05-3636 (SFD)P.O. BOX 1504
78495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 05-00003636
Property Address: 54365 -"EAST -RESIDENCE CLUB
APN: 775=380-999-26 .-31627 -
Application description: •DWELLING - SINGLE FAMILY
Property Zoning: MEDIUM DENSITY RES
Application valuation: 287914
Applicant: .
Architect or
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BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section700011 of Division 3 of the Business d Profess' als Code, and my License is in full force and effect:
License Class: B License No.: 799449
Date: 4b_%/u Contractor:
O ER -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 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.).
(_ 1 I am exempt under Sec. , B.&P.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, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
Owner:
NADADOR, LLC
78120 CALLE ESTADO, SUITE 203
LA QUINTA, CA 922.53
Contractor:
JACOBS HOMES INC, PETER
P.O. BOX 692
LA QUINTA, CA 92247
(760)777-9921
Lic. No.: 799449
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/16/05
WORKER'S COMPENSATION DECLARATION
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 Section3700 of the Labor Code, for the performance of the work for which this permit is
issued.
4_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 HRH INSUR Policy Number 176983305
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 sub'ect to the workers' compensation laws of California,
and agree that, if I shoul ecome subje o the workers' compensation provisions of Section
3700 of the Labor Co I all fo wi comply with those provisions.
Date: plicant:
WARNING: FAILURE TO SECURE WORKERS' 06 ENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTI S 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 ' rmation ' o rect. I agree to comply with all
city and county ordinances and state laws relating to building c r tion reby authorize representatives
of this county to enter upon the above-mentioned property o S.
Date/0 ;�/nature (Applicant or Agent'):
Application Number . . . . . 05-00003636
LQPERMIT
Structure Information
Construction Type
TYPE V - NON RATED
Occupancy Type' . . .
DWELLG/LODGING/CONE <=10
Flood Zone . .
. NON -AO FLOOD ZONE .
Other struct info . .
. . . CODE EDITION
2001 CBC
# BEDROOMS
3.00
FIRE SPRINKLERS
NO
GARAGE SQ FTG
531.00'
PATIO SQ -FTG
422:00
NUMBER -OF UNITS
1.00
--------------------------
1ST FLOOR SQUARE FOOTAGE
-----------------------------------
3365.00
---=-----------
Permit . . .
BUILDING PERMIT
Additional desc .
Permit Fee
1297.50 Plan Check.Fee .
843.38
Issue Date . . . .
Valuation . . .
. 287914
Expiration Date
2/12/06
Qty Unit Charge
Per
Extension
BASE FEE
639.50
188.00 3.5000
----------------------------------------------------------------------------
THOU BLDG 100,001-500,000
658.00
Permit . . .
MECHANICAL
Additional desc .
Permit Fee
171.50 Plan Check Fee
42.88
Issue Date
Valuation
0
Expiration Date
2/12/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
4.00 9.0000•EA
MECH FURNACE <=100K
36.00
4.00 9.0000
EA MECH.B/C <=3HP/100K BTU
36.00
12.00 6.5000
EA MECH VENT FAN
78.00
1.00 6-.5000
EA MECH EXHAUST HOOD
6.50
Permit . . .
ELEC-NEW RESIDENTIAL
Additional desc .
Permit Fee
145.60 P1an.Check Fee
36.40
Issue Date . . . .
Valuation'
0
Expiration Date
2/12/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
3365.00 .0350
ELEC NEW RES - 1 OR.2 FAMILY
117.78
LQPERMIT
Application Number ..
. . . . 05-00003636
Permit . . . . ELEC-NEW RESIDENTIAL
Qty Unit Charge
Per
Extension
641.00 .0200
----------------------------------------------------------------------------
ELEC GARAGE OR.NON-RESIDENTIAL
12.82
< Permit . . . PLUMBING
Additional desc .
Permit Fee . . . .
185.25 Plan Check Fee
46.31
Issue Date
Valuation . . . .
0
Expiration•Date
2/12/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
18.00 6.0000
EA PLB FIXTURE
108.00
1.00 15.0000
EA PLB BUILDING SEWER
15.00
2.00, 7.5000
EA PLB WATER HEATER/VENT
15.00
1.00 3.0000
EA PLB WATER INST/ALT/REP
3.00
1.00 .9.0000
EA PLB LAWN SPRINKLER.SYSTEM
9.00
7.00 .7500
EA PLB GAS PIPE >=5
5.25
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..
2/12/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
----------------------------------
Special Notes and Comments
----------------------------------------
--
SFD - LOT 26, PLAN BR.
PERMIT DOES NOT
INCLUDE POOL, SPA, BLOCK
WALLS, OR
DRIVEWAY APPROACH.
------------------------------
Other Fees . . . . .
------------------------------------
. . . . ART IN PUBLIC PLACES -RES
222.74
DIF COMMUNITY.CENTERS-RES
97.00
DIF CIVIC CENTER - RES
366.00
ENERGY REVIEW FEE
84.34
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
28.9Q
DIF STREET MAINT FAC -RES
15.00
LQPERMIT
LQPERMTT
Application Number
05-00003636
-------------------------------------
Other Fees . .
. . .. . .
---------------------------------------
DIF TRANSPORTATION
- RES
1098.00
Fee summary
Charged
----------
-Paid
----------
Credited
--------------------
Due
-----------------
Permit Fee Total
1814.85
.00
.00
1814.85
P1an.Check Total
968.97
.00'
.00
968.97
Other Fee Total
2740.98
.00
:00
2740.98
Grand Total
5524.80
.00
.00
5524.80
LQPERMTT
Certifidate.of Occupancy
�9ti
OF Buildin & Safet Department
9► Y p
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: 54-365 EAST RESIDENCE CLUB DR.
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 05-3636
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RC
Owner of Building: NADADOR, LLC Address: 78-120 CALLE ESTADO STE. 203
_ - City, ST, ZIP: LA QUINTA, CA 92253
By: DAVID GATICA
Date: AUGUST 17, 2006
Building Official
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