05-3595 (SFD)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
05-000.03595
81761 ULRICH DR
764-270-999-81 -300234-
DWELLLING - SINGLE FAMILY
MEDIUM HIGH DENSITY RES
123721
Tit!t 4'4 Qu4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
SHEA LA QUINTA
C/O JEFF MCQUEEN
DETACHED 8800 N_GAINEY CENTER 350•
SCOTTSDALE, AZ 85258
rchitect or Engineer:
LICENSED CONTRACTOR'S DECLARATION -
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 70001 of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License" Cl 13 Liceicensee No.: 672285
.tag_
te` �1�7 i��ontractor: { 1 "' • �
/- 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 _ 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: io
Lender's Address:
LQPERMIT
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
wi:
Date: 8/11/05
SEP 13 2005
CITY OF LA QUINTA
FlMeorn..
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 performance of the work for which this permit is issued, I shall not employ any
person in any manner so as tobe me subject to the workers' compensation laws of California,
and agree that, if Who beccm ubject to the workers' compensation provisions of Section
t 3,700 of the La4oTlWe, I shall rthwith comply with those provisions.
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 ($100,0001. 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 data 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 statethat t above informatio correct: I agree to comply with all
city ounty ordinances an state laws relating to bu struction, hereby authorize representatives
oqo n)yS inter up the above-mentioned prop pection p oses.
i
ate: gnature (Applicant or Agent)'
LQPERMIT
Application Number . . . . . 05-00003595
------ Structure Information PLAN 4210A W/26 SF BOX
-----
Construction Type . .
. . . TYPE V - NON RATED
Occupancy Type . .
. DWELLG/LODGING/CONG <=10
Other struct info . .
. . . CODE EDITION 2001
## BEDROOMS
3.00
FIRE SPRINKLERS, NO
GARAGE SQ 7TG
474.00
PATIO SQ FTG
214.00
NUMBER OF UNITS
1.00
----------------------------------------------------------------------------
1ST FLOOR SQUARE FOOTAGE
1381.00
Permit . . .
BUILDING PERMIT
Additional desc .
Permit Fee . . . .
723.50 Plan Check Fee
117.57
Issue Date . . . .
Valuation . . . .
123721
Expiration Date
2/07/06
.Qty Unit Charge
Per
Extension
BASE FEE
639.50
24.00 3.5000
----------------------------------------------------------------------------
THOU BLDG 100,001-500,000
84.00
Permit . . .
MECHANICAL
Additional desc .
Permit Fee . . . .
65.50 Plan Check Fee
4.10
Issue Date . . . .
Valuation
0
Expiration.Date
2/07/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 9.0000
EA MECH FURNACE <=100K
9.00
1.00 9.0000
EA MECH B/C <=3HP/100K BTU
9.00
4".00 6.5000
EA MECH VENT FAN
26.00
1.00 .6.5000
--------------------------------------------------------------------=-------
EA MECH EXHAUST HOOD
6.50
Permit . . .
ELEC-NEW RESIDENTIAL
Additional desc .
Permit Fee . . . .
72.82 Plan Check Fee
4.55'
Issue Date . . . .
Valuation
0
Expiration Date
2/07/06
Qty Unit_Charge
Per
Extension
BASE. FEE
15.00
1381.00 .0350
ELEC NEW RES - 1 OR 2 FAMILY
48.34
474.00 .0200
ELEC GARAGE OR NON-RESIDENTIAL
9.48
k
LQPERMIT
Application Number .
. . . . 05-00003595
Extension
----------------------------------------------------------------------------
Permit
. ...
PLUMBING
---------------------------------------------7------------------------------
Special
Notes and Comments
Additional
desc .
81 Plan 4210A (1381 SF) w/MBR
Box Bay
Permit Fee
. . . .
122.25
Plan Check Fee
7.64
Issue Date
APPROACH. 75% REDUCTION TO
Valuation
0
Expiration
Date
2/07/06
----------------------------------------------------------7-----------------
Other Fees
Qty Unit Charge
Per
Extension
97.00
BASE
FEE
15.00
9.00
6.0000
EA PLB
FIXTURE
54.00
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
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
---------------------------------------------7------------------------------
Special
Notes and Comments
SFD Lot
81 Plan 4210A (1381 SF) w/MBR
Box Bay
(26 sgft).PERMIT DOES NOT
INCLUDE
POOL, SPA, BLOCK WALLS OR
DRIVEWAY
APPROACH. 75% REDUCTION TO
PLAN CHECK
FEES DUE TO MULTIPLE
ISSUANCE
OF SAME PLAN TYPE
----------------------------------------------------------7-----------------
Other Fees
. . . . . . . . . ART IN PUBLIC PLACES -RES
.00
DIF COMMUNITY CENTERS -RES
97.00
DIF CIVIC CENTER- RES
366.00
ENERGY REVIEW FEE
11.76
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
12.37
DIF STREET MAINT FAC -RES
15.00
DIF TRANSPORTATION - RES
1098.00
LQPERMIT
Application Number . . . . . 05-00003595
Fee summary Charged Paid Credited Due
Permit Fee Total 999.07 .00 .00 .999.07
Plan Check Total 133.86 .00 .00 133.86
Other Fee Total 2429.13 .00 .00 2429.13
Grand Total 3562.06 .00 .00 3562.06