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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 ::.... ....... �.::.::....... ,.,.:.... :................. , ...�.... , ,.... < >.:..:.:.::.:... rN :.>: <. :,.,,,;�....«:.,.,.,::::.,3..:::....,. n...:...... a t: •. cease:v...:.<.>::;;,:.>:<.:<:.,:< ;:...ortcers.:C.. :,... ; ;: � , :.;•..: �.;::..:.,::>.::.:.,.�..::,..::G.ot+.erector:::.;::�;:;::::>:;>::;::>;�,::>«:�;.:::«;�:<>:::.;>:�.::...:,.:.,�t...te.�uatracior.s,L1. ,::..:...,:: :>;Yrada:.f..,Ctass�.f..ce3..an..,,.<..,.................:..,..:.,:.... ,...,....,,.:..._..,.,... . >�<z�> : �'<'` Company Name P Y Classification License Number Exp. Date (xx/xx/xxl Carrier Name (e.g. State Fund, CalComp) Policy. Number arias (Format Varies) Exp. 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