04-7480 (SFD)l000
T44,4a".
BUILDING &6 SAFETY DEPARTMENT
P.O. Box 1504 (760),777-7012
O� OF TY�9 78-495 CALLE TAMPICO
_FAX (760).777-7011
O LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-715,3
BUILDING PERMIT.,
0 pp "a�i- Number` 04-000017480 Date 2/14%05
Address .57750 TROON WY;
762=3607006- - -
plication description DWELLING. SINGLE FAMILY DETACHED
Property Zoning'. LOW DENSITY RESIDENTIAL
Application valuation 480693'.
Owner Contractor
SOUTHERN HILLS DEVELOPMENT 'OWNER-
5516.1.SOUTHERN HILLS _
LA QUINTP, CA 92253 `
----- Structure Information 5522 SQ. FT. SFD -----
Construction Type TYPE V - NON RATED
Occupancy Type' DWELLG/LODGING/LONG <=10, f
Flood Zone NON-AO FLOOD'ZONE
Other struct info •CODE EDITION •. 2001,CBC
- # BEDROOMS f 5.00
FIRE .SPRINKLERS NO .
GARAGE SQ FTGa._,;•, r. '1`07.7:00.
PATIO SQ FTG " _� 1008.00
,NUMBER OF UNITS 1.00
-1ST FLOOR SQUARE.. FOOTAGE '5522.00
--------------------------------------------------------------
Permit BUILDING PERMIT s
Additional desc - �, '
Permit Fee 1973.00 '�. Plan Check Fee_ 1282.45'
Issue Date Valuation 480693
Qty Unit Charge Per Extension
y r BASE FEE 639:50
3.81".00 3.5000-THOU BLDG 100-,010.1-500,000 ` 1333.50.
Permit ELEC-NEW RESIDENTIAL-
Additional desc
Permit.Fee . . . 244.81 Plan Check Fee 61.20
Issue Date , Valuation _ r 0
Qty Unit. Charge.. Per Extension
BASE FEE 15.00
5522. 00 0350 ELEC, NEW .RES - 1 -OR 2 FAMILY• 1 . 193.27
1077.00 :'0200 ELEC GARAGE OR NON-RESIDENT.IAL 21.54
•1..00 15 0000 EA --ELEC TEMPORARY POWER POLE 15.00
-----.--------------- F..--=---------.---- ,;- «---------
PermitGRADING' (PERMIT.
Additional desc'
Permit Fee . . . 15.00 "Plan Check-Fee-. .00
P.O. Box 1504ICE 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: pf % `f30 Date: 3- Z- c:tS-
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
Architect or Engineer's Address:
-4MIN, tal
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
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 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.).
0 1, 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 f9ason -on
i
Date ')3^2'DS�
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury of the following declarations:
I have and will maintain a ce icate 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
t)o I certify that, in the performance of the work for which this pemtit 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 shouldpe e subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
WARNING: FAILURE TO SECURE WORKERS' P95MPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSANDr 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, 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 mply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this county to enter X0"
n th hove me ion property for inspection purposes.
Date—' /Signature or Agent):- -
t
.
• i
i
Page
2
Application Number
. .
. 04-00007480 Date
2/14/05
Issue Date
Valuation
0
Qty Unit
Charge
Per
Extension.
BASE FEE
15.00
---------------------
Permit
---------------,--.-----------t---------------------------
MECHANICAL
Additional desc
'
Permit Fee
; .�
152.00 Plan Check Fee
°. 38.00
Issue Date .
. . .
Valuation
0
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
9.,00.
6.5000
EA
MECH VENT FAN
Y58.50
1.00
6.5000
EA
MECH EXHAUST'HOOD _
6.50
Permit
PLUMBING`
Additional desc
Permit Fee
.297.75 Plan Check Fee
74.44
Issue Date
w _Valuation . . . .
0
Qty M Unit
Charge
''Per
Extension
BASE FEE:
,15.00
30.00
610000
EA
PLB FIXTURE
180.00.'
1_00
15.0000
EA
PLB BUILDING SEWER
15..00
5,.00
6:0000
EA'
PLB ROOF DRAIN
30.00
3.00
7.5000
EA
PLB WATER HEATER/VENT-
22.50
1.00
.3:0000
EA
PLB WATER INST/ALT/REP
3.00
1'.:00
9:0000
EA
PLB-LAWN SPRINKLER SYSTEM
9:00
11.00
-7500
EA
PLB GAS PIPE >=5
8.25
1.00
15:.0000
EA
PLB GAS METER
15.00-
----------------------------------
Special Notes
and Comments'"
--- ---------------------------
`
5522 sq. ft.-sfd
this•prmit
does not
include pool,&
spa block
walls
or
'
driveway approach.
'
Other.Fees
.
. . .'
•ART}IN PUBLIC PLACES-RES
701.73
DIF COMMUNITY CENTERS-RES
97.00
DIF CIVIC CENTER - RES
366.00
ENERGY REVIEW FEE
128.25•
DIF FIRE PROTECTION-RES
97.00
GRADING PLAN CHECK FEE
.00
DIF LIBRARIES - RES
225.00
DIF PARK MAINT FAC - RES
5.00
Page .; 3
Application Number
04-00007480.
Date .2/14/05
Other Fees . . .
. . .
DIF 'PARKS'/REC - RES
502.00
STRONG MOTION,(SMI) - RES
48.06
DIFFSTREET'MAINV FAC -RES
15.06
DIF TRANSPORTATION— RES
1098.00
Fee 'summary .
Charged
Paid Credited
Due
Permit Fee Total'
2682.56
00 .00
2682.56
Plan Check Total
.1456.09
.00 .00
•1456.09
Other Fee Total
4
3283.04
.00 .00
3283.04
' Grand Total
7421.69
00, .00
7421.69
Coachella Valley Unified School District
83-733 Avenue 55, Thermal, CA 92274
(760) 398-5909 — Fax (760) 398-1224.
This Box For District Use Only
DEVELOPER FEES PAID
AREA:
AMOUNT
LEVEL ONE AMOUNT:
LEVEL TWO AMOUNT:
MITIGATION AMOUNT:
COMM/IND. AMOUNT:
OATF,
RF.r.RPT-
CHF.CK N-
:INITIALS'
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Project Name: S'outhertiH,lls D'evelopmerit Date: March 2, 2005
Owner's Name: Southern Hills Development Phone No. (760) 771-3497
t Project Address: 57-750 Troon Way
Project Description: Single Family Residence
APN: 762-360-006 Tract #: Lot #'s:
Type of Development: Residential KIN Commercial Industrial
Total Square Feet of Building Area: 5522 Sq. Ft.
Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement under
penalty of perjury and further represents that he/she is authorized to sign on behalf of er/developer.
Dated: 03/02/05 Signature:
SCHOOL DISTRICT'S REQUIREMENTS FOR THE OVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN
ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE) r I
Education Code Gov. Code Project Agreement Existing Not Subject to Fee:
17620 ' 65995 Approval Prior to 1/1/87 Requirement
Number of Sq.Ft. 5522
Amount per Sq.Ft. $ 2.68
Amount Collected $ 14,798.96 `
Building Permit Application Completed: Yes/No
By: Carey M. Carlson, Asst. Supt:; Business Services
Certificate issued by: ' Leticia C. Torres, Facilities Clerk Signa e:
NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND �IrA ENT OF FEES
Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requirertgat this District provide (1) a written notice to the
project appellant, at the time of payment of school fees, mitigation payment or other exactions (".Fees"), of the 90 -day period to protest the imposition of these
Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall serve to
advise you that the 90 -day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees -or performance of any other
requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as herein set forth, whether payable at this
time or in whole or in part prior to issuance of a'Certificate of Occupancy. As in the latter, the 90•days starts on the date hereof. This Certificate of
Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School District, and up
to three (3) such extensions may be granted. At such time as this Certificate expires, if a building permit has not been issued for the project that is the subject
of this, Certificate, the owner will be reimbursed all fees that were paid to obtain this Certificate of Compliance.
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