05-2523 (SFD)P.O. BOX 1504
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WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following. declarations:.
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
05-00002523
Property Address:
79773 PARKWAY ESPLANADE _
APN:"
609 -590 -002 -
Application description:
DWELLING - SINGLE FAMI
Property Zoning:
LOW DENSITY RESIDENTIA
Application valuation:
126211
Applicant:
..,�rchitec
4 4 4",
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
MMR- ®6?®
b\ 06
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
LENNAR HOMES OF CALIFORNIA
78401 HIGHWAY 111, STE C
LA QUINTA, CA
LA QUINTA, CA 92253
Contractor: .
LENNAR HOMES OF CALIFORNIA INC
40004 COOK S.T.
PALM DESERT, CA.92211
(951)817=3600
Lit. No 728102
Date: 6/22/05
• -CENSED CONTRACTOR'S''DECLARATION
,LI
I hereby affirm under penalty of perjury that.l am licensed under provisions of Chapter (commencing with
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WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following. declarations:.
Section 7000).of Division 3 of the Business and.Professiona_ Is Code, and my License is in full force and effect.
I have and will maintain a certificate of consent to.self=insure for workers' compensation, as provided
-License Cl ss;-'. B - ., License Ni .:" t728102
_
f. for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
2 .. ?
�J ntractor:.I
sued.
have and will maintain workers' compensation insurance, as required by Section3700 of the Labor
Fr
Code •for the performance of the work.for which this permit is issued. 'My workers' compensation ,
- OWNER.BUILDER DECLARATION
insurance carrier and policy number arc
' I hereby affirm under penalty, at perjury that) am iii cbmptfrom the Contractor,'s State License Law for the
_
Carrier "AON 'RISK SRVC ;: -Policy Number MWC11-114500
following reason (Sec.'7031.5," Business and Professions Code:' Any city or county that requires a permit to
_ I certify: that, in the performanceofthe'work forwhichthis permit is issued, I shall not employ any -
construct, alter; improve, demolish, or repair any structure, -prior to its issuance, also requires the applicant for the
person in any manner so as to.become subject to the workers' compensation laws'of California,
. permit to fili'a signed statement that he or she•is licensed pursuant to the provisions of the Contracto'r's State
and agree that, if'I should become subject to the workers' compensation provisions of Section
- License Law (Chapter 9 Icommencmg with Si:ctiori'7000) of Division 3 of the Business and Professions Code)'or
- 700 of the Labor de; I shall forthwith comply with those provisions.
that he or she'is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
J^ /� "
any applicantfor a permit subjects the applicant to a civil'penaliyof not more than five hundred dollars ($5001.:
ate: " �`� plicant:
( .) 1, as owner ofthe property, or my employees with.wages asAheir sole compensation; will do the work, and
- -
" - -- the structure is'.not intended or offered for sale (Sec. 7044, Business andProfessions Coder The
WARNING: FAILURE TO SECURE WORKR COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractorsfs_tate Licerise Law does not apply to ar owner. of property wh'o'builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMLINAPENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who.does the work himself or herself through his her own employees,• provided that the
•however,
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, .DAMAGES AS PROVIDED FOR IN
improvements'are not intended `or.offared for sale.. If, the building or improvement is sold within
.. SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES: -
one year of completion, the owner-buildd!,rill have.the burden of proving that he or she did not build or
a
improve for the, of sale.).
APPLICANT ACKNOWLEDGEMENT'
1—) I, as owner of the property, am+exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is.hereby made to the Director of Building and Safety for a.permit subject to the
7044, Business and Professions Code: The Contractors'•State License. Law does not apply to'an owner of
conditions and restrictions set forth on this application. '
property who builds or improves there6n, and who contracts for the projects with a contractorlsl licensed
1. Each person upon whosebehalf this application is made, each person at whose request and for
pursuant to the -Contractors' State License Law.).
whose benefit work is performed under or pursuant to'any permit issued as a result of this application,
(_) I am exempt under Sec. , B.&P.C. for this reason
_ 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 fovany act or omission related to the work being "
performed under or following issuance of this permit.
Date: Owner:
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
CONSTRUCTION LENDING AGENCY
permit to cancellation. -
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the -
I certify that I have read this application and state that the above information is correct. I agree to comply.with all
" work for which this permit is issued (Sec. 3097, Civ. C.).
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
oftnis cou ty t enter upon the above-mentioned
op for inspe ion purposes.
Lender's Name:
P 1A
ate: ature (Applicant or Agent)
Lender's Address:
LQPERNIIT
Application Number :.. 05-00002523
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 CRC
#.BEDROOMS
4.00
FIRE,SPRINKLERS
NO
GARAGE SQ:FTG
447.00
PATIO SQ,FTG
53.00
NUMBER -OF UNITS.
1.00.
1ST FLOOR SQUARE FOOTAGE
------------------------------------
2041.00 .
Permit
BUILDING PERMIT
_ Additional• desc .
Permit .:Fee..
734.0.0 734.00 Plan :Check Fee
417.10
Issue'Date
Valuation
126211
Expi-ration;Date
12/19/05
Qty Unit -Charge
Per
Extension
BASE FEE
639.50
.27.00 '3.5000
THOU BLDG'100,001-500,000
94.50
Permit.MECHANICAL
Addifional desc
Permt',Fee
46.00 Plan Check Fee
11.50'
Issue`:;D'ate
Valuzation
0
Expiration Date
12/19/05
Qty Uni-.t 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 <=3`HP/100K BTU
9.00
1.00 6.5000
EA MECH VENT FAN
6.50
1.00- 6.50.00
EA MECH.EXHAUST.HOOD
6.50
Permit
ELEC-NEW RESIDENTIAL
Additional' desc .
Permit Fee
95.38 Plan Check Fee ..
23.85.
Issue Date
Valuation . .
. 0 .
Expiration Date
12/19/05
Qty Unit Charge
Per
Extension
BASE FEE
15.00
2041.00 .0350'
ELEC NEW RES - 1 OR 2 FAMILY
71.44
LQPERMIT
LQPERAiIT
Application Number
.05-00002523
Permit . -ELEC-NEW
RESIDENTIAL
Qty Unit Charge
Per
Extension
447..00 .0200
------------------------------------------
ELEC GARAGE OR NON-RESIDENTIAL
----------------------------------
8.94
Permit . . .
PLUMBING
Additional_desc .
Permit Fee . . . .
164.25 Plan Check Fee'*-.
41.06
Issue Date
Valuation . . . .
0
.,Expiration Date
12/19/.05
Qty Unit Charge
Per
.Extension
BASE FEE
15.00
16-;-00, 6 : 0000
• EA PLB -FIXTURE
96:00.
-,i-.0 15.00:00
EA PLB.BUILDING SEWER
15.00.`
-1.OQ 7..5000
EA` PLB •WP.TER HEATER/VENT
7,. 50
1.00'. 3.0'0;00
EA' PLB°WATER INST/ALT/REP
3-.00
1:.00 9 �OOQO
EA :PLB .L•AWk"SPRINKLER_ -SYSTEM
._" 9.00
5.00 7500:
EA PLB GAS PIPE `>`=5`
3.75
...1 00 15:00.00,
EA PLB .GAS METER
15.00
Permit GRADING.PERMIT°'.
Additidnal>desc .
Permit :Fee
15.00 Plan Check Fee
.00
-Issue Date-
Valuation . . . .
0
Expiration" Date
12/19.%_05
Qty Unit Charge'
Per
Extension'
--------------
BASE FEE
I
15.00
----------------------------
----------------------------------------
Sp
Special Notes-and,,Commerits
-----------
SFD., * LOT :-20 PLAN "-lY.R,,. 2041 SF,: • PERMIT
DOES NOT,INCLUDE BLOCK WALL, POOL, SPA
OR DRIVEWAY APPROACH.::
Other:;Fees .. . ...
-------------------------------------
. . . ART IN PUBLIC•:PLACES-RES
------------
.00
DIF COMMUNITY. -CENTERS -RES
9.7.00
DIF.CIVIC .CENTER. - RES
366.00
_
ENERGY REVIEW FEE
47.71
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
12.62
DIF STREET MAINT FAC -RES
15.00
LQPERMIT
Application Number
. . . .
05-00002523
--------------------------------------------------
Other .Fees . . .
. .
DIF TRANSPORTATION
-------------------------
- RES
1098.00
• Fee summary.
Charged
Paid
Credited
Due
--
Permit Fee Total
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1054.63
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.00
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:00
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1054.63
Plan Check Total
553.51
.00
.00
553.51
Other Fee Total
2465.33
.00
.00
2465::33
Grand Total
4073.47
00
.00
4073:47
r
LQPERMIT