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04-4690 (SFD)I T4hf 4 4a" BUILDING & SAFETY DEPARTMENT P.O. Box 1504 �7�60) 777-7012 l 78-495 CALLS TAMPICO FAsX(;760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQU STS�(760) 77.7-7153 BUILDING PERMIT Application Number . . . . . 04-._00004690= -Date 8/26/0\4 Property Address . . . . . . 78850 CITRUS APN: 772-101-011- Application description . . . DWELLING - SINGLE FAMILY DE`I'ACHED�\",.� Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation . . . . 349736 Owner Contractor ------------------------ CAPITAL PACIFIC HOLDINGS ------------------ ------ CAPITAL PACIFIC HOLDING, INC. 4100 MACARTHUR BLV STE 200 200 SOUTH MAIN ST, STE #300 NEWPORT BEACH CA 92660 CORONA CA 92882 (909) 279-2447 WCC: EAGLE PCF INS WC: 1S0312202 09/12/04 CSLB: 740745 09/30/05 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 CRC # BEDROOMS 4.00 FIRE SPRINKLERS NO GARAGE SQ FTG 965.00 PATIO SQ FTG 1448.00 NUMBER OF UNITS 1.00 FIRST FLOOR SQ FTG 3856.00 ------------------------ -- Permit . . . . . . BUILDING PERMIT Additional desc Permit Fee . . . . 1514.50 Plan Check Fee 984.43 Issue Date . . . . Valuation . . . . 349736 Qty Unit Charge Per Extension BASE FEE 639.50 250.00 3.5000 THOU BLDG 100,001-500,000 875.00 ------------------------------------------7----------------------------------- Permit . . . . . . MECHANICAL Additional desc Permit Fee 114.50 Plan Check Fee 28.63 Issue Date . . Valuation . . . . 0 Qty Unit Charge Per Extension P.O. Box 1504ICE VOICE (760) 777-7012 7$-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 041- �(ofi Date: '0 Applicant: chi ct or Enginger:IV Applicant's Mailing Address: ]7_Arch_��itector Engin er's Address: ic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION Code a affirm icen natty 11 perjury that I am licensed provisions ter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals /`Code, and my License in full force and effect. 7 icense Class icense No. Dateh �'%�^Q ��Go tractort W/r1/%` e_ 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 fora permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): U 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 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. 7A 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 issu d. y wor}c�rs' compensation insurance carrier and I certify that, in Me performance of the work for which this emit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, anda ee that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those pro�ony WARNING: FAILURE TO SECURE WORKERS' COMFIENSATION 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 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 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 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 in ati n 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 o ent u on the above -men .oned propetty for inspection purposes. Date�Signature (Applicant or Agent . a b. Page 2 Application Number . . . . . 04-00004690 Date 8/26/04 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 . . . . 169.26 Plan Check Fee 42.32 Issue Date . . . . Valuation 0 Qty Unit Charge Per Extension BASE FEE 15.00 3856.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 134.96 965.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 19.30 ----------------------------------------------------- Permit . . . . . . PLUMBING ---------------------- Additional desc Permit Fee . . . . 198.75 Plan Check Fee 49.69 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 1.00 7.5000 EA PLB WATER HEATER/VENT 7.50 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.0.0 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 -----------I----------------------------------------------------------------- Special Notes and Comments SFD - LOT 11 PLAN 3BR W/CASITA 3856 SF.. 0 Fee summary Charged Permit Fee Total. 2012.01 Plan Check Total 1105.07 Other Fee Total 2912.75 Grand Total 6029.83 Paid Credited Due ---------- ---------- ---------- .00 .00 2012.01 .00 .00 1105.07 .00 .00 2912.75 .00 .00 6029.83 Page 3 Application Number . . . . . 04-00004690 Date 8/26/04 ---------------------------------------------------------------------------- Special Notes and Comments PERMIT DOES NOT INCLUDE BLOCK WALLS, POOL, SPA, -DRIVEWAY APPROACH OR TEMP POWER. ------------------------------------------------'---------------------------- Other Fees . . . . . . . . . ART IN PUBLIC PLACES -RES 374.34 DIF COMMUNITY CENTERS -RES 97.00 DIF CIVIC CENTER -. RES 366.00 ENERGY REVIEW FEE 98.44 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 34.97 DIF STREET MAINT FAC -RES 15.00 DIF TRANSPORTATION - RES 1098.00 Fee summary Charged Permit Fee Total. 2012.01 Plan Check Total 1105.07 Other Fee Total 2912.75 Grand Total 6029.83 Paid Credited Due ---------- ---------- ---------- .00 .00 2012.01 .00 .00 1105.07 .00 .00 2912.75 .00 .00 6029.83