10-1398 (SFD)P.O. BOX 1504 T4'!t 4
t!'dG�Gv
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Numbemr '-10-00001398 1 Owner:
Property Address: 81435 COLUMBUS WY JLS PROPERTIES LLC
APN: 767-690-008- - - 3409 HANOVER
Application description: DWELLING - SINGLE FAMILY DETACHED DALLAS, TX 75225
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 473895
Applicant:
Architect or Engineer:
..VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Contractor:
TAYLOR CONSTRUCTION INC, DAVID
306 N.W. EL NORTE PKWY, #490
ESCONDIDO, CA 92026=J
�I (760) 533-8262
Lic. No.: 773623
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I licensed under provisions of Chapter 9 (commencing with
Section 7 001 of Division 3 of the Busines n Professionals Code, and my License is in full force and effect.
Licen Cla s: Li se No.: 773623
ate: ntractor:
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 (5500).:
(_ 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
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 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.).
(_ ) I am exempt under Sec. , B.&P.C. for this reason
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: T]
LQPERMIT
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 required 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 policy number are:
Carrier EXEMPT Policy Number EXEMPT
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as t become subject to the workers' compensation laws of California,
and agree that, if I should c me subject to the workers' c pensation provisions of Section
700 of the Labor Code sh II forth it c y with t provisions.
E plicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATIO OVERAGE 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.
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, indemnity '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.
1 certify that I have read this application and state thobuildig
ormation is correct. I agree to comply with all
city and county ordinances and state laws relating touction, and here authoriz representatives
of chjs cou ty t enter upon the above-mentioned prctio 0
4ate�L Si ature (Applicant or Agent):
Application Number . . . . . 10-00001398
Structure Information
Construction Type . .
. . . TYPE V, UNPROTECTED
Occupancy Type . .
. . . DWELLG/LODGING/CONG <=10
Other struct info . .
. . . CODE EDITION
2007/08 ENERGY
# BEDROOMS
4.00
FIRE SPRINKLERS
NO
GARAGE SQ FTG
1032.00
PATIO SQ FTG
952.00
NUMBER OF UNITS
.00
----------------------=---------------------7-------------------------------
1ST FLOOR SQUARE FOOTAGE
5458.00
Permit . . .
BUILDING PERMIT
Additional desc .
Permit Fee . . . .
1948.50 Plan Check Fee
1266.53
Issue Date . . . .
Valuation . .
. . 473895
Expiration Date
10/25/11
Qty Unit Charge
Per
Extension
BASE FEE
639.50
374.00 3.5000
----------------------------------------------------------------------------
THOU BLDG 100,001-500,000
1309.00
Permit . . . MECHANICAL
Additional desc . .
Permit Fee . . . .
194.00 Plan Check Fee
48.50
Issue Date . . . .
Valuation . .
. . 0
Expiration Date
10/25/11
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 9.0000
EA MECH FURNACE <=100K
9.00
4.00 11.0000
EA MECH FURNACE >100K
44.00
2.00 9.0000
EA MECH B/C <=3HP/100K BTU
18.00
3.00 16.5000
EA MECH B/C >3-15HP/>100K-500KBTU 49.50
8.00 6.5000
EA MECH VENT FAN '
52.00
1.00 6.5000
----------------------------------------------------------------------------
EA MECH EXHAUST HOOD
6.50
Permit . . .
ELEC-NEW RESIDENTIAL
Additional desc . .
Permit Fee . . . .
241.67 Plan Check Fee
60.42
Issue Date . . . .
Valuation . .
. . 0
Expiration Date . .
10/25/11
Qty Unit Charge
Per
Extension
BASE FEE
15.00
LQPERMIT
Application Number . . . . 10-00001398
Permit . . . . . . ELEC-NEW RESIDENTIAL
Qty Unit Charge Per Extension
5458.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 191.03
1032.00 ..0200 ELEC GARAGE OR NON-RESIDENTIAL 20.64
1.00 15.0000 EA ELEC TEMPORARY POWER POLE 15.00
----------------------------------------------------------------------------
Permit . . . PLUMBING
Additional desc .
Permit Fee 384.75
Issue Date . . . .
Expiration Date . 10/25/11
Plan Check Fee . . 96.19
Valuation . . . . 0
Qty
Unit Charge
Per
15.00
-------------------------------------------------------- --------------------
Special Notes and Comments
Extension
5458 SF SINGLE FAMILY DWELLING (4818SF
MAIN LIVING + 640 SF CASITA] 952 SF
BASE
FEE
15.00
27.00
6.0000
EA
PLB
FIXTURE
162.00
1.00
15.0000
EA
PLB
BUILDING SEWER
15.00
22.00
6.0000
EA
PLB
ROOF DRAIN
132.00
3.00
7.5000
EA
PLB
WATER HEATER/VENT
22.50
1.00
3.0000
EA
PLB
WATER INST/ALT/REP
3.00
1.00
9.0000
EA
PLB
LAWN SPRINKLER SYSTEM
9.00
15.0.0
.7500
EA
PLB
GAS PIPE >=5
11.25-
1.251.00
1.00
----------------------------------------------------------------------------
15.0000
EA
PLB
GAS METER
15.00
Permit . .
Additional desc . .
Permit Fee . . . .
Issue Date . . . .
Expiration Date . .
GRADING PERMIT
15.00 Plan Check Fee . . .00
Valuation . . . . 0
10/25/11
Qty Unit Charge Per
Extension
BASE FEE
15.00
-------------------------------------------------------- --------------------
Special Notes and Comments
5458 SF SINGLE FAMILY DWELLING (4818SF
MAIN LIVING + 640 SF CASITA] 952 SF
PATIO, 1032 SF GARAGE. TYPE V -B
CONSTRUCTION. R-3 OCCUPANCY. 2007 CODES
2008 ENERGY. 2008 DIF.**PERMIT DOES NOT
INCLUDE BLOCK WALLS, FENCES, SWIMMING
POOLS, SPA, DRIVEWAY APPROACH and
BBQ'S** 2008 DIF.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . ART IN PUBLIC PLACES -RES
684.74
BLDG STDS ADMIN (SB1473)
19.00
DIF COMMUNITY CENTERS -RES
74.00
LQPERMIT
Application Number . . . . . 10-00001398
---------------------------------------------------------------------
Other Fees . . .
. . . . . .
DIF CIVIC CENTER _ RES
-------
995.00
ENERGY REVIEW FEE
126.65
DIF FIRE PROTECTION -RES
140.00
DIF LIBRARIES - RES
355.00
MULTI -SPECIES (MSHCP) FEE
1284.00
DIF PARK MAINT FAC - RES
22.00
DIF. PARKS/REC - RES
892.00
STRONG MOTION (SMI) - RES
47.39
DIF STREET MAINT FAC -RES
67.00
DIF TRANSPORTATION - RES
1930.00
Fee summary
-----------------
Charged
----------
Paid Credited
---------- --- - ------ ----------
Due
Permit Fee Total
2783.92
.00 .00
2783.92
Plan Check Total
1471.64
1000:00 .00
471.64
Other Fee Total
6636.78
.00 .00
6636.78
Grand Total
10892.34
1000.00 .00.
9892.34
LQPERMIT
CITY OF LA QUINTA SUB -CON TR CTOR LIST
JOB ADDRESS d �7'� �OrGI i�'►f%G1S PERMIT NUMBER _ OWNER �f � ' 90�07 BUILDER, L//%,/� �`��l/% �G�%-rte !h►�
This form shall be Dosted on the Job with the Building IgsRection Card at all times in a consicuous place. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list. must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance. y
of building permit._ For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
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Mc GEE SUR VEYING, INC.
45-100 Golf Center Pkwy, Ste .G, Indio, CA 92201
Phone (760) 342-2249 — Fax (760) 342-5044
June 15, 2011
City of La Quinta
78-495 Calle Tampico
La Quinta, CA 92253
Re: Form Certification — 3657
Pursuant to your request a field survey was conducted on the above referenced project to
determine the vertical location of the building forms. The above mentioned were found
as follows:
LOT
ADDRESS
FORM (DES)
FORM (FIELD)
16 -
81-435 Columbus Way
997.50'
997.46'
Sincerk.Gee
Wayn
L.S. 5479
Z
L