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05-2598 (SFD)`'-P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT -------------------------------------- - - - - -- - - - - - 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 Code, and my License is in full force and effect. License CI ss: B License No.: 701039 /Dat � ntractor. � ` OWNER -BUILDER DECLARATION j 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 ($500).: 1 _ 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 ISec. 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 contractorls) licensed pursuant to the Contractors' State License Law.). 1 _ ) 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: LQPERAIIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: - 6/27/05 -----7----------------------------------------- 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. X,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 STATE FUND Policy Number 1648813 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, Iagree that, if I should become subject to the workers' compensation provisions of Section. 3 00 of the Labor Code, I shall f with comfy with those pr isions. �te: scant: WARNING: WAILURE TO SECURE WORKER 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. 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. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and c my o finances and state laws relating to building cons ruction, and hereby autho ' e representatives of this/�/co/my t enter upon t above-mentioned pro pert sp tion purQoses. DateC v ignature (Applicant or Agent): a Application Number: 05-00002598 Owner: Property Address: 48363 STILLWATER DR IVANHOE LA QUINTA COVE APN: 658-140-999-120 -29436 - .0/O R BARRY MCCOMIC Application description: DWELLING - SINGLE FAMILY DETACH D 7979 IVANHOE AVE STE 550 Property Zoning: LOW DENSITY RESIDENTIAL 2005 A JOLLA, CA 92037 Application valuation: 199884 'UL 1 J CITY QF LAQUINTA CITY ontractor: Applicant: Architect or Engineer: �I�PICED RANS WEST HOUSING, INC. -7 9968 STREET, STE 4102 SAN DIEGO, CA 92131 (858)653-3003 Lic. No.: 701039 -------------------------------------- - - - - -- - - - - - 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 Code, and my License is in full force and effect. License CI ss: B License No.: 701039 /Dat � ntractor. � ` OWNER -BUILDER DECLARATION j 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 ($500).: 1 _ 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 ISec. 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 contractorls) licensed pursuant to the Contractors' State License Law.). 1 _ ) 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: LQPERAIIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: - 6/27/05 -----7----------------------------------------- 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. X,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 STATE FUND Policy Number 1648813 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, Iagree that, if I should become subject to the workers' compensation provisions of Section. 3 00 of the Labor Code, I shall f with comfy with those pr isions. �te: scant: WARNING: WAILURE TO SECURE WORKER 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. 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. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and c my o finances and state laws relating to building cons ruction, and hereby autho ' e representatives of this/�/co/my t enter upon t above-mentioned pro pert sp tion purQoses. DateC v ignature (Applicant or Agent): a Application Number 05-00002598 LQPEFNIIT 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 CRC # BEDROOMS 3.00 FIRE SPRINKLERS NO GARAGE SQ FTG 704.00 PATIO SQ FTG 315.00 NUMBER OF UNITS 1.00 ---------------------------------------------------------------------------- 1ST FLOOR SQUARE FOOTAGE 3180.00 Permit BUILDING PERMIT Additional desc"., Permit Fee . . °989.50 Plan Check Fee 160.80 Issue Date Valuation . . . . 199884. Expiration Date 12/24/05 Qty Unit Charge Per Extension BASE FEE 639.50 100.00 3.5000 ---------------=--------------------------- THOU BLDG 100,00.1-500,000 --------------------------=------ 350.00 Permit . . . MECHANICAL Additional desc .. Permit Fee . . . . 90.00 Plan Check Fee .. 5.63 Issue Date. Valuation ''0 Expiration Date 12/24/05 Qty Unit.Charge Per Extension BASE FEE 15.00 2.00 9.0000 EA MECH FURNACE <=100K 18.00 2.00 9.0000 EA MECH B/C•<=3HP/100K BTU 18.00 5.00 6.5000 EA MECH VENT FAN 32.50 1.00 6.5000 EA MECH EXHAUST HOOD 6.50 Permit " ELEC-NEW RESIDENTIAL Additional desc . Permit Fee . . . . 140.38 Plan Check Fee 8.78 Issue Date . . . . Valuation . . . . 0 Expiration Date 12/24/05 Qty. Unit Charge Per. Extension BASE FEE 15.00 3180.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 111.30 LQPEFNIIT I LQPERn4IT y . Application Number . . . . . 05-00002598 Permit . . . . . . ELEC-NEW RESIDENTIAL Qty Unit Charge Per Extension .704.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 14.08 Permit . . PLUMBING Additional desc . Permit Fee 178.50 Plan Check Fee .. 11.16 Issue Date Valuation . . . . 0 Expiration Date 12/24/05 Qty Unit Charge .Per Extension BASE FEE 15.00. 18.00 6.0000 EA PLB FIXTURE 108.00 1.00 15.00.00 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 8.00 .7500 EA PLB GAS PIPE >=5 6.00 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 12/24/05 Qty Unit Charge Per Extension L BASE FEE 15.00 --------------------------------------------------------------------------- Special Notes and Comments. SFD - LOT 120 PLAN 1B,3180 SF. PERMIT DOES NOT INCLUDE BLOCK WALLS, POOL, SPA OR DRIVEWAY.APPROACH. 75% PLAN CHECK FEE REDUCTION APPLIED FOR MULTIPLE ISSUANCE OF SAME PLAN TYPE. -- -------------------------- Other Fees . . . . . ------------------------------------ . . ART IN PUBLIC PLACES -RES ------------ .00 DIF COMMUNITY CENTERS -RES .97.00 DIF CIVIC CENTER - RES 366.00 / ENERGY REVIEW FEE. 16.08 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 LQPERn4IT LQPERA11T Application Number . . . . .. 05-00002598 ----------------------- Other Fees . . . ------------- . . . . . . ---------------------------------------- STRONG,MOTION (SMI) - RES 19.98 DIF STREET MAINT FAC -RES 15..00. DIF TRANSPORTATION RES 1098.00 Fee summary- Charged -------------------- Paid Credited ---------- ------- Due Permit Fee Total 1413.38 .00 .00 1413.36 Plan Check Total 186.37 .00 .00 .186.37 Other Fee Total 2441.06 .00 .00, 2441.06 Grand Total 4040.81 .00 .00. 4040.61