05-3240 (SFD)?:Z':"BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
�05-00_0.03240 _
Owner:
Property Address:
461.77 ROADRUNNER LN
d
LA QUINTA NORTH PARTNERS
APN:
649L040-007-6 -31816 -
2 CROOKED STICK DRIVE
Application description:
DWELLING - SINGLE FAMILY DE
DA/i�+
Aou
NEWPORT BEACH
"
Pr6perty /-Ohi tg:
'Application valuation:
MEDIUM DENSITY RES
196855
,4
0
NEWPORT BEACH, CA 92660
O
��Nq f�Qv
NCEDICA
Contractor:
Applicant:
/Architect or Engineer.
URBAN HABITAT
n
2 CROOKED STICK DRIVE
`'A �/"`'�IL
C to -
NEWPORT BEACH, CA 92660
(949)759-1018 8082� 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.
�License Class: 13 License No.: 808912
� `�V ontra
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 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
improvefor 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 l 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
WORKER'S COMPENSATION DECLARATION
Date: 7/27/05
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 I should become subject to the workers' compensation provisions of Section -
3700 of •ho i ah— Code rtft comply with those provisions.
WARNING: FAILURE TO SECVRE449FIRERS' 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 actor 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 t abew*AQ nr'on dd�*J-' '^spection purposes.
te: nature
ture (Applicant entl:
� ~ Application Number .
. . . . 05-00003240
-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
PATIO $Q FTG
509.00
NUMBER OF UNITS
1.UU
----------------------------------------------------------------------------
1ST FLOOR SQUARE FOOTAGE
.3060.00
Permit . . .
BUILDING PERMIT•
- Additional desc .
Permit Fee . .
979.00 Plan Check Fee
159.09
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
7.16
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
9.15
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
LQPERAIIT
-
Application Number. . . . 05-0000324.0
Permit . . . . ELEC-NEW RESIDENTIAL
Qty Unit Charge Per
Extension
1217.00 .0200 ELEC GARAGE OR NON-RESIDENTIAli
----------------------------------------------------------------------------
24.34
Permit PLUMBING
Additional desc .
Permit Fee 161.25 Plan Check Fee
10.08
f _
Issue Dare 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 - LOT 6, PLAN TYPE 1CR, 3,060 SQ.FT.
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 DIF COMMUNITY CENTERS -RES
97.00
DIF CIVIC CENTER - RES
366.00
ENERGY REVIEW FEE
15.91
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
LQPERMIT -
'^ Application Number
05-00003240
Other Fees . . .
. . . . . .
DIF TRANSPORTATION - RES
1098.00
Fee summary
Charged
Paid
Credited
Due
Permit Fee Total
1416.19
00
00
1416.19
Plan Check Total
185.48
.00
.00`
185.48
Other Fee Total
2440.59
.00
.00
2440.59
Grand Total
4042.26
.00
.00
4042.26
LQPERMIT