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04-3804 (SFD)T -V* 4 4 Q" BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number . . . . . 04-00003804 Date 9/17/04 Property Address . . . . . . 51020 AVENIDA VALLEJO APN: 773-063-023-22 -000000- Application description . . . DWELLING - SINGLE FAMILY DETACHED Property Zoning. . . . . COVE RESIDENTIAL Application valuation . . 126426 Owner Contractor GARCIA ALBERT F MTB.INC. 51040 AVENIDA VALLEJO 50855 WASHINGTON ST STE 149 LA QUINTA CA 92253 LA QUINTA CA 92253 (760) 272-6044 WCC: STATE FUND WC:' 1795095-2004 08/01/05 CSLB: 838089 05/31/06 CCC: B -------------------------- 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 # BEDROOMS 3.00 FIRE SPRINKLERS NO GARAGE SQ FTG 526.00 NUMBER OF UNITS 1.00 FIRST FLOOR SQ FTG 2030.'00 ---------------------------------------------------------------------------- Permit . . . BUILDING PERMIT Additional desc _ Permit Fee . . . 6.78.00 Plan Check Fee� Date V 4`40.70 ��;��, 1 Issue Dataluation 1810229 Expiration Date 26 Qty Unit Charge Per Extension BASE FEE CITY C�:Lc sC �G 639. 50 11.00 3.5000 THOU BLDG 100,001-500,000 FO VIO2 Dn. 3-8.50 ----------------------------------------------- ---------------------------- Permit . . . . . . ELEC-NEW RESIDENTIAL Additional desc Permit Fee . . . . 111.57 Plan Check.Fee 27.89 Issue Date Valuation 0 Expiration Date 9/17/05 Qty , Unit Charge Per Extension P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 0y` 380 4 Date: Applicant: I Architect or Engineer: Applicant's Mailing Address: A Y6 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. 83 'r a� License Class %3 License No. �f Date 9-2? y� Contractor l j �AL%e_l . OWNER -BUILDER DECLARATION 1 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 sate (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.). U 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 1 am exempt under Sec. . BA P.C. for this reason Date WORKERS' 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 c� issued. My w rkers' compensation insurance carrier and policy number are: Cartier d /�?� t' U N(Z_policy Number) "t 01 !rite Sr 490 _ 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—cl ( —Z- Z � U YApplicant //'14 WARNING: FAILURE TO SECURE WO KERS' 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 under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend; indemnity 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 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 with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above -mention y for inspection purposes. Date'? —Z- Z �� ] Signature (Applicant or Agent): �S • 3 1 Page 2 Application Number '. . . . . 04-000:03804 Date 9/17/04 Qty Unit Charge Per Extension BASE FEE 15.00 2030.00 .0350' ELEC NEW RES -.l OR 2 FAMILY 71.05 526.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 10.52 1.00 15:00.00 EA ELEC TEMPORARY'POWER POLE 15.00 Permit . . . . GRADING PERMIT Additional desc .. Permit Fee, 15.00 Plan Check Fee .00 Issue .Date Valuation 0 Expiration Date 9/17/05 . Qty Unit Charge Per Extension BASE FEE 15.00 �' .. - - - - - -- - - - - •- - - - - Permit Permit - - - - - .- - - - - -. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -' - - - - - - ------------ MECHANICAL ----------- -Additional desc Permit Fee `59.00 Plan.Check Fee 14.75 Issue_�Dat'e Valuation 0. .Expiration Date 9/17/05 Qty Unit Charge Per Extension BASE PEE 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 3.00- 6.5000 EA MECH VENT.FAN 19.50 1.00 6.5000 EA MECH EXHAUST HOOD 6.50 ---------------------------------------------------------------------------- Permit PLUMBING Additional desc Permit Fee .141:75 Plan. Check Fee 35.44 Issue Date Valuation 0 Expiration Date'. 9/•17/05 ` Qty. -,Unit Charge Per Extension BASE FEE 15.00 12.00 6.0000 EAPLB •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 3.0000 EA PLB WATER INST/ALT/REP 3.00 1.00 . 9.0000 EA PLB LAWN"SPRINKLER SYSTEM 9.00 Page' f Application Number 04-X00003804 Date 9/17/p4 Qty Unit,Charge Per Extension 7.00 7500 -EA PLB GAS PIPE, >=5 -•5.25 1.00 15.0000 .EA :•PLB -GAS METER 15":00 --------------------- L ---------------------------------------------- ---------- Special --------.-- ---------;----------------------------------------------------- Special Notes and Comments " 203.0 S.F. SFD PERMIT DOES -NOT INCLUDE BLOCK WALL,POOL/SPA OR DRIVEWAY APPROACH ' ------------------------------------------------------------------ Other Fees. . ' ART IN PUBLIC .PLACES -RES' y .00 DIF COMMUNITY CENTERS -RES 97.00 DIF CIVIC CENTER - RES 366.00 ENERGY REVIEW FEE '44:0.7 DIF FIRE PROTECTION -RES 97.00 `GRADING' PLAN .CHECK FEEL00- DIF LIBRARIES RES .225.00 DIF PARK MAINT FAC - RES 5 ..00 .DIF.PARKS/REC --RES 502.00 COVE 'PRECISE PLAN -FEE 100.00 STRONG MOTION•(SMI) - RES 12.64 „ DIF STREET MAINT - FAC -RES 15,.'00, DIFTRANSPORTATION - RES 1.098.00 Fee summary Charged Paid" Credited Due Permit Fee Total 1005..32 .00 .•00 .1005.32 ` Plan Check .Total.. 518.78 250.00' .00 268.78. Other Fee Totali 2561.71 .00 00 2561.71 Grand Total , 4085:81. 250.00 ' .00• 3835.81