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05-2523 (SFD)P.O. BOX 1504 ---- - - - - -— 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 ---- - - - - -— 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 ---- - - - - -- 1054.63 ---- - - - - -- .00 ---- - - - - --- :00 --- - - - - - - 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