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05-4837 (SFD)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253- Application 2253 Application Number: Property Address: APN: Application description: Property Zoning: Application valuation: Applicant: Tit�/ 4 4 Qum' BUILDING & SAFETY DEPARTMENT BUILDING PERMIT . 05-00004837 80-045 NORTH RESIDENCE CLUB DR 775-380-999-7 -31627 - DWELLING - SINGLE FAMILY DETACHED MEDIUM DENSITY RES 287914 �chitect or Engineer: Owner: NADADOR, LLC 78120 CALLE ESTADO, SUITE 203 LA QUINTA, CA 9225.3 OFr 12 WORKER'S COMPENSATION DECLARATION ctor: c O O✓ BS HOMES INC., PETER qOF� BOX 692 �CF4D, QUINTA, CA 92247 F�OI q 760) 777-9921 Date: /��ractor: Lic. No.: 799449 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 10/31/05 ------------------------------------------------------------------------------------------------ NSED CONTRAMORS DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury t 'Aim I' ensed un r rovisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Busi and essi de, 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 Lic nse Class: B i nse No.: 799449 _ for by Section 3700 of,the Labor Code, for the performance of the work for which this permit is issued. 1_F Date: /��ractor: 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 OWNER -BUILDER DECLARATION insurance carrier and policy number are: .I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier HRH INSURIcPolicy Number 176983305 following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to I certify that, in to he work 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 eco cttothe workcompensation laws of California,permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree thab' 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 3700 of the Lll 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 than five hundred dollars (5500).: Date: nI, as owner of the property, or my employees with wages as their sole compensation, will do the work, and �URE the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The WARNINCURE WORKERS' 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 ($100,000). 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 3706 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.). .. APPLICANT ACKNOWLEDGEMENT (_) I, 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 License Law does not apply to an owner of conditions and restrictions set forth on this application. property who builds or improves thereon, and who contracts for the projects with a contractorls) licensed , , 1. Each person upon whose behalf this application is made, each person at whose request and for pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any, permit issued as a result of this application, 1 _ 1 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 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: ,rte` Q Lender's Address: N / 1 LQPERMIT 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 bec as null and void if work is not commenced within 180 days from date of issuance of such pe t, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the a e i r aY correct. I agree to comply with all city and county ordinances and state laws relating to buildi r d hereby authorize representatives ;te: is c unty to enter upon the above-mentioned propert r i c n poses. ignature (Applicant or Agent): 127Z� Application Number . . . . 05-00004837 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 210.85 Issue Date Valuation, . . . . 287914 " Expiration Date 4/29/06 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 10.72 Issue Date . . . . Valuation 0 Expiration Date 4/29/06 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 Plan Check Fee 9.10 Issue Date .. . . . . Valuation. . . . . 0 Expiration Date.. 4/29•/06 Qty Unit.Charge Per Extension BASE FEE 15.00 3365.00 .0350 ELEC NEW RES "- 1 OR -2 FAMILY 117.78 LQPERMIT Ko i Application Number . . . . . 05-00004837 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 11.58 Issue Date . . . Valuation 0 Expiration Date 4/29/06 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 4/29/06 Qty Unit Charge Per Extension BASE FEE 15.00 -------------------------------- -------------------------------------------- Special Notes and Comments SFD - LOT 7, PLAN A. PERMIT DOES NOT INCLUDE POOL, SPA, BLOCK WALLS, OR DRIVEWAY•APPROACH. 75% REDUCTION TO PLAN CHECK FEE DUE TO MULTIPLE ISSUANCE OF SAME PLAN.TYPE ------------------------------------'---------------------------------------- Other Fees . . . . . . ART IN PUBLIC PLACES -RES 222.74 DIF COMMUNITY CENTERS -RES 97.00 DIF CIVIC CENTER -,RES. 366.00 ENERGY REVIEW.FEE 21.09 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 LQPERMIT LQPERMIT Application Number . . . . . 05-00004837 -------------------------------- ----- --------------------------------------------------------- Other Fees --------------------- . . . . I -------------- - STRONG MOTION (SMI) RES 28.90 DIF STREET MAINT FAC -RES 15.00 DIF TRANSPORTATION - RES 1098.00 Fee summary Charged Paid Credited Due Permit Fee Total -- - - - -- - -- 1814.85 -.------------------------- .00- .00 7- 1814.85 Plan Check Total 242:25 .00 .00 242.25 Other Fee Total 2677.73 .00 .00 2677.73 Grand.Total 4734.83. .00 00 4734.83