05-0706 (SFD)Tdf 4 449wgu.
BUILDING & SAFETY DEPARTMENT
Box 1504 (760).777-7012
�5 CALLE TAMPICO FAX (760) 777-7011
UINTA, CALIFORNIA 9225.3 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
nber . . . . .. 05-00000706 Date 5/05/05
Is 79032 TOM.FAZIO LN.,S
APN: 766-042-007- - -
Application description . . . DWELLING -'SINGLE FAMILY DETACHED
Property Zoning . . . . LOW DENSITY RESIDENTIAL
Application valuation .358552
Owner Contractor
--------------------------------- ---------------------------------
JOHN SHAW Owner
78-034-CALLE BARCELONA
LA QUINTA, CA 92253
P.O. Box 1504�� VOICE (760) 777-7012
T-Vf
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number:
App (cant:
Applicant's Mailing Address:
Date:
Architect or Engineer:
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
Code, and my License is in full force and effect.
License Class License No.
Date 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
y 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.).
(10 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. , B,&R-Z for this reason 1
Date
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the follows eclarations:
_ 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.
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 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 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Date Applicant
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 underbr 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 Y^all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this county toir p•Pn the aboxe-mentioned prop rty or inspection purposes.
Date Signature (Applicant or Agent):
- - - - - - - - - - - - -
Charge
Per
- - - - - - - - - - - - -
r q Application Number .
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
. . . . 05-00000706
- - - - - - - - - - - - -
----------------------------------------------------------------------------
BASE
------ Structure Information
4100 SQ. FT. SFD
-----
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
101.50
# BEDROOMS
4.00.
Issue Date . .
FIRE SPRINKLERS NO
Valuation . .
GARAGE SQ FTG
930.00
PATIO SQ FTG.
680.00'
NUMBER OF UNITS
1.00
---------------------------------------------------------------'-------------
1ST FLOOR SQUARE FOOTAGE
4100.00
Permit . . . . . .
BUILDING PERMIT
BASE
Additional desc
15.00
3.00
Permit Fee . . . .
1546.00 Plan Check Fee
1004.90
Issue Date . . . .
Valuation . . . .
358552
Expiration Date
11/01/05
27.00
Qty Unit Charge
Per
Extension
VENT FAN
BASE FEE
639..50
259.00 3.5000
----------------------------------------------------------------------------
THOU BLDG 100,001-500,000
906.50
Permit . . . . . .
ELEC-NEW RESIDENTIAL
r
Additional desc
Permit Fee . . . .
192.10 Plan Check Fee
48.03
Issue Date . . . .
Valuation
0
Expiration Date
11/01/05 ,
Qty Unit Charge
Per
Extension
BASE FEE
15.00
4100.00 .0350`
ELEC NEW RES - 1 OR 2 FAMILY
143.50
930.00 .0200
ELEC GARAGE OR NON-RESIDENTIAL
18.60
1.00 15.0000
----------------------------------------------------------------------=------
EA ELEC TEMPORARY POWER POLE
15.00
Permit . . . GRADING PERMIT
Additional desc
Permit Fee . . . . 15.00
Issue Date . . . .
Expiration Date 11/01/05
Plan Check Fee .00
Valuation . . . . 0
Qty Unit
Charge
Per
Extension
----------------------------------------------------------------------------
BASE
FEE
15.00
Permit .
. .
MECHANICAL
Additional desc
Permit Fee . .
. .
101.50
Plan Check Fee
25.38
Issue Date . .
. .
Valuation . .
. 0
Expiration Date-.
11/01/05
Qty Unit
Charge
Per
Extension
BASE
FEE
15.00
3.00
9.0000
EA MECH
FURNACE <=100K
27.00
3.00
9.0000
EA MECH
B/C <=3HP/100K BTU
27.00
4.00
6.5000
EA MECH
VENT FAN
26.00
1.00
6.5000.
EA MECH
EXHAUST HOOD
6.50
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -'- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Application Number . . . . . 05-00000706
----------------------------------------------------------------------------
-----------------------------------------------------------------------------
Permit . . . . . .
PLUMBING
Additional desc
Permit Fee . . . .
178.50 Plan Check Fee
44.63
Issue Date . . . .
Valuation
0
Expiration Date
11/01/05
Qty Unit Charge
Per
Extension
BASE FEE
15.00
18.00 6:0000
EA PLB FIXTURE
108.00
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
8.00 ..7500
EA PLB GAS PIPE >=5
6.00
1.00. 15.0000
EA PLB GAS METER
15.00
--------------------------- -----------------------------------------
Special Notes.and Comments
4100 SQ. FT. SFD THIS
PERMIT DOES NOT
INCLUDE POOL & SPA BLOCK
WALLS OR
DRIVEWAY APPROACH. 3/22/05
6:46:02 AM
JJOHNSON
----------------------------------------------------------------------------
,Other_Fees . . . . .
. . . . ART IN PUBLIC PLACES -RES
396.38
DIF COMMUNITY CENTERS -RES
97.00
DIF CIVIC CENTER - RES
366.00
ENERGY REVIEW FEE
100.49
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
.35.85
DIF STREET MAINT FAC -RES
15.00
DIF TRANSPORTATION - RES
1098.00
Fee summary Charged
Permit Fee Total 2033.10
Plan Check Total 1122.94
Other Fee Total 2937.72
Grand'Total 6093.76
Paid Credited Due
.00 .00 2033.10
500.00 .00 622.94
.00 .00 2937.72
500.00 .00 .5593.76
P.O. BOX 1504 APP1 1IdATI N :ONLY -
Buildin cy 78-495 CALLE TAMPICO 121105
Address roM FQZio �E �J, LA QUINTA, CALIFORNIA 92253 f
Owner L. OF -'
CITY LA QUINTA
Mailing BUILDING: TYPE'CONST.�J ANCE DEPT.
Address `
. '1 A.P. Number
City Zip Tel
Legal Description
Contractor Project Description
Address
State Lic.I City
& Classif. Lic. #
Arch., Engr., DF
Designer GS(G�CJ
Address 'jTD Tel.
City Zip State
q-Z2Fb',2j Luc. # --
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031 . 5,Business and Professions Code: Any city or county which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to 'its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he 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 (E500).
I: 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
y
rovement is sold within one year or completion, the owner -builder will have the burden
ing that he did not build or improve for the purpose of sale.)
s owner of the property, am exclusively contracting with licensed contractors to con -
the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
doesnot apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licen,%8dpursuapJ to the Contractor's License Law.)
I'! I am exempt under Sec. 4 1 B.A/P.C. for
Date
WORKER COMPENSATION DECLARATION
I hereby affirm that I he"
a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insuran e, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
(l Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed iIthe fmit fs f one hundred dollars (E100) valuation
or less.)
I certify that in the perform ork hich this permit is issued, I shall not
employ any person i ny me er oe subject to ers' Compensation
Laws 1 C i
Date � her
NOTICE TO APPLICANT: If, aft 1making this eruticate of Exemption you should become
subject to the Workers' Comp psation provisions of the Labor Code, you must forthwith
comply with such provisions or thi hermit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
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 city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
Sq. Ft. No. No. Dw.
Size I �� Stories Units
Add ❑ Alter ❑ Repair ❑ Demolition ❑
imated
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
AMOUNT in
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = BUILDING DEPARTMENT YELLOW = APPLICANT PINK = FINANCE
Comments
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkwaM residential additions under 5
00 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile ho
mes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.24 X 4,100 S.F. or $9,184.00 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued.
Fees Paid By O/C -Wells Fargo & Co., Molly Check No. 0737704681
Name on the check Telephone 720/273-8091
Funding Residential
By Dr. Doris Wilson
Superintendent .
Fee collected /exe ted by
Signature ,
is Barbuzza
Payment Recd
$9,184.00
' s0.00
Over/Under
NOTICE: Pursuant to Government Code Section M20(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees o
r other payment identified above will begin to run from the date on which the building or instalkition permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original -Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
CERTIFICATE OF COMPLIANCE
� �r<�rt�,�y
Desert Sands Unified School District
o�►�,.�0
'
47950 Dune Palms Road
ERMUDA DUNES Q
Date
5/5/05.
La Quinta, CA 92253
Cr RANCHO MIRAGE .
V� INDIAN WELLS
No.
27161
(760) 771-8515
�PALM
�LA QUINTA
INDIO
Owner
John Shaw
APN #
766-042-007
Address
79-032 Tom Fazio
Jurisdiction
La Quinta
City
La Quinta Zip 92253
Permit #
Tract #
Study Area
Type
Single Family Residence
No. of Units
1
Lot # No. Street
S.F. Lot # No.
Street S.F.
Unit 1
79032 Tom Fazio
4100 Unit 6
Unit 2
Unit 7
Unit 3
Unit 8
Unit 4
Unit 9
Unit 5
Unit 10
Comments
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkwaM residential additions under 5
00 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile ho
mes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.24 X 4,100 S.F. or $9,184.00 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued.
Fees Paid By O/C -Wells Fargo & Co., Molly Check No. 0737704681
Name on the check Telephone 720/273-8091
Funding Residential
By Dr. Doris Wilson
Superintendent .
Fee collected /exe ted by
Signature ,
is Barbuzza
Payment Recd
$9,184.00
' s0.00
Over/Under
NOTICE: Pursuant to Government Code Section M20(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees o
r other payment identified above will begin to run from the date on which the building or instalkition permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original -Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting