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04-3678 (SFD),i P.O. 'Box 1504 78-495 CALLE TAMPICO LA QUINTA' CALIFORNIA 92253 BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760),777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 Application Number . . . . .04-00003678 Date" -12/16/04 Property Address 40 LA CT APN: 643-170-999-12 -31348 - Application description . . . DWELLING - SINGLE FAMILY DETACHED Property Zoning . . . . . . LOW DENSITY RESIDENTIAL',:,,., Application valuation... 173 .868 Owner Contractor 'PH RANCH LLC EHLINE COMPANY 78370 HIGHWAY 111 STE 200 55375 MEDALLIST DR LA QUINTA CA 92253 LA QUINTA -CA 92253 (760) 771-8130 WCC: STATE FUND WC: 2290006783 01/01/05. CSLB: 4.82086 11/30/05 CCC: B ------ Structure Information 2800 SQ.FT. SFD --•--- 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 504.00 PATIO SQ FTG 288.00 NUMBER OF UNITS 1.00 1ST FLOOR SQUARE FOOTAGE 2800.00 ---------------------------------------------------- Permit BI ITT T G PERMIT Add itiona desc R .. Permit Fe '� -.50. Plan Check Fee 584..03 Issue Dat D��.2.9 �o 041 Valuation 173868 Qty U, it-CY�agee. Extensin cITY of LA �uINTA FINANCE DEPT. BASE FEE 6 39.5'0 74.00 3-750'0-0—TRO BLDG 100,001-500,00,0 259.00 ----------------------------------------------------------- ----------------- Permit . . . . . . MECHANICAL Additional desc Permit Fee 101.50 Plan Check Fee 25.38 Issue Date . . . . Valuation 0 Qty Unit.Charge Per. Extension BASE FEE 15.00 3.00 9.0000 EA MECH FURNACE <=100K 27.00 3.00 9.0000 EA MECH B/C <=3HP/100K BTU 27.00 4.00 6.5000 EA MECH VENT FAN 26.00 C&hf 4 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT Application Number: QLf - 31 7 9 Applicant: Hppiicanrs mauing Address or VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: Engineer's Address: Lic. No.: ( / 9.;7-/ 0 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 Code, and my License is in full force and effect. License Class License No. Date Contractor OWNER -BUILDER '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 fora 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.). 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 1 am exempt under Sec. B 8 `p.Cwfor this jTason 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 issued. My workers' compensation insurance carrier and policy number are: Cartier Policy Number I certify that, in the performance of the work for which this permit is issued. I shall not 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, 1 shall forthwith comply with those provisions. /Cfat /Applicent 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 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 IMPORTANT Application is hereby made to the Director of BuildingAPPLICANT Safety for ACKNOWLEDGEMENT 1. Each person u Y permit subject to the conditions and restrictions set forth on this application. pe 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, indemnity and hold harmless the City of La Ouinta, 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 is correct I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes. atejG Signature (Applicant or Agent): PC Page 2 Application Number . . . . . 04-00003678 Date 12/16/04 Qty Unit Charge Per Extension 1.'00 ---- 6.5000 EA MECH EXHAUST HOOD 6.50 --------------- Permit . . . ------- . . . --------------------------------------- ELEC-NEW RESIDENTIAL. ----------- Additional desc Permit Fee . . . . 138.08 Plan Check Fee 34.52 Issue Date Valuation . . . . 0 Qty Unit Charge, Per Extension BASE FEE 15.00 2800.00 '.0350 ELEC NEW RES - 1 OR 2 FAMILY 98.00 504.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 10.08 1.00 ---------------------------------------------------------------------------- 15.0000 EA ELEC TEMPORARY POWER POLE 15.00 Permit .. . . . PLUMBING Additional desc.. Permit Fee . . . . 174.75 Plan Check Fee 45.75 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per. Extension BASE FEE 15.00 17.00. 6.0000 EA PLB FIXTURE 102.00 1.00 15.0000 EA PLB BUILDING SEWER 15.00 1.00 7.5000 EA PLB WATER HEATER/VENT 7.50 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 1.00 9.0000 EA PLB LAWN SPRINKLER SYSTEM 9.00 .00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS .00 11.00 _ .7500 EA PLB GAS PIPE >=5 8.25 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 12, 2800 SF.; PLAN B3R. PERMIT DOES NOT INCLUDE POOL,SPA BLOCK WALLS -OR ------7-----------------------7--------------------------------------------- DRIVE WAY APPROACH. Other Fees . . . . . . . . .ART IN PUBLIC PLACES -RES .00 DIF COMMUNITY.CENTERS-RES 97.00 Page 3 Application Number . . . 04-00003678 Date 12/16/04 ---------------------------------------------------------------------------- Ot'her Fees . . . ..... . . . DIF CIVIC CENTER ---RES 366.00 ENERGY REVIEW FEE 58.40 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 17.38 DIF STREET MAINT FAC -RES 15.00 DIF TRANSPORTATION - RES 1098.00 Fee summary ----------------- Charged Paid Credited ----------- Due Permit Fee Total ---------- 1327.83 ---------- ----------- 00 .00 1327.83 Plan check Total 689.68 500.00 .00 189.68 Other Fee Total 2480.78 .00 .00' 2480.78 Grand Total 4498.29 500.00 .00 3998-29