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04-3477 (SFD)r . . s.' P.O. Box 1504 78-495 CALLE TAMP.ICO LA ;QUINTA- CAL•IFORNIA'92253 44UAw BUILDING & SAFETY DEPARTMENT (760)777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7.153 BUILDING PERMIT p Application Number:04-000.034_7.7} Date' 4/14/04 Property• Address • 08.0390--OLD-RANCH TR S APN: .762-240-999-67 -30834 - Application descriptionDWELLING - SINGLE-FAMILY DETACHED Property Zoning LOW DENSITY RESIDENTIAL Application -valuation- 204195 Owner =5 Contractor MADISON ESTATES SOUTH ,.P01 -NT CONSTRUCTION INC 437 S HIGHWAY 101 NO 220. .44420 VIA DEL SOL SALANA BEACH CA 92075 LA QUINTA- CA 92253. (760) 345-5521 WCC: STATE FUND:. .WCs 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 CBC FIRE SPRINKLERS NO GARAGE SQ FTG 563.00 PATIO SQ FTG -920.00 NUMBER OF UNITS 1.00.' FIRST FLOOR SQ FTG 3,,163..00 Permit BUILDING PERMIT .Additional desc Permit Fee 1007:00 Plan..Check Fee;163.64 Issue Date 'Valuation . . . . 204195 Qty Unit • Charge Per Extension BASE FEE 639.50 105.00 3.5000 THOU BLDG 100,001-500,000. 367.50 - - - - - - - - - - - - - - - - - - - - - - - - - - - \ - - - - - - - - --------- Permit -------- Permit . . . . .. . MECHANICAL .Additional desc Permit Fee . . . .. 111.50 Plan Check See 6.03 Issue Date . . . . Valuati©l Q" 0 Qty 'Unit Charge Per D 12 20{xt = - ion" BASE FEE�uL .�� 1 . 00 2.,00 9.0000. EA MECH .FURNANCE <=100K 1 0 0 CITY ®� �uET� 8 FI�II��CE OSPT. C&f 4 4 P.O: BOX 1504 agwoul 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT Application Number: 0 117 7 Applicant: Applicant's Mailing Address: VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: ? - 4? •04 chitect or Engineer: N AS Ag LC 4W Ili re- in o1a S /d 4 ou4reJX1 chltect or Engineer's Address: Palms D'esa--l vJ- �zzs o . No.: 14 66T6,S t UILUINU PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Cha ter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my l.ic@Qse ' I ro effect�� / -7963 1--tl'nse Class ii�s �icS~nse No. i. / OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 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 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 1, 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 theieon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). C-) I am exempt under Sec. , BA P.C. for this reason Date Owner I hereby affirm under persalt of WORKERS' COMPENSATION DECLARATION Penalty 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 lissupd. �Y� w-orkers'� compensation insurer varier and policy number are: artier 5h1Z&A PotiestJebr_��1�QQl _ I certify that, in the performance of the work for which this pernd is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agy that, if 1 sh become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. J WARNING: FAILURE TO SECURE WORKERS' COMPONSATION 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, INTERESY, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I hereby affirm under,, perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). ,,,_�LendeesName Lender's Address L 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 Ouinta, 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 inform tion is I agree to comply with all city and county ordinances and stale laws relating to building construction. and hereby authorize representatives of this county toe r po bove-nentioned property for inspection purposes. /Date V - 42LV Sig aturrta a (Applicant or Agent): Page 2 Application Number 04-00003477 Date 4/14/04 Qty Unit Charge Per Extension 2.00 .16.50.00 EA MECH B/.0 >3-15HP/>100K-30OKBTU 33.00 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 136.97 Plan Check =ee 8.56 Issue Date Valuation.- . 0 Qty Unit Charge Per Extension BASE FEE 15.00 3163.00 .0350 ELEC NEW RES - 1 OR 2 F_�MILY 110.71 563.00 .0200 ELEC GARAGE OR.NON-RESIDENTIAL 11.26 ----------------------------------------------------------------------------- Permit . . . . PLUMBING Additional desc . Permit Fee . . . 218.25 Plan Check.Fee 12.99 Issue Date . . . . Valuation 0 Qty Unit Charge Per Extension BASE FEE 15.00. 22.00 6.0000 EA PLB FIXTURE 132.00 1.00 15.00.00 EA PLB BUILDING SEWER 15.00 1.00: 6.0000.EA PLB.ROOF DRAIN 6.00 2..00 7.5000 EA PLB WATER HEATER/VENT 15.00. 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 1.00 9.0000•EA PLB LAWN SPRINKLER'SYSTEM 9.00 11.00 .7500 EA PLB GAS PIPE >=5 8.25 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 67, PLAN D. PERMIT DOES NOT INCLUDE BLOCK WALLS, POOL, SPA OR Page 3 ,Application Number 04700003477 Date, 4/14/04 Special Notes and Comments DRIVEWAY APPROACH. 75% REDUCTION TO PLAN CHECK'FEES DUE TO MULTIPLE ISSUANCE OF SAME PLAN TYPE Other Fees . . . . . . . ART IN PUBLIC PLACES -RES 20.00 DIF COMMUNITY CENTERS -RES 97.00 DIF CIVIC CENTER - RES 366.00 _ ENERGY REVIEW FEE 16.36 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 20.41 DIF STREET MAINT FAG -RES 415.00 DIF TRANSPORTATION - RES 1098.00 -Fee summary Charged Paid Credited Due, Permit Fee Total ..1488.72 .00 =.D0 1488.72 Plan Check Total_ 191.22 .00, D0 .191.22 Other Fee Total 2461.77 .00 D0 2461.77 Grand Total ..4141.71 .00 ••.D0 4141.71 t _ .. TANDrS in INSPECTION INC. PO BOX 13766 PALMI DESERT, CA 92255 SPECIAL INSPECTION DAILY REPORT UFFICE/FAX 909,769.9717 PAGER 760.776.3339 TYPE OF INSPECTION PERFORMED Co — Zt— __ SUPPLIER TICKET NUMBER MIX NUMBER TIME AIR TEMP SAMPLE SLUMP TIME IN MIXER SAMPLED TEMP p u �.. s�, s,—I PHYSICAL ADDRESS I G�f �iuiHrN' PERMIT NUMBER . 4- 341' ' ,OB NAME TYPF,,OF STRUCTURE CERTIFYING AGENCY AND CERTIFICATION NUMBER JI;, ARCHITECT ENGINEER �� >Jr ,�� 1' `��jZ,+- 4 GENERAL CONTRACTOR SUBCONTRACTOR lAT DESCRIPTION OF •' 1 TAW t_ Lam\ I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK, UNLESS OTHERWISE NOTED, AND TO THE BEST OF MY ABILITY 1 HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS, SPECIFICATIONS & APPLICABLE BUILDING LAWS. As PECTORS SIGNATURE SAMPLE INFORMATION SUPPLIER TICKET NUMBER MIX NUMBER TIME AIR TEMP SAMPLE SLUMP TIME IN MIXER SAMPLED TEMP �WlOoi ��1,60 `•Spy ® (o ° 1 `� Q' p�1.� LOCATIONSd WELDING INFORMATION PROCESS VVELDERS NAME CERTIFYING AGENCY AND CERTIFICATION NUMBER JI;, I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK, UNLESS OTHERWISE NOTED, AND TO THE BEST OF MY ABILITY 1 HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS, SPECIFICATIONS & APPLICABLE BUILDING LAWS. As PECTORS SIGNATURE IN9PECTORS CERTIFICATION AGENCY AND.NUMBER , r JI;, I n