04-7174 (SFD)h'
P4 BO 1504 .
.78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BALDING PERMIT
Application Number: 04-00007174 O Owner:
Property, Address: 46007 -ROADRUNNER LN LA QUINTA NORTH PARTNERS
,APN: 649-040-007-1 -31816 - Q 2 CROOKED STICK -DRIVE
Application description: DWELLING - SINGLE FAMILY DETACH,9/' NEWPORT BEACH
Property Zoninq: MEDIUM DENSITY RES UV PdEWPORT BENCH, CA 92660Application valuation: 196855 C/A 0
40
/9,`�� `®v ntractor:
Applicant: rchitect or Engineer: l��dRBAN HABITAT
v �A 2 CROOKED STICK DRIVE
��
_12ACL NEWPORT BEACH, CA 92660
(949)759-1018
Lic. No.: 808912
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.
/Lic la s: B r License No.: 808912
D ntra `�"'`�
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 (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 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 applicanttoa civil penalty of not more than five hundred dollars ($500).:
(_ 1 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 -1
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 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.). -
( 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: 'ln
LQPERMIT
VOICE.(760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760).777-7153
Date: 7/27/05
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.
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:
Carrier STATE FUND Policy Number 1741937-2005
_ 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 1 should become subject to the workers' compensation provisions of Section
3700 of the Labor Code. I shall forthwith comply with those provisions.
WARNING: FAILURE TO SECQRE-YtlMERS' 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.
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 is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of ttt�(hhiii/ss/count to enter upon the abo tion purposes.
Da¢qature (Applicant or ,
LQPERAIIT ,
Application Number .
. . . .• 04-00007174
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
# BEDROOMS
4.00
FIRE SPRINKLERS
NO
GARAGE SQ FTG
768.00
PATTn SQ FTr,
5nq 00
NUMBER OF UNITS
1.00
---------------------------------------------------
1ST FLOOR SQUARE FOOTAGE
-------------------------
3060.00
Permit . . .
BUILDING PERMIT
Additional desc .
Permit Fee
979.00 Plan Check Fee
636.35
Issue Date . .
Valuation
196855
Expiration Date
1/23/06
Qty Unit Charge
Per
Extension
BASE FEE
639.50
97.00 3.5000
THOU BLDG 100,001-500,000
339.50
Permit . . .
MECHANICAL
Additional desc .
Permit Fee . . . .
. 114.50 Plan Check Fee
28.63
Issue Date . . . .
Valuation
0
Expiration Date
1/23/06
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
6.00 6.5000
EA MECH VENT FAN
39.00
1.00 6.5000.EA
----------------------------------------------------------------------------
MECH EXHAUST HOOD
6.50
Permit . .
ELEC-NEW RESIDENTIAL
Additional desc .
Permit Fee . . .
146.44 Plan Check Fee
36.61
Issue Date
Valuation . . .
.0
Expiration Date
1/23/06
Qty Unit Charge,
Per
Extension
BASE FEE
15.00
3060.00 .0350
ELEC NEW RES - 1 OR 2 FAMILY
107.10
LQPERMIT
Application Number 04-00007174
Permit . . . . .'. ELEC-NEW RESIDENTIAL
-Unit Charge Per
Extension
,Qty
1217.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL
24.34"
Permit. . . PLUMBING
Additional desc .
Permit Fee . .. 161.25 Plan Check Fee
40.31
Issue Date . . . . Valuation . . . .
0
Expiration Date 1/23/06
Qty Unit Charge Per
Extension
BASE FEE
.15.00
15.00 6.0000 EA PLB FIXTURE
90.00
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
9.00 .7500 EA PLB GAS PIPE >=5
6.75
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 1/23/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
---------------------------------------
Special Notes and Comments
SFD - PLAN TYPE 1C, 3,060 SQ.FT. PERMIT
DOES NOT INCLUDE POOL, SPA, BLOCK WALLS
OR DRIVEWAY APPROACH
-------.---------------------------------------------------------------------
Other Fees . . . . . . . . . DIF COMMUNITY CENTERS -RES
97.00
DIF CIVIC CENTER - RES
366.00
ENERGY REVIEW FEE
63.64
DIF FIRE PROTECTION -RES
97.00
DIF LIBRARIES - RES
.225.00
DIF PARK MAINT-FAC - RES
5.00
DIF PARKS/REC - RES
502.00
STRONG MOTION (SMI) - RES
19.68
DIF STREET MAINT FAC -RES
15.00
DIF TRANSPORTATION - RES
1098.00
Fee summary Charged Paid Credited
Due
LQPERMIT
Application Number 04 -0000.7174
----------------- -------
Permit Fee Total 1416.19 .00 .00 1416.19
Plan Check Total 741.90 500.00 .00 241.90
Other Fee Total 2488.32 .00. .00 2488.32
August 23, 2005
Mr. Timothy Jonasson
City Engineer
City of La Quinta
78-495 Calle Tampico
La Quinta, CA 92201
RE: WESTWARD SHADOWS
Urban Habitat
Tract No. 31816
Form Certification
Lots 1 through 5. '
The Keith Companies 0 EM
C
Dear Mr. Jonasson:
I hereby state that the building pads and forms, for the above referenced Lots, within Tract No. 31816, were
surveyed under my direct supervision and have been found to be within substantial conformance, both horizontally
and vertically, to the Precise Grading Plan, as shown by the table below.
Lot No.
Address
• Permit
Plan
Field
Difference
Plan
Field
Difference
No.
Pad Elev.
Pad Elev.
FF Elev.
FF Elev.
1
._46=007
047174
273.4
273.4
0.0
273.90
2-,3.91
+ 0.01 .
rRoadranner
2
6s04;1=-
047175
272.4
272.4
0.0
272.90
2 ; 2.89
-0.01
Roadfaf er
3
X46_47,5,
053237
270.8
270.8
0.0
271.30
2:1.30.
0.00
-Roadrunner.
_
4
.4.6-1.0=9_-_
053239
269.4
269.4
0.0
269.90
269.92
+ 0.02
Roadrunner
5
`°4`6=143-"
053246
268.0
268.0
0.0
268.50
268.52
+0.02
Roadrunner
Sincerely,
THE ITH COMPANIES, INC.
R ssell J Mullins, PLS 371
D ector of Survey
LAND S�'�G
V RUSSELL J. MUWNS p.
No. 3712 p
*
Exp•
Palm Desert Division ��Q Palm Desert Division
�/y l 73-733 Fred Waring Drive
Suite 100
Palm Desert
California 92260-2590
4 1760.346.9844
0:\40921\4092100\docs\CERTS\C-LQ.FORM CERT.URBAN HABITAT.WESTWARD SHADOWS.T. F: 760.34
31816.doc
www.keithco.coco.com