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05-3605 (SFD)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 05-00003605 Property Address: .81713 ULRICH �DR APN: 764-270-999-77 -300234- Application description: DWELLING - SINGLE FAMILY DETACHED Property Zoning: MEDIUM HIGH DENSITY RES Application valuation: 187396 Applicant: .-,Architect or Engineer: C 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. Licens CI s: B4, Li, cense No.: 672285 e: ntractor: •.��N�` OWNER -BUILDER DECLARATION 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 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.). (_ 1 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.). ( 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:��DA LQPERMIT Owner: SHEA LA QUINTA C/O JEFF MCQUEEN 8800 N GAINEY CENTER 350 SCOTTSDALE, AZ 85258 Contractor: SHEA HOMES, INC. 81260 AVENUE 62 LA QUINTA, CA 92253 (760)777-6005 Lic. No.: 672285 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/12/05 SEP 13 2005 CITY OF LA QUINTA FINANCE DEPT. 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. 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 NTL UNION INS Policy Number 6436568 I certify that, in the performance4beco rk for which this permit is issued, I shall not employ any person in any manner so as tsubject to the workers' compensation laws of California, and agreethab cct to the workers' compensatctt to the workers' compensation provisions of Section 700 ofthe Lab e, shh comply with those provisions. lit 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. 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 Ouinta, 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 per4tru sation of work for 180 days will subject permit to cancellation. 1 certify that I have read this application and state t oveon is correct. I agree to comply with all city an county ordinances and state laws relating ildin cohereby authorize representatives o unttit enter upon he above -men prop f inurposes. Bate: ► nature (Applicant or Ag Application Number . . . . . 05-00003605 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 CBC FIRE SPRINKLERS NO GARAGE.SQ FTG 478.00 PATIO SQ FTG 178.00 NUMBER OF UNITS 1.00 ---------------------------------------------------------------------=------ 1ST FLOOR SQUARE FOOTAGE 2174.00 Permit . . BUILDING PERMIT Additional desc . Permit Fee . . . . 926.50 Plan Check Fee 602.23 Issue Date Valuation . . . . 181091 Expiration Date 2/08/06. Qty Unit Charge Per Extension BASE FEE 639.50 82.00 3.5000 ------------------------------------------------------------ THOU. BLDG 100,001-500,000 ---------------- 287.00 Permit . . . MECHANICAL Additional desc Permit Fee 77.00 Plan Check Fee'. 21.63 Issue Date . . . . Valuation . . . . 0 Expiration Date 2/08/06 Qty Unit Charge Per Extension BASE FEE 15.00 2.00 9.0000 EA MECH FURNACE <=100K 18.00 .00 11.0000 EA MECH FURNACE >100K .00 2.00- 9.0000 EA MECH B/C <=3HP/100K BTU 18.00 .00 16.5000 EA MECH.B/C >3-15HP/>10OK-50OKBTU 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 . . . . 100.65 Plan Check Fee . Issue Date Valuation Expiration Date 2/08/06 Qty Unit Charge Per BASE FEE LQPERMIT 3.77 0 Extension 15.00 Application Number . . . . . 05-00003605 Permit ELEC-NEW RESIDENTIAL Qty Unit Charge Per Extension 2174.00 .0350 ELEC NEW RES -1 OR 2 FAMILY 76.09 478.00 .0200 ----------------------------------------- ELEC GARAGE OR NON-RESIDENTIAL --------------------------- 9.56 Permit . . . PLUMBING Additional desc . Permit Fee . . . . 138.00 Plan. Check Fee 34.50 Issue Date . . . . Valuation . . . . 0 Expiration Date 2/08/06 Qty Unit Charge Per Extension BASE FEE 15.00 12.00 6.0000 EA PLB FIXTURE 72.00 1.00 15.0000 EA PLB BUILDING SEWER 15.00 1.00 7.5000 EA PLB WATER HEATER/VENT 7.50 . 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 .0.0 Issue Date . . . . Valuation . . . . 0 Expiration Date 2/08/06 Qty Unit Charge Per Extension BASE FEE 15.00 --------------------------------------------------------------------=-------- Special Notes and Comments SFD - LOT 77, PLAN 5515C, 2174 SF, .INCLUDES 26 SF BOX BAY Q MBR & 26 SF BOX BAY Q NOOK. PERMIT DOES NOT INCLUDE BLOCK -WALL, POOL, SPA OR DRIVEWAY APPROACH. -------------------------------------------------------------=-------------- Other Fees . . . . . ... . . ART IN PUBLIC PLACES -RES .00 DIF COMMUNITY CENTERS -RES 97.00 DIF CIVIC CENTER - RES_ 366.00 ENERGY REVIEW FEE 60.22 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 LQPERMIT Application Number . . . . 05-00003605 - =-------------------------------------------------------------------------- Other Fees . . . . . . . . . STRONG MOTION (SMI) - RES 18.73 DIF STREET MAINT FAC -RES 15.00 DIF TRANSPORTATION - RES 1098.00 Fee summary ----------------- Charged Paid Credited ---------- Due Permit Fee Total ---------- 1257.15 -------------------- .00 .00 1257.15 Plan Check Total 662.13 .00 .0.0 662.13 Other Fee Total 2483.95 .00 .00 2483.95 Grand'Total 4403.23 .00 .00. 4403.23' LQPERMIT