05-2679 (SFD)KD
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
C&iv; 4.4 "
BUILDING & SAFETY DEPARTMENT
. BUILDING PERMIT
Application Number: 050.0-0-0.26.7.9
Property Address: 54425 EAST RESIDENCE CLUB DR
APN: 775-390-999-27 -31627 -
Application description: DWELLING - SINGLE FAMILY DETACHED
Property Zoning: MEDIUM DENSITY RES
Application valuation: 287914
Applicant: v ��rchitect or Engineer:
Soy
�14Y Ir 20-20 Z Z,
--------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury #4 1 am licensed rider provisions of Chapter 9 (commencing with
Section 70001 of Division 3 of the Busi d Profe si als Code, and my License is in full force and effect.
License Class: B icense No.: 799449
Date: -R 'd ontractor:
/
OWA/R-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.).
(_ 1 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.I..
Lender's Name:
Lender's Address:
LQPERDIIT
Owner:
NADADOR, LLC
78120 CALLE ESTADO, SUITE 203
LA QUINTA, CA 92253
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
6/30/05
------------------
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 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 HRH INSUR Policy Number 176983305
certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so a o become subject to the workers' compensation laws of California,
and agree that, if I shou c esu.' ct the workers' compensation provisions of Section
3700 of the Labor Co fo ,t • o ply with those provisions.
i0ate: /plicant:
WARNING: FAILURE TO SECURE WORKERS' C PENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 0100,000). 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' formation is correct. I agree to comply with all
city and county ordinances and state laws relating to building truction, and reby authorize representatives
of this county to enter upon the above-mentioned property f ' sp ion p p
e: —G,,nature (Applicant or Agent):
t
Application Number
05-00002679
Structure Information
Construction Type . .
. . . TYPE V - NON RATED
Occupancy Type . . .
. . . DWELLG/LODGING/LONG <=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
12/27/05
Qty Unit Charge
Per
Extension
BASE'FEE
639.50
188.00 3.5000
-------------- 7---------------------------'----------------------------------
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
12/27/05
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
Additional desc .
Permit Fee . . . .
Issue Date . . . .
Expiration Date . .
Qty Unit Charge
3365.00- .0350
LQPERMIT
ELEC-NEW RESIDENTIAL -
145'.60 Plan Check Fee .
Valuation . . . .
12/27/05
Per
BASE FEE
ELEC NEW RES 1 OR 2 FAMILY
36.40
0
Extension
15.00
117.78
LQPERM1T
Application Number .
. . . . 0.5-00002679
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
12/27/05
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
12/27/05
Qty Unit Charge
Per
Extension
BASE FEE
15.00
-----------------------------------------------------"-----------------------
Special Notes and Comments
SFD - LOT 27, PLAN Aft
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
28.90
DIF STREET MAINT FAC -RES
15.-00
LQPERM1T
LQPERAIIT
Application Number
05-00002679
----------------------------------------------------------------------------
Other Fees . . .
. . . . . .
DIF TRANSPORTATION
- RES
1098.00
Fee summary
Charged
Paid
--------=-
Credited
----------
Due
----------
-----------------
Permit Fee Total
----------
1814.85
.00
.00
1814.85
Plan 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
LQPERAIIT
MAR -2T-06 05:30FM FROM-BORM ASSOCIATES INC.
srnvcrolw. ao)E1�Tlorl . ryV
Project Name:
Observer
A visit to the project We was made on the above date to:
O Address specific elements of the work .
T-044 P.01/02 F-971
L—A-1I 11 V I
STRUCTURAL ENGINEERS
Pmjca Number.
Date OtObservation:
49
771 "97Z4?
XAssist the field personnel with complyitlg with the intent of the construction doctuncnts. Y 1 /17
Assist the field personnel with complyigg with the findings fiom a previous structural job site observation.
At the dm of our vb1i6 work bad progressed tq the pdot or;
h to mapom and boluE As such, it coasists of ncilber a gttaraaae nor a watranttec =Fewod or implied.
Field Supwh tesdest (third cop
Phase:
Cliwrt (aseond copy via am) .
Address:
Flem VROMW (liras "Py)
Data:
If you bane*" queaftes please contact o
COSTA bMA, CALMRI" "w= 710.513.7500
Bhig. / LotNumber
WSi3VII= CAUFORNIA Phone: 916.774-7597
Fax: 916-770.7599
PLZASANtON, CAUFORN1A Phone 925.474.1180
Fax: 925.467-1780
LAS VEGAS, NEVADA Phma 702-740-5427
Bldg. / Plan Type tit Eketradon:
PHOENDL AREMA Phaco: 6234694607
Pax: 623469-0609
Foundation perched
0
o
O
0
Foundation Poured
0
0
0
0
Roof Sheathing Covered
0
0
O
0
Roofing Material Sucked and Loaded
0
o
O
O
Exterior walls Covered
O
a
D
0
0
Interior wall Covered
a
o
0
0
0
Ittsulation Imsalled
p
0
a
O
0
Pkcwical, Mochenical, Plumbing
0
a
o
a
0
Final Framing Pick-up Complexed
O
o
0
a
p
Building Complete
0
0
0
0
0
Based upon our vbitt
0 Relhr to the attached field notes to be addressed by the construction persomoel.
Cl"1
0 Additional information will be seta harp our office which will need to be addressed by the construction persomieL
It is our opinion that this building is being constructed in general eonfotmanaa with the intent of the construction documents ympared by
our office.
0 Sire Observation ceased, framing was not at it stage of completion in which six observation could be performed.
0 Cmncerns brought to the attention of fie{d pwsomtel based on previous site observation made on have yet to be addressed.
Please note:
Out findings anddationiz may have oar than structure] Unification which we have trot addressed, Be advised that changa to the
caasnaetion doaunents need approval of the building official. Our firm is not audm mrd to an as the Ow pees agent. Our findings shau not be
construed as mnbaAftg the cgmmdit m of sdditioval fronds.
Site Observation was made only to determine Sepetal conformance with the intent of the construction documents Observation was made of those
pot603 of the work which would best W resent the intent of the construction doeurnems, nag eacb and every element of the work. Site observation
did act include review, approval or observation at; atmgg other items:
1. The contractors caddy precaadons, proccduum, dos*m% methods or toehnitptes.
2. Any shoeing, aea$Rld'urg, nnderpiaaiag, trmpotitry ttxaiaing of areava Wns. or any other ereaio n methods or temporary bracing
3. Any sols a die site. their adequacy in apppaa the builds ng, a qums vaum or any odwr soil related catulitionL
4. Any drainage courses or devises of a tmWora Y no= or as s permanent part of Ila atruc0ae. including roof and Boor dqm% drains and
OPM
'Plc fiudiogs of this observation are understood to be an vspr don of professional opinion by die engineer based on . or her best knowledge,
h to mapom and boluE As such, it coasists of ncilber a gttaraaae nor a watranttec =Fewod or implied.
Field Supwh tesdest (third cop
7 ]Date:��
Cliwrt (aseond copy via am) .
��
Flem VROMW (liras "Py)
Data:
If you bane*" queaftes please contact o
COSTA bMA, CALMRI" "w= 710.513.7500
Pax 714-513-7555
WSi3VII= CAUFORNIA Phone: 916.774-7597
Fax: 916-770.7599
PLZASANtON, CAUFORN1A Phone 925.474.1180
Fax: 925.467-1780
LAS VEGAS, NEVADA Phma 702-740-5427
Fax: 702-740.5431
PHOENDL AREMA Phaco: 6234694607
Pax: 623469-0609
r