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04-3457 (SFD)�F �'wQ�rw BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760) 777-7012 78-495 CALLE TAMPICO FAX (760).777-7011 LA-QU,I`NTA-, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT 'Appldcation Number 04 :66b0 345 7- .,Date 4/14/04 Property.Addres_q . .. . . . . 80355 OLD RANCH TR S APN: 762-240-999-39 -308.34 - Application description DWELLING - SINGLE FAMILY DETACHED Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation 209177 Owner Contractor - - - - - --- - - - - - - - - - - - - - - MADI*SON ESTATES - - - - - - - - -- - - - --- - - - - - - - - 7- SOUTH -POINT CaDNSTRUCTiO'N`- INC 437 S HIGHWAY 101 NO 220* 44420 VIA DEL SOL SALANA BEACH CA 92075 LA QUINTA CA 92253 (760) 345-5521 WCC: .*STATS FUND WC: 0460010835 08/21/04 CSLB: 4478.33 08/31/04 CCC: B --------------------------- 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 .3.00 'FIRE SPRINKLERS ,NO. GARAGE.SQ FTG -595.00 PATIO SQ FTG 568.00 NUMBER.-OF UNITS - FIRST -FLOOR SQ FTG 3321.00 ------------------------------------------------------------------------------ Permit . . . . . . BUILDING PERMIT Additional desc Permit Fee . . . . . 1024.50 Plan'Check Fee 166.48 Issue Date Valuation 209177 Qt!y Unit Charge Per Extension BASE FEE 639.50 110.00 3.5000 ----------------------------------------------------------- THOU BLDG 100,'001-500,000', 385.00 .Permit . . . . . . MECHANICAL ----------- Additional desc Permit Fee . . . . 156,00 Plan Check Fee 9.75 Issue' Date Valuat?,Q,n 0 Qty Unit Charge 'Per BASE FEE JUL. 12 2004 coffin.O 14 r. R n't'�ZA —ERUbnsion 15.00 P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing Address: Date: i -q -0 or lieci or tngmeer's A dress: .-No.: BUILDING PERMIT DECLARATIONS 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 Li� full force and effect/�� ioense Class tense No. Z ' OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor;' 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 Contractors' 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 pemrit 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 or 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.). U 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.). U I am exempt under Sec. , BA P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: _ I have and will maintain a certificate of consent to self4nsure 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 rssueg work ' wm enation insme ce Artier and policy �nytnber are: farrier 5 t=61 olrP�'cy Number _ C� 0 40 4z, -e> 16 3 s _ I certify that, in the performance of the work for which this it is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agJee that, if I Id become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply wiUi those provisionsl/ WARNING: FAILURE TO SECURE WORKERS' COIGPENSATION 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. CONSTRUCTION LENDING AGENCY I hereby affirm undernal • f peri that th is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). _--l-endefs Name Len er's Addre 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 pernit 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 Ouinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this per mit 2. Any permit Issued as a result of this application becomes nu and void if rk is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancel tion. I certify that I have read this application and state that the above info o is rt 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 r the bove-mentioned property for inspection purposes. ate ignature (Applicant or Agent): Page 2 Application Number . . 04-00003457 Date 4/14/04 Qty Unit Charge Per Extension 4.00 9.0000 EA MECH FURNANCE <=100K 36.00 4.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU 66.00 5.00 6.5000 EA MECH VENT FAN 1.00 6.5000 EA MECH EXHAUST HOOD 6.50 Permit . . . . . ELEC-NEW RESIDENTIAL Additional desc Permit Fee .143.14 Plan Check Fee 8.95 Issue Date Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 3321.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 116.24 595.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 11.90 ----------------------------------------------------------------------------- Permit . . . . PLUMBING Additional desc Permit Fee . . . 231.00 Plan Check Fee 14.44 Issue Date . . . . Valuation 0 Qty Unit Charge Per Extension BASE FEE 15.00 21.00 6.0000 EA PLB FIXTURE 126.00 1.00 15.0000 EA PLB BUILDING SEWER 15.00 2.00 6.0000 EA' PLB ROOF DRAIN 12.00 2.00 7.5000 EA PLB'WATER HEATER/VENT 15.00 2.00 3.0000 EA PLB WATER INST/ALT/REP 6.00 2.00 9.0000 EA PLB LAWN SPRINKLER SYSTEM 18.00 12.00 .7500 EA PLB GAS PIPE >=5 9.00 .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 Qty Unit Charge Per Extension BASE FEE 15.00 Special Notes and Comments ------------------- SFD - LOT 39, PLAN AR. PERMIT DOES NOT d, Page 3 Application Number 04=00003457 Date 4/14/04 ---------------------------------------------------------------------------- Special Notes and Comments INCLUDE POOL, SPA, BLOCK WALLS, OR DRIVEWAY APROACH. 75% REDUCED PLAN -CHECK FEE APPLIED FOR MUTIPLE ISSUANCE OF SAME PLAN TYPE ---------------------------------------------------------------------------- Other Fees . . . . . . . ART IN PUBLIC PLACES -RES 22.94 DIF COMMUNITY CENTERS -RES 97.00 DIF CIVIC CENTER - RES 366-.00 ENERGY REVIEW FEE 16.65 DIF FIRE PROTECTION -RES 97.00 GRADING PLAN CHECK FEE .00 DIF LIBRARIES - RES 225.00 DIF PARK MAINT FAC - RES 5.00 DIF PARKS/REC - RES 502.00 STRONG MOTION (SMI) - RES 20.91 DIF STREET MAINT FAC. -RES 15.00 DIF TRANSPORTATION - RES 1098.00 Fee summary Charged Paid Credited Due Permit Fee Total 1569.64 .00 .00 1569.64 Plan Check Total 199.62 .00 .00 199.62 Other Fee Total 2465.50 00 .00 2465...50 Grand Total 4234.76 .00 .00 4234.76 r-- • XY, Certificate of -Occupancy 0 OF Building & Safety Department This Certificate is issued pursuant to the requirements of Section 109 of the California Building Code, certifying that, at the time of issuance, this structure was in compliance with the provisions of the Building Code and the various ordinances of the City regulating building construction and/or use. BUILDING ADDRESS: 80-355 OLD RANCH TRAIL SOUTH Use classification: SINGLE FAMILY DWELLING Building Permit No.: 04-3457 Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL Owner of Building: MADISON ESTATES Address: 437 S. HWY 101 #220 City, ST, ZIP: SOLANA BEACH, CA By: GARY HARTMAN Date: NOVEMBER 8, 2005 Building Official POST IN A CONSPICUOUS PLACE