10-1161 (SFD)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
10-00001161
81.212 CASPIAN CT
764-280-004-21 -35996 -
DPIELLING - SINGLE FAMILY
LOW DENSITY RESIDENTIAL
225245
.BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
SHEA LA QUINTA
6.0800 TRILOGY PARKWAY
DETACHED LA QUINTA, CA 92253
Architect or Engineer:
Contractor:
SHEA HOMES, INC.
60800 TRILOGY PARKWAY
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/03/10
LA QUINTA, CA 92253" �i>HjA
(760)777-60,32 GvF Vau
kiCE ��
/ Lia. No.: 672285PL
V-------------------- * --------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury.that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarationsc
Section 7 ) o Division of the,ausine Professional@ and my License Is In full force and effect." _ I have and will "maintain a conificate.of consent to self -Insure for workers' compensation, as provided
Ucen CI Li No:: 672285 for by Section 3700 of the:Labor Cade, for the performance.of the work for which this permit is
issued.
Date: ntrector. I have and will maintain workers' compensation Insurance, as required by Section 3700 of the Labor
Code,.for the performance of the workfor which this permit is issued: My workers' compensation
OWNER -BUILDER DECLARATION insurance carrier and policy number are:
1 hereby affirm under penalty of perjury that) am exempt,from the Contractor's State License Law for the, Carrier LIBERTY MUTUAL Policy Number WA266DO66115030
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 tfiis'.permit is issued, I shall not employ any
construct, alter, Improve, demolish; or repairany.structure, prior to Its Issuance, also requires thwapplicant 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 provisionsof'the Contractor's State nd agree that, If I should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) olDivision 3 of the Business and Professions Code) or 00 of the L&d
Labor e, shall forthwith comply with those provisions:
that he or she is exempt,therefrom andthebasis for the alleged. exemption. Any violation ofSection7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of nwt,more than five hundred dollars (8500).: ate ' pplicantc
(_) 1, as owner of the property, or my employees with wages as their sole compensation, will do4he work, and
the structure is not Intended or offered for sale (Sec. 7044, Business and Professions Code The WARNING: FAILURE TO SECURE:W ERS' COMPENSATION COVERAGE IS UNLAWFUL, AND 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 HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the DOLLARS (6100,000). 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 3708 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:):
(_) 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.):
(_) I am.exempt under Sec. , BAP.C. for this reason
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, CN, C:).
Lender's Name:
Lender's Address:.
LQPERMIIT
APPLICANT ACKNOWLED(MAUNT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permitsubject 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 ass result of this application,
the owner, and the applicant, each°agrees to, and shall defend, indemnify and hold harmless the City
of La Quints, its officers; agents and employees for any actor omission related to the work being
performedunderor'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) have read this application and state that the above information is correct. I -agree to comply with all
sty and ty of�er
nces and'stafe laws relating to'building construction, and hereby authorize representatives
of�thiscoun to upon the above-mentioned prope for Inspection purposes]
Date: nature (Applicant or Agent)::
Application Number . . . . . 10-00001161
Permit.
. . .
BUILDING PERMIT
Additional
desc . .
Permit Fee
. . . .
1080.50
Plan Check Fee
175.58
Issue Date
. . .
Valuation . . . .
225245
Expiration
Date . .
5/02/11
Qty Unit Charge
Per
Extension
BASE
FEE
63.9.50
126.00
3.5000
THOU .BLDG
1.00,001-500,000
441.00
PermitMECHANICAL
Additional*desc
. .
Permit Fee
. . . .
111.50
Plan Check Fee
6.97
Issue Date
. .
Valuation . . . .
0
Expiration
Date
5/02/11.
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
2.00
9.0000
EA MECH
FURNACE <=.100K
18.00
2.00
16.5.000
EA MECH
B/C >3-15HP/>100K-500KBTU
33.00
6.00
6.5000
EA MECH
VENT FAN
39.00
1.00
6.5`000
EA MECH
EXHAUST HOOD
6.50
Permit.
. . .
ELEC-NEW RESIDENTIAL
Additional
desc . .
Permit_ Fee
117.85
Plan Check Fee
7.36
Issue Date
Valuation . . . .
0
Expiration Date . 5/02/11
Qty Unit Charge Per Extension
BASE FEE 15.00
2599.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 90.97
594.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 11.88
Permit. . . . PLUMBING
Additional desc . .
Permit Fee . . . 160.50 Plan Check Fee 10.03
Issue Date . . . . Valuation . . . . 0
Expiration Date 5/02/11
Qty Unit Charge Per Extension
BASE FEE 15.00
15•.00 6.0000 EA PLB FIXTURE 90.00
1.00 15.0600 EA PLB BUILDING SEWER 15.00
LQPERMIT
Application Number . . . . . 10-00001161
Permit . . . . . . .P.LUMBING.
Qty Unit Charge Per
Extension
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 5/02/11
Qty Unit Charge Per
Extension
BASE FEE
15.00
----------------------------------
- Special Notes and Comments
SFD - LOT 21, PLAN 5560A, 2599 SF.
INCLUDES 14.9 SF. EXERCISE ROOM. 63 SF.
BOX.BAY @ MBR & 83 SF. GARAGE EXTENSION.
PERMIT DOES NOT INCLUDE POOL, SPA, BLOCK
WALLS OR DRIVEWAY APPROACH. .75%
REDUCTION TO PLAN CHECK FEES DUE TO
MULTIPLE ISSUANCE OF SAME PLAN TYPE.
2007/2008 CODES. 2010 PLAN UPDATE.
--------- --------.-_----------------------- --
Other Fees . . . . . . . ART IN PUBLIC ,PLACES -RES
63.11
BLDG STDS ADMIN (SB1473)
10..00
DIF COMMUNITY CENTERS -RES
74.00
DIF CIVIC CENTER - RES
995.00
ENERGY REVIEW FEE
17.56
DIF FIRE PROTECTION -RES.
140.00
GRADING PLAN CHECK FEE
.00
DIF LIBRARIES - RES
355.00
MULTI -SPECIES (MSHCP) :FEE
1284.00
DIF PARK MAINT FAC - RES
22.00
DIF PARKS/REC - RES
892.00
STRONG MOTION (SMI) - RES
22.82
DIF STREET MAINT FAC -RES
67.00
DIF TRANSPORTATION - RES
1930.00
Fee summary Charged Paid Credited
------------------ ---------- -
Due
Permi:t Fee Total 1485.35 .00 .00
1485.35
Plan Check Total 199.94 .00 .00
199.94
LQPERMIT
R 1
LQPERMIT
Application Number
other Fee Total
Grand Total
. . . . 10-00001161
5872.49 .00 .00 5872.49
7557.78 .00 .0.0 7557.78