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05-4840 (SFD)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T4,ht " BUILDING & SAFETY DEPARTMENT BUILDING PERMIT - Application Number: 05-00004840 Property Address: 8'0"0 -65 -NORTH -RESIDENCE CLUB DR APN: 775-380-999-8 -31627 - Application description: DWELLING - SINGLE FAMILY CHED b Property Zoning: MEDIUM DENSITY RES Application valuation: 287914 DEC 22005 Applicant: /Zrchitect or En, ineer: Y®p AI�IMi� , VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 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 Date: 10/31/05 ------------------ ------------------------------------------------------------------------------ CENSED CO RACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury I a Ii ns nder provisions of Chapter 9 (commencing with • I hereby affirm under penalty ofperjury one of the following declarations: Section 7000) of Division 3 of the Busi e s a Prof io als 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 License Class: B License No.: 799449 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 which this permit is issued. My workers' compensation WN(,-.UlLDER DECLARATION insurance carrier and policy numbe are: I hereby affirm under penalty of perjury that I am exefrom the Contractor's State License Law for the Carrier HRH INSUR icy Number - 76983305 following -reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance e -work for w c 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 manner so as t eco a subje ,io t e workers' compensation 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 that, if I should b ject fie orkers' compensation provisions of Section 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 3700 of the Labor Code,, all co p with those provisions. r� i Ili— ` /i' any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: ate: ;Atiplicant: - (_ 1 1, 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 1-11 WARNING: FAILURE TO SECURE WORKERS' COMPEN ATION 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 1 — 1 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 contractors) 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, (_) 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: Lender's Address: 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 becomes null and void if work isnot commenced within 180 days from date of issuance of such per ' , or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the abo e i form tion i orrect. I agree to comply with all city and county ordinances and state laws relating to buildin c stru , a ereby authorize representatives of this county to enter up the above-mentioned property nspe on p es. Date: ignature (Applicant or Agent): Application Number . . . . . 05-00004840 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,.0.0 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 Application Number . . 05-00004840 Permit . . . . . . ELEC-NEW RESIDENTIAL Qty , UnitChargePer - 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 8, PLAN C. 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 Application Number . . . . . 05=00004840 ----------------------- Other Fees ------------------------------- ------=--------------- 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. 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