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05-4842 (SFD)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description: Property Zoning: Application valuation: Applicant: T4'yl 4.4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT CO5-0 000 4842 -J 8010"5 ON RTH RESIDENCE CLUB DR 775-380-999-10 -31627 - DWELLING - SINGLE-FAMILY DETACH MEDIUM DENSITY RES O d 287914 DEC X005 _,,,-'Xrchitect or Engineer: yip r NANF L4e® HYTi4 --------------------------------------------------- _ LIC ED CONTRACTOR'S DECLARATION hereby affirm under penalty of perjury that licensed and rovisions of Chapter 9 (commencing with ' Section 7000) of Division 3 of the Business d ofessio de, and my License is in full force and effect. License Class: B c nse No.: 799449 /ate: /Contractor: / 2r1 4;r: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason ISec. 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).: (_) 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 sof 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 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 10/31/05 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 ---------------- 7 - 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. 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 perform c of he work for wh' this permit is issued, I shall not employ any person in any manner s a to ecome subject j e workers' compensation laws of California, and agree that, if I sh I be bjec o e orkers' compensation provisions of Section 3700 of the Labor C all fort i y with those provisions. 2- ` Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPE CATION COVERAGE IS UNLAWFUL, AND SHALL . SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES 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 knu ssation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that ton is cor I agree to comply with all - city and county- ordinances and state laws relating to bu, an y authorize representatives of th/is county to enter upon the above-mentioned prope Ddfe: ignatme (Applicant or Agent): Application Number ... .. 05-00004842 Structure Information Construction Type . . . . . TYPE V - NON RATED Occupancy Type . . . . . . DWELLG/LODGING/CONG <=10 •Flood Zone . . . NON -AO FLOOD ZONE Other struce 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 LQPERMIT Application Number . . . . . 05-00004842 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 10, PLAN B. 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 LQYERMIT Application Number . . . . . 05-00004842_ ----------------------------------------------------------------=----------- 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