04-4994 (SFD)TAW
,t 4 4Q"
4
TAMPICO
ALIFO_RNIA, 9,2253
BUILDING PERMIT
APN:
Application description
Property Zoning . . . . .
Application valuation
BUILDING & SAFETY DEPARTMENT
(760).777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
c04-0000-4994Date 6/21/04
60582 SILVER TORCH CIR
764-270-999-73 -300233-
DWELLING - SINGLE FAMILY DETACHED
MEDIUM HIGH DENSITY RES
1.66621
Owner
.Contractor
SHEA LA QUINTA
SHEA HOMES,.INC.
C/0 JEFF MCQUEEN
81260 AVENUE 62
8800 N GAINEY CENTER
350 LA QUINTA
CA 92253
SCOTTSDALE
AZ 85258 (760)' 777-6005
-WCC: NTL UNION
INS -
WC: -7165833
08/01/04
CSLB: 672285
06/30/05
CCC: B
--------------------------
Structure Information -------------------------
Construction Type . .
. . . TAPE V - NON RATED.
Occupancy Type. . . .
. . . DAELLG/LODGING/CONG <=10
Flood Zone . . . . .
. .. . NON -AO FLOOD ZONE
Other struct info . .
. . . CODE EDITION
2001 CBC
F -RE SPRINKLERS
NO
GARAGE SQ FTG ,
539:00
PATIO—SQ FTG. ;
537:0:0
NUMBER OF`UNITS
1.00
F`RST FLOOR SQ FTG
1843.00
Permit . . . . . .
BUILDING PERMIT.
Additional desc
Permit Fee . . . .
874.00 Plan Check Fee
568.10
Issue Date
Valuation
16662--
6662_Qty
QtyUnit Charge
Per
Extension
BASE FEE
639.50
67.00 3.5000
THOU BLDG 100,001-500,000
234.50
.
Permit . . . . . .
MECHANICAL,
Additional desc
Permit Fee
77.00 Plan Check Fee
19.25
Issue Date
Valuation
0
Qty Unit Charge Per r Extension
P.O. BOX 1504 •
VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
Applicant's Mailing Address:
or
or Enqineer's Add
Lic. No.:l CL �l `161
Date:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm enalty of perjury that I am licensed under provi so C�pter 9 com�ncing with Section 7000) of Division 3 of the Business and Professionals
Code, and my Lic is in full force and effect. F Il
License Cl ss �� License No.
Date -6 V !tom Contractor"'�
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 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 Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ 1 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.
have1ar�v-I will maintain w ers' compensation in
sur as requid by Section 3700 of the Labor Code, for the performance of the work for which this permit is
/issl�Q �y�ypdcers' co n tion i�eurance c
Came w �U 1'► 1Policy Numb
_ I certify that, in the pe ormance of the work for w c I 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 tha , i I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
n forth 'th comply with tho
/Date `-� Dplican ,
WARNING: FAILURE TO SECURE WORKERS' 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 wo being performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void i ork is not commenced within 180 days from date of issuance of such permit, or
cessation of work for 180 days will subject permit to ca ellation.
I certify that 1 have read this application and state that the above inf ion is cor I agree to comply with all city and county ordinances and state laws relating to building
const , and h reby authorize representatives of this cou nter pon a ve / tio�ned.prrooperty for inspection purposes.
M t (✓ -
.,,.,Date ` g�nature (Applicant or Agent):
Page
2
Application
Number .
. . .
. 04-00004994 Date
6/21/04
Qty
Unit Charge
Per
Extension
BASE FEE
15.00
2..00
9.0000
EA
MECH FURNACE <,=100K
18.00
2.60
9.0000
EA
MECH B/C <=3HP/100K BTU
18.00
3.00
6.5000
EA
MECH VENT FAN
19.50
1.00
6.5000
EA
MECH EXHAUST HOOD
6.50
Permit .
. . . . .
ELEC-NEW RESIDENTIAL
Additional
desc
Permit Fee
. . . .
90.29 Plan Check Fee
22.5
Issue Date
. . . .
Valuation,
0
Qty
Unit Charge
Per
Extension
BASE FEE
.15.00
1843.00
.0.350
ELEC NEW RES -'l OR 2 FAMILY
64.5=
539.00
--
.0200
ELEC GARAGE OR NON-RESIDENTIAL
10.78
. -------------
Permit
-----------
---------------------------------------
PLUMBING
-----------
Additional
desc
Permit Fee
. . .
129.00 Plan Check Fee
32.25
Issue Date
. . . .
Valuation . . . .
- 0
Qty
Unit Charge
Per
Extension
BASE FEE
15.00
10.00
6.0000
EA
PLB FIXTURE
60.00
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
6.00
.7500
EA
PLB GAS PIPE >=5
4.50
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 . . . .
C.
Qty
Unit Charge.
Per
Extension
BASE FEE
15.00
Special Notes
and Comments
SFD.- LOT
73, PLAN -5505A/22
SF BAY @ •.,
a
Page 3
Application Number .. . . . .
04-00004994 Date
6/21/04
Special Notes and Comments
MBR/83 SF GARAGE EXT./315 SF
EXT. PATIO
PERMIT DOES NOT.INCLUDE BLOCK
WALLS,
POOL, SPA OR DRIVEWAY APPROACH.
1843 SF.
Other Fees . . . . . .
ART IN PUBLIC PLACES -RES
.00
DIF COMMUNITY CENTERS -RES
97.00
DIF CIVIC CENTER - RES
366.00
ENERGY REVIEW -.FEE
56.81
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
16.66
DIF STREET MAINT FAC -RES
15.00
DIF TRANSPORTATION - RES
1098.00
Fee summary Charged
Paid Credited
Due
Permit Fee Total 1185.29
.00 .00
1185.29
Pl-an Check Total 642.17
.00 .00
642.17
Other Fee Total 2478.47
.00 .00
2478.47
Grand Total 4305.93
.00 .00
4305.93