Permit Fee . . . . 97.49 Plan Check Fee 24.37 Issue Date Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 1647.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 57.65 492.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 9.84 1.00 15.0000 EA ELEC TEMPORARY POWER POLE 15.00 ---------------------------------------------------------------------------- Permit . . . . . . PLUMBING Additional desc . . Permit Fee . . . . 141.00 Plan Check Fee 35.25 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 12.00 6.0000 EA PLB FIXTURE 72.00 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 ------------------7--------------------------------------------------------- Special Notes and Comments . 1647 S.F. SFD PERMIT DOES NOT INCLUDE BLOCK WALL, POOL/SPA OR DRIVEWAY APPROACH Page 3 Application Number . . . . . 04-00004277 Date 5/17/04 -----------------------------------------------------------------'----------- Other Fees . . . . . . . . . ART IN PUBLIC PLACES -RES .00 DIF COMMUNITY CENTERS -RES 97.00 DIF CIVIC CENTER - RES 366.00 ENERGY REVIEW FEE 42.71 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 10:48 DIF STREET MAINT FAC -RES 15.00 DIF TRANSPORTATION - RES 1098.00 Fee summary Charged Permit Fee Total 962.99 Plan Check Total 249.80 Other Fee Total 2558.19 Grand Total 3770.98 Paid Credited .00 .00 .00 .00 .00 .00 .00 .00 Due 962.99 249.80 25.58.19 3770.98 CITY OF LA QUINT.A SUB -CONTRACTOR LIST r7 c / ILDER O1./�n- �y JOB ADDRESS I � � �/ [ � ���s��-i/�'�' PERMIT NUMBER d r 2 WNER Goy f= S��N�✓►�'•� � This form shall be posted on the iob with the Building Inspection Card at all times'in a conspicuous place. Only persons appearing on. ' t or their employees are authorized to work on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance of building permit. For each applicable trade, all intormation requested below must be com nt. "On File" is not an acceptable response. Company Name Classification License Number Exp. Date Carrier Name Polic Number Exp. Date Licenseen se Number Exp.. Date e.9 A 8 C 8 x xxx) 1x /xx/xx.(e.g...e.9State Fund, CalComp) Format Varies) xx/x z xx xxxx) 1xx x x xx ) i S AFtT 1Al RK:t :.; _2Y:.; .......::.::.:: / nR2 ES i l l ` T �✓ r /. Cc�NS 5 9g z3 Sr rte / ,- Certificate of Occupancy0 o -4 412ukro Lica �inan�4 C� OF - 9�5 9► y p Building & Safety Department This Certificate is issued pursuant to the requirements of Section 109 of the California Building Code, certifying that, at the time of issuance, this structure was in compliance with the provisions of the Building Code and the various ordinances of the City regulating building construction and/or use. BUILDING ADDRESS: 77-895 CALLE COLIMA Use classification: SINGLE FAMILY DWELLING Building Permit No.: 04-4277 Occupancy Group: R3 Type of Construction: VN Land Use Zone: RC Owner of Building: GEORGE SCHENKMAN Address: 53-540 AVENIDA VILLA City, ST, ZIP: LA QUINTA, CA 92253 By: KIRK KIRKLAND Date: AUGUST 10, 2004 Building Official POST IN A CONSPICUOUS PLACE i ��