14-0218 (SFD)PA BOX 1$04
iy
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4ht °F4Q"
BUILDING & SAFETY DEPARTMENT.
BUILDING PERMIT
Application Number'
14-0000.0218
I hereby affirm underpenalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Property Address:
'46141 ROUDEL LN
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
APN:
600-040-020, - -
Da _21_ 7*1 Co� c6nd
Application description:
Property Zoning:
DWELLING - SINGLE FAMILY DETACHED
MEDIUM DENSITY RES
i
Application valuation:
182376
following reason (Sec. 7031.5,essions Code: Any city or county that requires a permit to
Applicant:
Architect or Engineer:
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 become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) o�------.t•«
Owner:
ROUDEL VENTURES, LLC
77-682 COUNTRY CLUB U
PALM -DESERT, CA 92211
(949)533-9408
Contractor:
GHA ENTERPRISE,
30875 DATE PALM
CATHEDRAL CITY,
(760)969-1400
Lic. No.: 750957
INC.
DRIVE
CA 92.
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/26/14
----------------------------------------------------------------------------------
' LICENSED CONTRACTOR'S DECLARATION
---------------
WORKER'S COMPENSATION DECLARATION
I hereby affirm underpenalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations: -
Section 7000) of Division 3 of the Business and Professionals Code, and 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 Class: B License No.: 750957
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
Da _21_ 7*1 Co� c6nd
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
WNER-BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty oexempt from the Contractor's State License Law for the
Carrier STATE FUND Policy Number 9076853-2014
following reason (Sec. 7031.5,essions 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 become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) o�------.t•«
._�T� 3700 of the Labor Code, 1 shall forthwith comply with those 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 0500).:
"Date: 3 ZL,' :w Applicant:
(_ 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
WARNING: FAILURE TO SECURE WO ERS' CO PENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
P IES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
SUBJECT AN EMPLOYER TO CRIMIN "e
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
(_ 1 1, 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. , BAP.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:
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 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 propeq%jeFinspection purposes.
r
.� Application Number
14-00000218
- ------ Structure Information
2,820SF DWELLING/VB/RES-3/CLASS-A/13D
-----
other struct info . .
. . . CODE EDITION
2010
# BEDROOMS
4.00
FIRE SPRINKLERS
3420
GARAGE SQ FTG
600.00
PATIO SQ FTG
263.00
NUMBER OF UNITS
1.00
----------------------------------------------------------------------------
1ST FLOOR SQUARE FOOTAGE
2820.00
Permit . . .
BUILDING 2013
Additional desc .
Permit Fee
559.84 Plan Check Fee
.00
Issue Date
Valuation
182376'
,Expiration Date
9/22/14
Qty Unit Charge
`Per
Extension
BASE FEE
431.86
158.00 .8100
------------------------------------------------------"----------------------
THOU BLDG $25,001-$200,000
127.98
Permit . . .
ELECTRICAL 2013
Additional desc .
Permit Fee . .
203.31 Plan Check Fee'.
.00*
Issue Date . . . .
Valuation . .
. . 0
Expiration Date..
9/22/14
Qty Unit Charge
Per
Extension
1.00 23.8300
EA ELEC TEMP POWER POLES
23.83
1.00 143.0000
LS ELEC NEW RES, FIRST 1 KSF
143.00
..3.00 12.1600
--------------------------------------------------------------------------
EA ELEC NEW RES, ADD!L 1 KSF
36.48
Permit . . . MECHANICAL 2013
Additional desc .
Permit Fee
238.36 Plan Check Fee
.00
Issue Date . . . . .
Valuation . .
. . 0
Expiration Date
9/22/14
Qty Unit Charge
Per
Extension
2.00 35.7500
EA MECH FURNACE
71.50
2.00 35.7500
EA MECH CONDENSER/COMP,
71.50
7.00 11..9200
EA MECH VENT FAN
83.44
1.00 11.9200
EA MECH EXHAUST HOOD.'
11.92
Permit . . . . . . PLUMBING 2013
LQPERMIT _.
LQPERMIT
Application Number . . . . . 14-00000218
Permit . . . PLUMBING 2013
Additional desc .
Permit Fee . . . . 309.91 Plan Check Fee
.00
Issue -Date . . . Valuation
0
Expiration Date 9/22/14
Qty Unit Charge Per.
Extension
19.00 11.9200 EA PLBG FIXTURE/TRAP
226.48
1.00 11.9200 EA PLBG BUILDING SEWER
11.92
1.00 11.9200 EA PLBG WATER HEATER/VENT
11.92
1.00 11:.9200 DA FLDG'WATER INST/ALT/REP`
11.92.
1.00 11.9200 EA PLBG BACKFLOW DEVICE
11.92
1.00 35.7500 LS PLBG GAS SYS, 5+ OUTLETS
35.75
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Special Notes and Comments
.2,820SF DWELLING - PLAN 2AR, LOT 23
[VB/RES-3/CLASS A'-FR/13D] THIS PERMIT
DOES NOT INCLUDE POOL, -SPA, BLOCK WALLS
OR DRIVEWAY APPROACH ***APPLICATION_
ASSESSED A BASE PLAN REVIEW FEE OF
$47.67 FOR MULTIPLE ISSUANCE OF PLAN
TYPE*** 2010 CALIFORNIA BUILDING CODES.
March 3, 2014 1:47:31 PM AORTEGA
----------------------------------------------------------------
Other Fees . . . . ... . . . BLDG STDS ADMIN (SB1473)
8.00
DIF COMMUNITY CENTERS -RES
129".00
DIF CIVIC CENTER - RES
942.00
DIF FIRE PROTECTION -RES
433.00
DIF LIBRARIES - RES
344.00
MULTI-SPECIES,(MSHCP) FEE
1278.00
DIF PARK MAINT FAC - RES
40.00
DIF PARKS/REC - RES
2048.00
PLAN CHECK, MULTIPLE STR
47.67
STRONG MOTION (SMI) - RES
18.24
TUMF: RESIDENTIAL
1837.44
DIF STREET MAINT FAC -RES
116.00
DIF TRANSPORTATION.- RES
2842.00
Fee summary Charged" Paid Credited
Due
Permit Fee Total 1311.42 .00 .00
1311.42
Plan Check Total .00. .00 .00
.00
Other Fee Total 10083.35 .00 .00
10083.35
Grand Total 11394.77 .00 .00
11394.77
LQPERMIT