14-0275 (SFD)—P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
A —F—t•
T4ht 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
14-00000275
58857'JEREZ
764-200-999-17 -316813-
DWELLING - SINGLE FAMILY DETACHED
LOW DENSITY RESIDENTIAL
454592
Architect or Engineer:
V
--------------------------------------------------
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 C , n 'cense is in full force and effect.
License lass: B nse No.: 76 87
/bat �� ontractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License L 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.).
( ) 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: h
Lender's Address: 1>
LQPERMIT
Owner:
T.D. DESERT DEVELOPMENT
81570 CALBONEROS
LA QUINTA, CA 92253
Contractor:
TD DESERT DEVELOPMENT
P.O. BOX 1716
LA QUINTA, CA 92247
(760)771-1941
LiC. No.: 762987
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/13/14
-------------------------------- - - ----- / -----
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 CA REST MUTUAL Policy Number CRO1134517
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,
nd agree that, if I should ernrbb 'ect to th rkers' comp provisions of Section
3700 of the Labor Co , I shall forthw h ply w th those o. P_
ate!' pplicam:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNL FUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE UNDRED 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 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.
certify that I have read this application and state that ove informati ' correct. I agree to comply with all
city and co ty ordinances and state laws relatin building construction, and reby authorize representatives
of thi co% ty t ante pon the above-mentio property for inspection purposes.
ate: Li Si ature (Applicant or gent):
Application Number .
. . . . 14-00000275
Permit
. . .
BUILDING 2013
Additional
desc .
Permit Fee
. . . .
716.23
Plan Check Fee
.00
Issue Date
. . . .
Valuation . . .
. 454592
Expiration
Date . .
12/10/14
Qty Unit Charge
Per
Extension
BASE
FEE
573.43.
255.00
----------------------------------------------------------------------------
.5600
THOU BLDG
$200,001-$1M
142.80
Permit
. . .
ELECTRICAL
2013
Additional
desc . .
Permit Fee
. . . .
251.46
Plan Check Fee
.00
Issue Date
. . . .
-
Valuation . . .
. 0
Expiration
Date . .
12/10/14
Qty Unit Charge
Per
Extension
1.00
23.8300
EA ELEC
SERVICES
23.83
1.00
23.8300,EA
ELEC
TEMP POWER POLES
23.83
1.00
143.0000
LS ELEC
NEW RES, FIRST 1 KSF
143.00
5.00
----------------------------------------------------------------------------
12.1600
EA ELEC
NEW RES, ADD'L 1 KSF
.60.80
Permit
. . . MECHANICAL
2013
Additional
desc . .
Permit Fee
476.70
Plan Check Fee
.00
Issue Date
Valuation . . .
. 0
Expiration
Date
12/10/14
Qty Unit Charge
Per
Extension
5.00
35.7500
EA MECH
FURNACE
178.75
1.00
11.9200
EA MECH
APPL REP/ALT
11.92
5.00
35.7500
EA MECH
CONDENSER/COMP
178.75
8.00
11.9200
EA MECH
VENT FAN
95.36
1.00
----------------------------------------------------------------------------
11.9200
EA MECH
EXHAUST HOOD
11.92
Permit
PLUMBING 2013
Additional
desc . .
Permit Fee
. . . .
369.51
Plan Check Fee
.00
Issue Date
. . . .
Valuation . . . .
0
Expiration
Date
12/10/14
Qty Unit Charge
Per
Extension
24.00
11.9200
EA PLBG
FIXTURE/TRAP
286.08
1.00
11.9200
EA PLBG
BUILDING SEWER
11.92
LQPERMIT
Application Number . . . . . 14-00000275
Permit . . . . . . PLUMBING 2013
Qty Unit Charge Per
Extension
2.00 11.9200 EA PLBG WATER HEATER/VENT
23.84
1.00 11.9200 EA PLBG WATER INST/ALT/REP
11.92
1.00 35.7500 LS PLBG GAS SYS, 5+ OUTLETS
35.75
--------------------------------------------------------- --------------------
Special Notes and Comments
STANDARD PLAN 26 FOR ANDALUSIA,5131 SQ.
FT. WITH CASITA AND OPT..FIREPLACES.,THIS
PERMIT DOES NOT INCLUDE POOL, SPA,
BLOCKWALLS, FIRE -PIT, BBQ, WATER
FEATURES, OR DRIVEWAY APPROACH.HOME IS
FIRE SPRINKLED PER 2013 CRC CODES.
April 16, 2014 2:24:06 PM jjohnson.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . ART IN PUBLIC PLACES -RES
636.48
BLDG STDS ADMIN (SB1473)
19.00 .
DIF COMMUNITY CENTERS -RES
129.00
DIF CIVIC CENTER - RES
942.00
DIF FIRE PROTECTION -RES
433.00
DIF LIBRARIES - RES
344.00.
- MULTI -SPECIES (MSHCP) FEE
1278.00
PLAN CHECK, ELECTRICAL
100.84
DIF PARK MAINT FAC - RES
40.00
PLAN CHECK, MECHANICAL
257.38
PLAN CHECK, SFD GRADING
143.00
PLAN CHECK, PLUMBING
348.05
DIF PARKS/REC - RES
2048.00
BLDG PC 200K -1M
1538.83
STRONG MOTION (SMI) - RES
45.46
TUMF: RESIDENTIAL
1837.44
DIF STREET MAINT FAC -RES
116.00
DIF TRANSPORTATION - RES
2842.00
Fee summary Charged Paid Credited
----------------------------------------------------------
Due
Permit Fee Total 1813.90 .00 .00
1813.90
Plan Check Total .00 .00 .00
.00
Other Fee Total 13098.48 .00 .00
13098.48
Grand Total 14912.38 .00 -i1.00
14912.38
LQPERMIT