12-1403 (SFD)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
f�!'�GkiGv
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT .
Application Number: 1-2-
2 00001403 _7
Property Address: 81878 SEABISCUIT WY
APN: 767-200-999-32 -312023-
Application description: DWELLING - SINGLE FAMILY DETACHED
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 171399
Applicant: Architect or Engineer:
-------------------
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: B License No.: 916227
Date: Contractor:.
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, 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, as owner of the property, am exclusio y contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Cadle,
T e Contractors' State License law does not apply to an owner of
property who builds or improves thernd who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State Li@Law.).
I am exempt under Sec. , B.&�f r this reason
ate: / /
CONS/ITRUCTION LENDING AGENCY
1 hereby affirm under penalty of perjury that there is� construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Ci C.).
Lender's Name:
Lender's Address: IY'�
LQPERMIT
Owner:
DESERT CHEYENNE,
78401 HIGHWAY 1
LA.QUINTA, CA 9
(760)777-9920
Contractor:
GJH DEVELOPMENT
27636"YNEZ ROAD
TEMECULA, CA 92
(760)578-3545
Lic. No.: 916227
INC.
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/03/12
. 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 requiied 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 pol'cy number are: .
Carrier EU MPT Policy Number EXEMPT
certify that, in the perform cof the work for which this permit is issued, I shall not employ any
person in any manner so a become subject to the workers' compensation laws of California,
and agree that, if I should ome subject to the workers' compensation provisions of Section
3700 of the Labor Code, 1 all forthwith comply with those provisions.
/t� �( � Applicant. j
WARNING: FAILURE TO SECURE WORKS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL ENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO HE 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 "wliosebebalf this application is made, each person at whose request and for
whose benefit work is performe8-under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agiees•"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 v,.ork being
performed under or following issuance of this permit. '
2. Any permit issued as a result of this application %,a r�i es null and void if work is not commenced
within 180 days from date of issuance of such die it, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the ab ,le n formation is correct. I agree to comply with all
city and county ordinances and state laws relating to building onstruction, and hereby authorize representatives
o�this county to ter up the above-mentioned property fo nspection purposes.
/Date /1 / �,n.t, re (Applicant or Agent): r
" Application Number
. . .12-00001403
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
2010 CBC
# BEDROOMS
4.00
FIRE SPRINKLERS
yes
GARAGE SQ FTG
658.00
PATIO SQ FTG
319.100
NUMBER OF UNITS
1.00
-----------------------------------------------------------------------------
.1ST FLOOR SQUARE FOOTAGE
2600.00
Permit BUILDING PERMIT.
Additional desc .
Permit Fee
891.50 Plan Check Fee
579.48
Issue Date
Valuation
171399
Expiration Date
6/01/13
Qty Unit Charge
Per
Extension
BASE FEE
639.50
72.00 3.5000
THOU BLDG 100,001-500,000
252.00
Permit MECHANICAL -
• Additional desc .
Permit Fee . . . .
90.'00 Plan Check Fee
22.50
Issue Date . . .
Valuation
0
Expiration Date
6/01/13.
Qty Unit Charge
Per
Extension
BASE FEE
15.00
2.00 9.0000
EA MECH FURNACE <=100K
18.00
2.00 9.0000
EA MECH B/C <=3HP/100K BTU
.18.00
5.00 6.5000
'EA MECH VENT FAN
32.50
1.00 6.5000
---------------•-------------------------------
EA MECH EXHAUST HOOD
------------------------------
6.50
Permit . . . ELEC-NEW RESIDENTIAL
Additional desc .
Permit Fee . . . .
119.16 Plan Check Fee
29.79
Issue Date . . . .
Valuation
0
Expiration Date
6/01/13
Qty Unit Charge
Per
Extension
_
BASE FEE
15.00
2600.00 .0350
ELEC NEW RES - 1 OR 2 FAMILY 91.00
LQPERMIT '
Application Number .
. . . . 12-00001403
Permit . . . . . . ELEC-NEW RESIDENTIAL
Qty Unit Charge
Per
Extension
658.00 .0200
----------------------------------------------------------------------------
ELEC GARAGE OR NON-RESIDENTIAL
13.16
Permit . . . PLUMBING
Additional desc .
Permit Fee . . . .
166.50 Plan Check Fee
41.63
Issue Date . . . .
Valuation . . . .
0
Expiration Date
6/01/13
Qty Unit Charge
Per
Extension
BASE FEE
15.00
16.00. 6.0000
EA PLB FIXTURE
96.00
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
8.00 .7500
EA PLB GAS PIPE >=5
6.00'
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
6/01/13
Qty Unit Charge
Per
Extension
BASE FEE
15.00
7 --------------------------------------------------------------------
Special Notes and Comments
SFD - LOT 32, PLAN 2A,
2600 SF. PERMIT
DOES NOT INCLUDE POOL,
SPA, BLOCK WALLS,
OR DRIVEWAY APPROACH.
2010 CODES.
----------------------------------------------------------------------------
Other Fees . . . . .
. . . . BLDG STDS ADMIN (SB1473)
7.00
DIF COMMUNITY CENTERS -RES
104.00
DIF CIVIC CENTER - RES
1089.00
ENERGY REVIEW FEE
57.95
DIF FIRE PROTECTION -RES
612.00
DIF LIBRARIES - RES
334.00
MULTI -SPECIES (MSHCP) FEE
1254.00.
DIF PARK MAINT FAC - RES
51.00
DIF PARKS/REC - RES
1773.00
STRONG MOTION (SMI) - RES
17.14
DIF STREET MAINT FAC -RES
158.00
LQPERMIT
Application Number . . . 12-00001403
Other Fees . . . DIF TRANSPORTATION - RES 3592.00
Fee summary Charged Paid Credited Due
----------------- ---------= ----"---- ----- ----- -- ------
Permit Fee Total 1282.16 00 00 - 1282:,16
Plan Check Total 673.40 .00 .00 673.40
Other'Fee Total 9049.09 .00 .00 9049.09
Grand Total- 11004.65 _00 .00 11004.65
LQPERMIT - .