05-0734 (SFD);ate
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Tlihf 4 aCP a"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/03/05
Application Number: n5 -n0000734 Owner:
Property Address: 58385 CARMONA CORAL, OPTION I
APN: 764-200-006-19 -316811- 79295 RANCHO LA QUINTA DR
Application description: DWELLING - SINGLE FAMILY DETACHED LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 439037 0
Contractor: D
Applicant: / r to Engineer: SPARKS
O4CA.— P.O. BOX1716
0UCTION, INC JUN p g 2005
LA QUINTA, CA 92247 Q�`�jA
(760) 771-1941 CITY OF
Lic. No.: 674074 sNANCEDEprT.
-----------------7-------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with 1 hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code d 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 Clas : B Lic a No 674074 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
paten � p� ontractor: 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
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 STATE FUND Policy Number 00003482004
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to_ I certify that, in the performance of the work for 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 manner so as to become subject to the 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 a subject to the wor mpensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 00 of the Labor Co , I shall f thwith compl 1th thos 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 ($500): e. O scant:
(_) 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 WARNING: FAILURE TO SECURE 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 contractor(s) 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—) 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: _� ie
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 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 ' or ation is correct. I agree to comply with all
city and co u ty or finances and state laws relating to buildin ruc on, 'and hereby authorize representatives
of this cou y to nte�r upon the above-mentioned prop in ecti n purpose
nature (Applicant or Agent):
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Application Number . . . . . 05-00000734
Permit . . . . . . ELEC-NEW RESIDENTIAL
Qty Unit Charge Per Extension
791.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 15.82
----------------------------------------------------------------------------
Permit . . . PLUMBING
Additional desc . .
Permit Fee . . . . 214.50
Issue Date . . . .
Expiration Date . . 6/03/05
Plan Check Fee . . 53.63
Valuation . . . . 0
Qty Unit Charge
Per
Extension
BASE FEE
15.00
22.00 6.0000
EA
PLB FIXTURE
132.00
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
14.00 .7500
EA
PLB GAS PIPE >=5
10.50
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 . .
6/03/05
Qty Unit Charge
Per
Extension
:
BASE FEE
15.00
-----------
Notes and Comments
SFD - LOT 19, PLAN 6BR,
5089
SF. PERMIT
DOES NOT INCLUDE POOL,
SPA,
BLOCK WALLS
OR DRIVEWAY APPROACH
---------------------------
Other Fees . . . . .
------
. . .
------------------------------
. ART IN PUBLIC PLACES -RES
-------------
597.59
DIF COMMUNITY CENTERS -RES
97.00
DIF CIVIC CENTER - RES
366.00
ENERGY REVIEW FEE
118.92
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
43.90
DIF STREET MAINT FAC -RES
15.00
LQPERMIT
LQPERMIT
Application Number . . . . . 05-00000734
----------------------------------------------------------------------------
Other Fees . . . . . . . . . DIF TRANSPORTATION - RES 1098.00
Fee summary Charged
Permit Fee Total 2406.94
Plan Check Total 1329.80
Other Fee Total 3165.41
Grand Total 6902.15
Paid Credited Due
.00 .00 2406.94
.00 .00 1329.80
.00 .00 3165.41
.00 .00 6902.15