04-8239 (SFD)Coil
-4
U
BUILDING & SAFETY DEPARTMENT
04 y (760).777-7012
7 495 E TAMPICO
FAX (760) 777-7011
LA QUIN CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
CIIY �P L�►QUTATA
FINANCE DEQ
Ap ication Number . . . 04-00008239 'Date 2/22/05
Property Address,).;,. 54580 WEST RESIDENCE CLUB DR
APN: 775-390-999-31 -31627 -
Application description DWELLING - SINGLE FAMILY DETACHED
Property Zoning . . . . . . . MEDIUM DENSITY RES
Application valuation . . . . 287914
Owner Contractor
NADADOR, LLC JACOBS HOMES INC, PETER
78120 CALLE ESTADO, SUITE 203 R.O. BOX 692 -
LA QUINTA CA 92253 LA QUINTA CA 92247
(760) 777-9921
WCC: HRH INSUR
WC: 176983304 06/01/05
CSLB: 799449 04/30/05
CCC: B
-------------------------- Structure Information -------------------------
Construction Type . . . . . TYPE V - NON RATED
Occupancy Type . . . . . . DWELLG/LODGING/CONG <=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 OP 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
Qty Unit Charge Per Extension
BASE FEE 639.50
188..00 3.5000 THOU BLDG 100,001-500,000'.658.00
--------------------------------------------------------- ------- ---------
Permit
----------------------------- ----------------------=-`'-----------------
Permit . . . . . MECHANICAL
Additional desc
Permit Fee . . . . 171.50 Plan Check Fee 42.88
Issue Date Valuation . . . . 0
Qty Unit Charge Per
4.00 9.0000 EA_
4.00 9.0000 EA
12.00 6.5000 EA
BASE FEE
MECH FURNACE <=100K'
MECH B/C'<=3HP/100K BTU
MECH VENT FAN
Extension
15.00
36.00
'36.00
78.00
P.O. Box 1504
VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 0,4 - 807 39 Date: 3 3 l .65
—
Applicant: I Architect or Engineer:
Applicant's Mailing Address:
'Architect or Engineer's Address:
S20
ic. No.: G 2 V Seo 9
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
�, and my Licens%e 'stir full force and effect�.�icenseNo.2!mcz--�,-�Z—
OWNER-BUILDER
icense Class / DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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).):
U 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 or 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.).
U 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.).
U I am exempt under Sec. , BA P.C. for this reason
Date Owne
WORKERS' 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
iss teed. My workers' compensation i nce carrier �n� p�1ic nymbe�r are:
vier i� a, r ( olicy Number / (C� 1� .f >A G�
_ I certify that, in the performance of the work for which this permit is issued, I shall riot employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
/ Date
t./
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION 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.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a consiruction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address 0 1A
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 information ' gree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize rep sentalives of this county toe po &e-mmeentioned property for inspection purposes.
ate /2,- QS Signature o ent : ,,- S
f
Page
2
Application
Number .
. . . . 04-00008239 Date
2/22/05
Qty
Unit -Charge
Per
Extension
1.00
---------------------
6.5000
EA MECH EXHAUST HOOD
6.50
PermitELEC-NEW
------------------------------------------------------
RESIDENTIAL
Additional
desc
Permit Fee
. . . .
145.60 Plan Check Fee
36.40
Issue Date
. . . .
Valuation
0
Qty
Unit,Charge
Per
Extension
BASE FEE
15.00.
3365.00
.0350
ELEC NEW RES - 1 OR 2 FAMILY
117.78
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
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
Qty
Unit Charge
Per
Extension
----------------------------------------------------------------------------
BASE FEE
15.00
Special Notes
and Comments
SFD - LOT
31, PLAN A,
3365 sf.. 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
Page 3
Application Number
. . . . .
04-00008239 Date
2/22/05
----------------------------------------------------------------------------
Other Fees_ . . . .
. . . . .
DIF FIRE PROTECTION -RES
97.00
GRADING PLAN CHECK FEE
.00
DIF LIBRARIES .- RES
225.0'0
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
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
-4.
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Certificate of Occupanc0 Y
c OF9� Building & Safety Department
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: 54-580 WEST RESIDENCE CLUB DRIVE
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 04-8239
Occupancy Group: R3 Type of Construction: V -N Land Use Zone: RM
Owner of Building: NADADOR, LLC Address: 78-120 CALLE ESTADO, STE. 203
f .
City, ST, ZIP: LA QUINTA, CA 92253
By: GARY HARTMAN
Date: FEBRUARY 28, 2006
Building Official
POST IN A CONSPICUOUS PLACE
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