10-1167 (SFD)N
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
10-00001167
81200 CASPIAN CT
764-280-004-22 -359.96 -
DWELLING - SINGLE FAMILY
LOW DENSITY RESIDENTIAL
174086
Tit!t 4 4 Q",
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
SHEA LA QUINTA.
60800 TRILOGY PARKWAY
DETACHED LA QUINTA, CA 92253
Architect or Engineer:
PIA -
Contractor:
SHEA HOMES, INC.
6080.0 TRILOGY PARKWAY
LA QUINTA, CA 92253
(760)777-6032
Lia.. No.: 672285
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/09/10
----- - - - - -- - - -- -
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensedunderprovisions of. Chapter 9 (commencing with
I:herebyafirm under penalty of perjury one of the following declarations:
Section 70 1 Division 3 of the Busi and Prof i s Code, and my license is in full force.and effect.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
Li ce 1 cense No.: 672285
for by Section 3700 of the Labor Code, for the performance of the work for which this permit Is
ate: ontractor:
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 whichthispermit is issued. My workers' compensation
OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I herebyeffinn under penalty of perjury that am exempt from the Contractor's State License Lew for the
Carrier LIBERTY MUTUAL Policy Number WA266DO66115030
following reason (Sec. 7031:5, Business and Profession&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 mennerso as to become subject to the workers' compensation laws of California„
permit to file a signed statement that he or she islicensedpursuant to the provisions of the Contractor+s Statend
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
700 of he Labor Code, l shall, forthwith comply,with those 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 then.five hundred dollars' ($500)::Date'
( _.1 I, as owner of the property, or my' employees with wages as their sole compensation, will do the.work; and'110,
the structure isnot intended or offered for sale (Sec. 7044, Business•and Professions Code: The
WARNING: FAILURE TO SECUREWORKERS' COMPENSATION, COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law doesmot 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 ($100,000). IN ADDITION TO THE COST`OF COMPENSATION; DAMAGES AS PROVIDED FOR IN
Improvements are not intended or offered forsale. 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 orrshe did not`build or
Improve for the purpose of sale.).
APPLICANT ACKNOWLEDGEMENT
(_ 1 1, 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 Llcense,Law does not apply to an owner of
conditions and restrictions set forth on this application.
property who builds or Improvesthereon, and who contracts for the projects with a contractor(s) licensed
1. Each person upon whose behalf this application is made, each person atwhose request and for
pursuant to the. Contractors' State License.Lawa.
whose benefit work, is performed under or pursuant to any permit issued as a -result of this application,
(_) 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
Of La Ouima,.its officers, agents and'employessforany act or omission related to the work being
performed under or following issuance of this permit.
Date:. Owner:
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
CONSTRUCTION LENDING AGENCY
permit to cancellation.
I. hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
I certify that I have read this application and state that the above information is correct. 1 agree,to comply with all
work for which this permit is Issued (Sec. 3097, Civ. C:1.
city and county ordinances.and state laws relating to building construction, and hereby authorize representatives
of thi noun enter upon,the above-mentioned p operty for Inspection purposes.
Lender's Name:
ate SI re (Applicant or Agent
Lender's Addresw
L,QPERMIT
Application Number . . . . 10-00001167
Permit.
. . . BUILDING PERMIT
Extension
Additional
desc .
BASE FEE
15.00
Permit Fee
. . . . 902.00
Plan Check Fee
146.57
Issue Date
. .
- Valuation . . .
. 174086
Expiration
Date . . 5/08/11
EA MECH B/C_>3-15HP/>100K-500KBTU
16.50
Qty Unit Charge Per
6.5000
Extension
26.00
BASE
FEE
639.50
75.00
3.5000 THOU BLDG
100,001-500,000
262.50
Permit.
. . . MECHANICAL
Additional
desc . ..
95.54 Plan Check Fee
5.97
Permit Fee
88..5.0
Plan Check.Fee
5.13
Issue Date
. . . .
Valuation . . .
. 0
Expiration Date . . 5/08/11
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
1.00
16.5000
EA MECH B/C_>3-15HP/>100K-500KBTU
16.50
4.00
6.5000
EA MECH VENT FAN
26.00
2.00
6.5000
EA MECH EXHAUST HOOD
13.00
Permit.
. . . ELEC-NEW RESIDENTIAL
Additional
desc . .
Permit Fee
. . . .
95.54 Plan Check Fee
5.97
Issue Date
. .
Valuation . . . .
0
Expiration
Date
5/'08/11
Qty . Unit Charge
Per
Extension
BASE FEE
15.00
1972.00
.0350
ELEC NEW RES - 1 OR 2 FAMILY
69.02
576.00
----------------------------------------------------------------------------
.0200
ELEC GARAGE OR NON-RESIDENTIAL
11.52.
Permit
. . .
PLUMBING
Additional
desc . .
Permit Fee
. . . .
15.3.00 Plan Check Fee
9.56
Issue Date
. . .
Valuation . . . .
0
Expiration
Date
5/08/11
Qty Unit Charge
Per
Extension
BASE FEE
15.00
14.00
6.0000
EA PLB FIXTURE
84.00
LQPERMFr
Application Number . . . . . 10-00001167
Permit . . PLUMBING
Qty Unit Charge Per
Extension
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 .750:0 EA PLB GAS PIPE >=5
4.50
1.00 .15.000.0 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 . . 5/08/11
Qty Unit Charge :Per
Extension
BASE FEE
15.00
Special Notes and Comments
SED - LOT 22, PLAN 4520C. INCLUDES 255
SF. DETACHED CASITA, 26 SF. BOX BAY
@MSR, 88 SF. GARAGE EXTENSION. PERMIT
DOES NOT INCLUDE POOL_,. SPA, BLOCK WALLS,
OR DRIVEWAY APPROACH. 75V REDUCTION TO
PLAN CHECK FEES DUE TO MULTIPLE ISSUANCE
OF SAME PLAN TYPE. 2007/2008 CODES. 2010
PLAN UPDATE.
--:----------------_--------------------------------------------
Other Fees . . . .. . . . BLDG STDS ADMIN (SB1473)
----------
7.00
DIF COMMUNITY CENTERS=RES
74.00
DIF CIVIC CENTER - RES
995..00
ENERGY REVIEW FEE
14.66
DIF FIRE PROTECTION -RES
1.40.00
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
17.41
DIF STREET MAINT FAC -RES
67.00
DIF TRANSPORTATION - RES
1930.00
Fee summary Charged Paid Credited
Due
Permit Fee Total 1254.04 .00 .00
1254.04
Plan Check Total 167.23 .00 .00
167.23
LQPERMIT
Application Number
Other Fee Total
Grand Total
LQPERMIT
. . . 10-00001167
5798.07 .00 ..00 5798.07
7219.34 .00 .00 7219.34