04-5404 (SFD).1�
M
P.O. Box 1504
78-495 CALLE TAMPICO
,tLA QUINTA, .CALIFORN;IA 92253
BUILDING PERMIT
BUILDING & SAFETY DEPARTMENT
(760).777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
Application Number . . . . 04-00.0.05404 Date 7/12/04
Property Address 81090 SHINNECOCK HILLS
APN: 762-340-001- - -
Application description DWELLING - SINGLE FAMILY DETACHED
Property Zoning . . . . LOW DENSITY RESIDENTIAL
Application valuation 316193
Owner Contractor
SOUTHERN HILLS DEVELOPMENT SOUTHERN HILLS DEVELOPMENT INC
55161 SOUTHERN HILLS '81070 CHANTICLEER DR
LA QUINTA. CA 9225.3 LA-QUINTA. •CA 92253
(760) 771-3497
WCC EXEMPT
WC: EXEMPT 05/31/05
CSLB: 838041 05/31/06
CCC: B
-- - - - - - - - - -= -- - ------7- 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 9.7.0 .. 0 0
- PATIO.SQ FTG 996:00
NUMBER OF UNITS 1.00
j FIRST FLOOR SQ FTG' 3512..00
Permit BUILDING PERMIT'
,Additional desc
Permit,Fee 1399.00 Plan Check Fee 909.35
Issue Date Valuation 316193
Expiration Date.. 1/12/05
Qty Unit Charge Per Extension
BASE FEE 639.50
217.00 3.5000 THOU BLDG 100,001-500,000 759.50
Permit MECHANICAL
Additional desc
Permit Fee 132.50 Plan Check Fee 33.13
Issue Date D b a u 0
Expiration Date. 1/12/05
Qty Unit Charge Per JUL 152004 Extension
CRYOF .►,,..
1
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: D 41- Sq0Date: ?— Je— - 014
LArchitect
Applicant: or Enaineer: .
Applicant's Mailing Address:
Architect or Engineer's Address:
No. r! Z! 07�
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
1 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
e, and my Licen js in full force -and effect.
cense Class X19 /License No.
Date /I 4011 Contract
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of ped hat 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).):
U 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 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 contractors) licensed pursuant to
the Contractors' State License Law.).
U I am exempt under Sec. , BA P.C. for this reason
Date
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
issued. My workers' compensation insurance carrier and policy number are:
Cartier Policy Number
I certify that, in the perforhance of. the work for which this permit is issued, I shall not employ- p y any person in any manner so as to become subject to the workers'
compensation laws of California nd agree that, if I should become subject to the workers' compensation provisions of Section 37d0 of the Labor Code, I shall
forthwith comply with those p visi s.— —. —Soo
,7 -1y -e
WARNING: FAILURE TO SECUR& ORKERS' COMPENSATION 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, 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.
I certify that I have read this application and state that the above information is 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 to enter u n the above -me property for inspection purposes.
ate f �� 40,f4 Signature (Applicant or Agent): '
Page
2
Application Number
. . . 04-00005404
Date
7/12/04
Qty Unit
Charge
Per
Extension
BASE
FEE
15.00
4.00
9.0000
EA MECH
FURNACE <=100K
36.00
4.00
9.0000
EA MECH
B/C <=3HP/100K BTU
36.00
6.00
6.5000
EA MECH
VENT FAN
i 39.00
1.00
6.5000
EA MECH
EXHAUST HOOD
6.50
--------------------------------------
Permit . . .
. .
EL-EC-NEW.RESIDENTIAL
--------------------------------------
Additional desc
Permit Fee
157.84
Plan Check Fee
39.46
Issue Date . .
. .
Valuation
0
Expiration Date
1/12/05
.
Qty Unit
Charge
Per
Extension
BASE
FEE
15.00
3512.00
.0350
ELEC
NEW RES - 1 OR 2 FAMILY
122.92
996.00
.0200
ELEC'GARAGE
OR NON-RESIDENTIAL
=-
19.92
--------------------
Permit
------
-----------
PLUMBING
--------------------------
-----------
Additional desc
Permit Fee .
. .
191.25
Plan Check Fee ..
47.06
Issue Date . .
. .
Valuation
0
Expiration Date.
1/12/05
Qty Unit
Charge
Per
Extension
BASE
FEE
15.00
20.00
6.0000
EA PLB
FIXTURE
120.00
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
9.00
.7500
EA PLB
GAS PIPE >=5
6.75
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
1/12/05
Qty Unit
Charge
Per
Extension
j
al
i
Page 3
Application Number
04--000054.04 Date
7/12/04
Qty Unit Charge
Per
Extension
BASE FEE
15.00
-----------------------
Special Notes and
------------
Comments
---------------------------
--------------
SFD - LOT 9, PLAN
6 3512.SF.'PERMIT DOES
NOT INCLUDE BLOCK
WALLS, POOL,
SPA OR
DRIVEWAY APPROACH
----------------------------------------------------------------------------
Other Fees
. . . . . .
ART IN PUBLIC PLACES -RES
290.48
DIF COMMUNITYrCENTERS-RES
97.00
DIF CIVIC CENTER - RES
'366.00
ENERGY REVIEW FEE
90.94
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
31.61 -
DIF STREET MAINT FAC -RES
15.00
DIF TRANSPORTATION - RES
1098.00
Pee summary
Charged
Paid Credited
Due
Permit Fee Total
1895.59
.00 .00
1895.59
Plan Check Total
1029.00
.00 .00
1029.00
Other Fee Total
2818.03
.00 .00
2818.03
Grand Total
5742.62
.00 I .00
5742.62
CITY OF LA QUINTA SUB -CONTRACTOR LIT
-PERMIT NUMBER O�1� 1 t iC� a r4 -nu S BUILDER
JOB ADDRESS OWNER )-
This form shall be posted on the iob with the Building Inspection Card at all times in a conspicuous 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
f t d k.1— must be com leted b an licant "On File". is not an acceptable response.
of buildin Permit. For each applicable trade, all In ormatlon re ues e
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