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04-5405 (SFD)T-Vf 4 44" -, P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT (760).777-7012 . "'FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-71.53 BUILDING PERMIT •A Application Number . . . 04-0000.5405,,, Date 7/-13/04 Property Address 81110 SHINNECOCK.HILLS APN;:. 7627340-003- - - Application -description . . . DWELLING - SINGLE FAMILY DETACHED Property Zoning ,. LOW.DENSITY RESIDENTIAL Application valuation 316193 Owner Contractor SOUTHEAN-HILLS DEVELOPMENT SOUTHERN HILLS DEVELOPMENT INC 55161 SOUTHERN_ HILLS 81070 CHANTICLEER,DR LA'QUINTA CA 92253 LA QUINTA CA -922.53 (760) 771-3497 WCC: EXEMPT WC: EXEMPT 05/31/05 CSLB: 838041 05/31/06 CCC: B -------------------------- Structure Information -----------------=------- Construction Type -TYPE.V - NON RATED Occupancy Type . . . . . DWELLG/LODGING/LONG <=•10 .Flood Zone •. . . . . . . . NON -AO FLOOD ZONE Other struct info CODE EDITION 2001 CBC FIRE SPRINKLERS NO GARAGE SQ FTG 970.00 PATIO SQ FTG, 996.00 NUMBER: -OF UNITS 1.00 FIRST -FLOOR SQ FTG 3512.00 -----------------------------------`----------------------------------------- Permit . . . BUILDING.PERMIT Additional desc ,. Permit Fee . . 1399.00 -Plan Check' Fee 227.-34 Issue Date. Valuation ... 316193 .Expiration Date 1/13/05 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• lan Check Fee 8.28 Issue Date . . . tion 0 'Expiration Date 1/13/05 Qty Unit Charge Per. Extension 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: J`lo!5 I Date: Applicant: - Applicant's Mailing Address: PT - Architect or Engineer's Address: Lic. No. - BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION... I 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 c ' and my Licens� s in full force and effect. 1 Qi / •,(i i[icense Class 11 -License No. &3 R& `1 1 ate OWNER -BUILDER DECLARATION .i I hereby affirm under penalty of pe ry 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 7d00):& 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 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 WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent t67self-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: - Cartier Policy Number 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 to become. subject to the workers' ' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700of the Labor Code, 1 shall forthwith comply with those provisions. /.ate '7� -D pican " ewARNING: FAILURE TO SECUR ORKERS' COMPENSATION- COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND ' CIVIL FINES UP TO ONE HUNDR D THOUSAND DOLLARS ($900,000), 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 -1 heregy affirn 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 Lenders 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. 't 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 on the abmentioned roperty for inspection purposes. Date �%—d ignature (Applicant or Age Page 2 Application Number . . . . ..04-00005405 Date 7/13/04 Qty 'Unit'Char .e Per Extension BASE PEE 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. 39.00 1.00 6.5000 EA- MECH EXHAUST HOOD 6.50 ---------------- Permit . . ------------------------------------------------- . ELEC-NEW RESIDENTIAL ----------- Additional ,desc Permit . Pee. •: 157.84 Plan Check Fee 9A7 ''Issue Date Valuation 0 .Expirat,ion Date 1/13/05 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 0R'NON-RESIDENTIAL. 19.92 Permit . . . . . . PLUMBING Additional desc .. Permit Fee 191.25 Plan Check Fee 11.77 Issue Date. Valuation _ 0 Expiration Date 1/13/05 J .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'. 0 0 ---------------------------------------------------------------------------- Permit . . . . . . GRADING PERMIT Additional desc Permit Fee. 15.00 Plan Check Fee 00 Issue Date . . . . Valuation ,., 0 Expiration Date 1/13/05 Qty Unit Charge Per Extension C+ r ' Page 3 . Application,Number . . . . . .04-00005405 Date 7/13./04 Qty. Unit Charge Per Extension =--------------------------------------------------------------------------- BASE FEE , 15.00 Special Notes and Comments SFD - LOT 11, PLAN,6 3512 SF. PERMIT DOES NOT INCLUDE BLOCK'WALLS,POOL, SPA OR DRIVEWAY'APPROACH. 75% REDUCTION TO PLAN CHECK FEE DUE TO MULTIPLE ISSUANCE OF SAME PLAN TYPE - 7 --------------------------------------------------------- Other Fees . . .. . . . . . . ART IN PUBLIC PLACES -RES 7 ----------- 290.48 DIF COMMUNITY CENTERS -RES 97.00 DIF CIVIC CENTER - RES .366.00. ENERGY REVIEW FEE 22.73 DI.F 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 Fee summary ----------------- Charged: Paid Credited Due Permit Fee Total ---------- . 1895.59 ------------------------------ .00 .00 1895.59 'Plan Check Total 257.26 .00 .00 257.26 Other Fee Total 2749.82 .00 .00 2749.82 Grand Total 4902.67 .00 .00 4902.-67 -Cert�fica to Ofocc u anc 0 ,- Fri Lrr. .' y- .,.;�� -i • - r ., f S 1... r`. � o -Building. & Safety Department %This Certificate is issued p"ursuant to the requirements -of Section 109 of the California Building Code,�'xertifying that, at� the time of issuance, . this structure was in "compliance with , the • provisions of -the Building Code and the various ordinances of the :City_�regulating � �buildirig ' construction: and/or use: BUILDING ADDRESS: 81-110'SHINNECOCK HILLS Use classification: SINGLE FAMILY DWELLING y,,; ti.' , .: Building Permit No.:.04-5405 Occu anc Gr'o'up -.-,R3 _ T e-of:Construction: VN ;Land. -Use Zone:, RL Owner pf Building:, SOUTHERN HILLS DEVELOPMENT: Address: 78-150 CALLE TAMPICO.-STE. 101 ' City, ST, ZIP: LA QUINTA, CA 92253` By:,GARY -HARTMAN Date: JULY -28,-2005' L- Building Official POST IN A CONSPICUOUS PLACE - :' k CITY OF LA QUINTA SUB -CONTRACTOR LI T.. JOB ADDRESS PERMIT NUMBER . OWNER i . (( BUILDER '�FDO' U�V� r✓t l� i �� I p 'This form shall be posted on the job 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 iob. 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