05-3577 (SFD)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: Q 05-00003577 !
Property Address: 81749 ULRICH DR
APN: 764-270-999-80 -300234-
Application description: DWELLING - SINGLE FAMILY DETACHED
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 170639
Applicant: chitect or Engineer:
Com
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that 1 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: B License No.: 672285
Date ontractor:
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: N
LQPERAUT
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: 8/11/05
u
SEP 131005
CITYOFLA I
FINAAIre QUINTA
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
JLissued.
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 performance4bece
ork for which this permit is issued, I shall not employ any
person in any manner so as to subject to the workers' compensation laws of California,
and agree that, if ho becect to the workers' compensation provisions of Section
3700ofthshi with those provisions.
t l� PPlic '
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 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 vo' 'f work is not commenced
within 180 days from date of issuance of such permit, or cessatio o work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the a information ' rrect. I agree to comply with atl
jitynd countgordinanucp ws relating to c structionhereby authorize representatives
un mentioned p pertyorecti ses.
nt or Agen .'
Application Number . . . . . 05-00003577
LQPERMIT
Structure Information
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
FIRE SPRINKLERS NO
GARAGE SQ FTG
576.00
PATIO SQ FTG
177..00
NUMBER OF UNITS
1.00
-----------------------------------------------------------------------------
1ST FLOOR SQUARE FOOTAGE
1943.00
Permit ... .
BUILDING PERMIT
Additional desc .
Permit Fee . . . .
888.00 Plan Check Fee
144.30
Issue Date
Valuation . . . .
170639-
70639Expiration
ExpirationDate
2/07/06
Qty Unit Charge
Per
Extension
BASE FEE
639.50
71.00 3.5000
-------------------------------------------------------------
THOU BLDG 100,001-500,000
--------------
248.50
Permit . . .
MECHANICAL
Additional desc .
Permit Fee . . . .
70.50 Plan Check Fee
4.41
- Issue Date
Valuation
0
Expiration Date
2/07/06 '
Qty Unit Charge
Per
Extension .
BASE FEE
15.00
2.00 9.0000
EA MECH FURNACE <=LOOK
18.00
2.00 9.0000
EA MECH B/C <=3HP/100K BTU
18.00
2.00 6.5000
EA MECH VENT FAN.
13.00
1.00 6.5000
---------=------------------------------------------------------------------
EA MECH EXHAUST HOOD
6.50
Permit . . .
ELEC-NEW RESIDENTIAL
Additional desc .
Permit Fee . .
94.53 Plan Check Fee
5.91
Issue Date
Valuation
0
Expiration Date
2/07/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1943.00 .0350
ELEC NEW RES - 1 OR 2 FAMILY
68.01'
576.00 .0200
ELEC GARAGE OR NON-RESIDENTIAL
11.52
LQPERMIT
Application Number . . . . . 05-00003577
Permit
PLUMBING
Additional desc .
Permit Fee . . . .
152.25 Plan Check Fee
8.95
Issue Date
Valuation
0
Expiration Date
2/07/06
Qty Unit Charge.
Per
Extension
BASE FEE
15.00
14.00 6.0000
EA PLB FIXTURE
84.00
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
5.00 .7500
EA PLB GAS PIPE >=5
3.75
1.00 15.0000
------------------7---------------------------------------------------------
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
2/07/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
----------------------------------------------------------------------------
Special Notes and Comments
SFD - LOT 80, PLAN 4520A,
1943 SF/ 255
SF CASITA,BOX BAY Q MBR -26 SF 4- GARAGE
EXT - 88 SF.PERMIT DOES
NOT INCLUDE
BLOCK WALLS,POOL, SPA
OR DRIVEWAY
APPROACH. 75% REDUCTION TO PLAN CHECK
FEES DUE TO 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
14.43
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 A SMI) - RES
17.06
DIF STREET MAINT FAC -RES
15.00
LQPERMIT
Application Number . . . . . 05-00003577
-----------------------------------------------
Other Fees . . .
. . . . . .
----------------------
DIF TRANSPORTATION - RES
-------
1098.00
Fee summary
Charged
----------
Paid
----------
Credited
--------------------
Due-
-----------------
Permit Fee Total
1220.28
.00
.00
1220.28
Plan Check Total
163.57
.00
.00
163.57
Other Fee Total
2436.49
.00
.00
2436.49
Grand Total
3820.34
.00
.00
3820.34
LQPERMIT