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05-3252 (SFD)f .s P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA; CALIFORNIA 92253 Application Number: Property Address: APN: Application description Prnrerty 7nninr0- Application valuation: Applicant: 05-00003252 46078 ROUDEL LN 649-040-007-16 -31816 .DWELLING - SINGLE FAMIL MTTr)TTTM r)FTT91TV RES 195966 Architect or Ct--( CC,- BUILDING & SAFETY DEPARTMENT BUILDING PERMIT ------------------ 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 3.2f the Business and Professionals Code, and my License is in full force and effect. License lass: License No.: 808912 at ��10 ontractor: 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).: 1 _ 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 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.). (_ I 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: M+ LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 7/27/05 Owner: LA QUINTA NORTH -PARTNERS 2 CROOKED STICK DRIVE NEWPORT BEACH, CA 92660 Contractor: URBAN HABITAT 2 CROOKED STICK DRIVE NEWPORT BEACH, CA 92660 (949)759-1018 Lic. No.: 808912 ------------------ 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. 1 haveand 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 %� /� 370 `- o e, s o with comply with those provisions. Date: I � �p nt: - WARNING: FAILURE TO ORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 1$100,0001. 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 anypermitissued 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. 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 onstruction, and hereby authorize representatives bf this c �entern t - entioned p petty for inspection purposes. at ture (Ap or A nt). Application Number . . . . . 05-00003252 LQPERAIIT 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 743.00 PATIO SO FTG 436.00 NUMBER OF UNITS 1.00 ---------------------------------------------------------------------------.- 1ST FLOOR SQUARE FOOTAGE 3070.00 Permit BUILDING PERMIT Additional desc ` Permit Fee . . . . 975.50 Plan Check Fee 158.52 Issue Date Valuation 195966 Expiration Date 1/23/06. Qty- Unit Charge Per Extension BASE FEE 639.50 96.00 3.5000 ---------------------------------------------------------------------------- THOU BLDG 100,001-500,000 .336.00. 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 146.03 Plan Check Fee 9.13, Issue Date . . . . Valuation . . 0 Expiration Date 1/23/06 Qty Unit Charge Per Extension BASE FEE 15.00 3070.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 107.45 LQPERAIIT LQPERA11T 'Application Number . . . . 05-00003252 Permit . . . . . . ELEC=NEW RESIDENTIAL Qty Unit Charge Per Extension 1179.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 23.58 Permit . . . PLUMBING Additional desc . Permit Fee 161.25 Plan Check Fee .. 10.08 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 7.50010 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 16 PLAN TYPE 2AR, '3,070 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 15.85 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 19.59 DIF STREET MAINT FAC -RES 15.00. LQPERA11T Application Number 05-00003252 ". ----------------------------------------------------------------t-------- Other Fees . . . . . . . DIF TRANSPORTATION - RES -- 1098.00 Fee summary Charged Paid _ Credited Due Permit Fee Total 1412.28 ---------- .00 ---------- ---------- .00 1412.28 Plan Check Total 184.89 .00 .00 184.89 Other Fee Total 2440.44 .00 .00 2440.44 Grand Total 4037.61 .00 .00 4037.61