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BRES2015-012278-495 CALLE TAMPICO T LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 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 Professions Code, and my License is in full force and effect. License Cl s: B GLLiic�ense No.: 927267 D e: ✓ Cont actor. 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).: (_) 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.). (_) 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: Lender's Address: 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: Polity Number: 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 1 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with t se pro isions. Da �Aplicant: 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 ($100,000). 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 Building Official 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. 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 city to enter upon the above - me nt' ed p opert or inspection purposes. Dat e: �� Signature (Applicant or f: Date: 4/8/2015 Application Number: BRES2015-0122 Owner: Property Address: 80465 CHAMPIONS WY RREF II CWC LAQ LLC APN: 775220021 5927 PRIESTLY DR STE 110 Application Description: THE SIGNATURE PH 1 ESTATES LOT 80 TM 36537 CARLSBAD, CA 92008 Property Zoning: z h Application Valuation: $221,476.60 0 T me � Applicant: Contractor: CALIFORNIA WEST CONSTRUCTION I CALIFORNIA WEST CONSTRUCTION I vy 0 5927 PRIESTLY DRIVE.STE 110 5927 PRIESTLY DRIVE STE 110 n�i D cin CARLSBAD, CA 92008 CARLSBAD, CA 92008 (760)918-6768 ------------'--------------------------------------------------------------------------------- Llc. No.: 927267 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 Professions Code, and my License is in full force and effect. License Cl s: B GLLiic�ense No.: 927267 D e: ✓ Cont actor. 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).: (_) 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.). (_) 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: Lender's Address: 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: Polity Number: 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 1 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with t se pro isions. Da �Aplicant: 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 ($100,000). 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 Building Official 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. 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 city to enter upon the above - me nt' ed p opert or inspection purposes. Dat e: �� Signature (Applicant or f: FINANCIAL •• • -" DESCRIPTION ACCOUNT` QTY AMOUNT PAID PAID DATE ART IN PUBLIC PLACES - RESIDENTIAL 270-0000-43201 0 $53.69 $0.00 METHOD : RECEIPT'# CHECK # CLTD BY Total Paid forART IN PUBLIC PLACES - AIPP: $53.69 $0.00 DESCRIPTION : ACCOUNT QTY AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $9.00 $0.00 : PAID BY ' .: METHOD RECEIPT # CHECK # CLTD BY Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $9.00 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - CIVIC CENTER 252-0000-43200 0 $942.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT -PAID PAID DATE DIF - COMMUNITY CENTERS 254-0000-43200 0 $129.00 $0.00 PAID BY METHOD RECEIPT # CHECK # - CLTD.BY DESCRIPTION , ACCOUNTQTY AMOUNT PAID PAID DATE DIF - FIRE PROTECTION 257-0000-43200 0 $433.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID . PAID DATE DIF - LIBRARIES 253-0000-43200 0 $344.00 $0.00 PAID BY METHOD RECEIPT # CHECK # ;, CLTD :BY DESCRIPTION ACCOUNT ` QTY AMOUNT PAID : PAID DATE DIF - PARK MAINTENANCE 256-0000-43200 0 $40.00 $0.00 PAID BY .. _ METHOD - RECEIPT # CHECK # CLTD BY `DESCRIPTION ACCOUNT. QTY AMOUNT PAID PAID DATE DIF - PARKS/REC 251-0000-43200 0 $2,048.00 $0.00 PAID BY METHOD.. RECEIPT # CHECK # > CLTD BY. DESCRIPTION. - ACCOUNT QTY. AMOUNT : PAID PAID DATE DIF - STREET MAINTENANCE 255-0000-43200 0 $116.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - TRANSPORTATION 250-0000-43200 0 $2,842.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for DIF - SINGLE FAMILY DWELLING: $6,894.00 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE TEMP POWER SERVICE 101-0000-42403 0 $24.17 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT : QTY AMOUNT PAID . PAID DATE TEMP POWER SERVICE PC 101-0000-42403 0. $16.92 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for ELECTRICAL: $41.09 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RESIDENTIAL, EA ADDITION 1,000SF 101-0000-42403 0 $36.99 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RESIDENTIAL, EA ADDITION 1,000SF, PC 101-0000-42600 0 $15.24 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RESIDENTIAL, FIRST 1,000SF 101-0000-42403 0 $145.03 $0.00 PAID BY METHOD RECEIPT# CHECK # CLTD BY DESCRIPTION ACCOUNTQTY AMOUNT PAID PAID DATE RESIDENTIAL, FIRST 1,000SF, PC 101-0000-42600 0 $47.86 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid forELECTRICAL - NEW CONSTRUCTION: $245.12 $0.00 DESCRIPTION ACCOUNT. QTY AMOUNT - PAID PAID DATE CONDENSER/COMPRESSOR 101-0000-42402 0 $72.52 $0.00 PAID: BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE EXHAUST HOOD 101-0000-42402 0 $12.09 $0.00 PAID BY METHOD RECEIPT# CHECK# CLTD BY DESCRIPTION ACCOUNT QTY =AMOUNT PAID PAID DATE FURNACE 101-0000-42402 0 $72.52 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT'QTY . AMOUNT PAID PAID DATE VENT FAN 101-0000-42402 0 $72.54 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for MECHANICAL: $229.67 $0.00' DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE MULTI STRUCTURE PLAN CHECK - EACH 101-0000-42600 0 $48.34 $0.00 PAID BY METHOD RECEIPT # CHECK '# CLTD BY Total Paid for MULTI STRUCTURE PLAN CHECK - EACH: $48.34 $0.00 - DESCRIPTION ACCOUNT = QTY AMOUNT PAID PAID DATE MULTI -SPECIES RESIDENTIAL 0-8 UNITS 101-0000-20310 0 $1,292.00 $0.00 PAID BY METHOD RECEIPT # CHECK #` CLTD BY Total Paid forMULTI-SPECIES RESIDENTIAL $1,292.00 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE NEW CONSTRUCTION PERMIT 101-0000-42400 0 $593.89 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid forNEW CONSTRUCTION PERMIT: $593.89 $0.00 DESCRIPTION ACCOUNT . `- QTY AMOUNT PAID PAID DATE BACKFLOW DEVICE 101-0000-42401 0 $12.09 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE BUILDING SEWER 101-0000-42401 0 $12.09 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY : DESCRIPTION ` ACCOUNT QTY AMOUNT PAID PAID DATE FIXTURE/TRAP 101-0000742401 0 $229.71 $0.00 PAID BY METHOD RECEIPT # CHECK #. CLTD BY DESCRIPTION. ACCOUNT QTY AMOUNT . PAID PAID DATE GAS SYSTEM, 5+ OUTLETS 101-0000-42401 0 $36.26 $0.00 PAID BY - METHOD = RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WATER HEATER/VENT 101-0000-42401 0 $12.09 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT= QTY AMOUNT PAID PAID DATE WATER SYSTEM INST/ALT/REP 101-0000-42401 0 $12.09 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for PLUMBING FEES: $314.33 $0.00 - ' DESCRIPTION ACCOUNT ' QTY AMOUNT PAID PAID DATE SMI - RESIDENTIAL 101-0000-20308 0 $28.79 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid forSTRONG MOTION INSTRUMENTATION SMI: $28.79 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE SINGLE FAMILY DETACHED 224-0000-20320 0 $1,837.44 $0.00 PAID BY METHOD. RECEIPT # CHECK #. CLTD BY Total Paid forTUMF - RESIDENTIAL: $1,837.44 $0.00 TOTALS:00 Description: THE SIGNATURE PH 1 ESTATES LOT 80 TM 36537 Type: BUILDING, RESIDENTIAL Subtype: DWELLING - SINGLE Status: UNDER REVIEW Applied: 4/7/2015 MFA FAMILY DETACHED Approved: 4/8/2015 MFA Parcel No: 775220021 Site Address: 80465 CHAMPIONS WY LA QUINTA,CA Subdivision: PM 20426 Block: Lot: 80 Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $221,476.60 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 ADDRESS1 Details: 3,479 SF DWELLING. 171 SF BALCONY PLAN TYPE 4C LOT 80 [VB/RES-3/CLASS A-FR/13D] THIS PERMIT DOES NOT INCLUDE POOL, SPA, BLOCK WALLS OR DRIVEWAY APPROACH. 2013 CALIFORNIA BUILDING CODES.. CHRONOLOGY CONDITIONS CONTACTS NAME TYPE NAME ADDRESS1 CITY STATE ZIP PHONE FAX EMAIL APPLICANT CALIFORNIA WEST CONSTRUCTION 1 5927 PRIESTLY DRIVE CARLSBAD CA 92008 LBELLOSO@CALWESTC STE 110 OMMUNITIES.COM CONTRACTOR CALIFORNIA WEST CONSTRUCTION[ 5927 PRIESTLY DRIVE CARLSBAD CA 92008 LBELLOSO@CALWESTC STE 110 OMMU.NITIES.COM OWNER RREF II CWC LAQ LLC 5927 PRIESTLY DR STE CBAD ARLS CA 92008 110 FINANCIAL INFORMATION Printed: Wednesday, April 08, 2015 3:23:13 PM 1 of 4 SYST: M S Printed: Wednesday, April 08, 2015 3:23:13 PM 2 of 4 (rowsrSTEMs CLTD DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY . ART IN PUBLIC PLACES - 270-0000-43201 0 $53.69 RESIDENTIAL .$0.00 Total Paid forART IN PUBLIC PLACES - AIPP: $53.69 $0.00 BSAS SB1473 FEE 1 101-0000-20306 1 0 $9.00 $0.00 Total Paid for BUILDING STANDARDS ADMINISTRATION $9.00 $0.00 BSA: DIF - CIVIC CENTER 252-0000-43200 0 $942.00 $0.00 DIF - COMMUNITY 254-0000-43200 0 $129.00 $0.00 CENTERS DIF - FIRE PROTECTION 257-0000-43200 0 $433.00 $0.00 DIF - LIBRARIES 253-0000-43200 0 $344.00 $0.00 DIF - PARK 256-0000-43200 0 $40.00 $0.00 MAINTENANCE DIF - PARKS/REC 251-0000-43200 0 $2,048.00 $0.00 DIF - STREET 255-0000-43200 0 $116.00 $0.00 MAINTENANCE DIF - TRANSPORTATION 250-0000-43200 0 $2,842.00 $0.00 Total Paid for DIF - SINGLE FAMILY DWELLING $6,894.00 $0.00 TEMP POWER SERVICE 101-0000-42403 0 $24.17 $0.00 TEMP POWER SERVICE 101-0000-42403 0 $16.92 $0.00 PC Total Paid for ELECTRICAL: $41.09 $0.00 RESIDENTIAL, EA -101-0000-42403 0 $36.99 $0.00 ADDITION 1,000SF RESIDENTIAL, EA 101-0000-42600 0 $15.24 $0.00 ADDITION 1,000SF, PC Printed: Wednesday, April 08, 2015 3:23:13 PM 2 of 4 (rowsrSTEMs Printed: Wednesday, April 08, 2015 3:23:13 PM . 3 of 4 SYSTEMS CLTD DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD. PAID BY BY RESIDENTIAL, FIRST 101-0000-42403 0 $145.03 $0.00 1,000SF RESIDENTIAL, FIRST 101-0000-42600 0 $47.86 $0.00 1,000SF, PC Total Paid for ELECTRICAL - NEW CONSTRUCTION: $245.12 $0.00 CONDENSER/COMPRES 101-0000-42402 0 $72.52 $0.00 SOR EXHAUST HOOD 101-0000-42402 0 $12.09 $0.00 FURNACE 101-0000-42402 0 $72.52 $0.00 VENT FAN 101-0000-42402 0 $72.54 $0.00 Total Paid for MECHANICAL: $229.67 $0.00 MULTI STRUCTURE 101-0000-42600 0 $48.34 $0.00 PLAN CHECK - EACH Total Paid for MULTI STRUCTURE PLAN CHECK - EACH: $48.34 $0.00 MULTI -SPECIES 101-0000-203100 $1,292.00 $0.00 RESIDENTIAL 0-8 UNITS Total Paid forMULTI-SPECIES RESIDENTIAL $1,292.00 $0.00 NEW CONSTRUCTION 101-0000-424000 $593.89 $0.00 PERMIT . Total Paid forNEW CONSTRUCTION PERMIT: $593.89 $0.00 BACKFLOW DEVICE 101-0000-42401 0 $12.09 $0.00 BUILDING SEWER 101-0000-42401 0 $12.09 $0.00 FIXTURE/TRAP 101-0000-42401 0 $229.71 $0.00 GAS SYSTEM, 5+ 101-0000-42401 0 $36.26 _ $0.00 OUTLETS WATER HEATER/VENT 101-0000-42401 0 $12.09 $0.00 Printed: Wednesday, April 08, 2015 3:23:13 PM . 3 of 4 SYSTEMS DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD BY WATER SYSTEM 101-0000-42401 0 $12.09 $0.00 INST/ALT/REP Total Paid for PLUMBING FEES: $314.33 $0.00 SMI - RESIDENTIAL 101-0000-20308 0 $28.79 $0.00 Total Paid forSTRONG MOTION INSTRUMENTATION SMI: $28.79 $0.00 SINGLE FAMILY 224-0000-203200 $1,837.44 $0.00 DETACHED Total Paid forTUMF - RESIDENTIAL: $1,837.44 $0.00 TOTALS:06 INSPECTIONS SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED DATE DATE RESULT REMARKS NOTES 0 FINAL" BLD Printed: Wednesday, April 08, 2015 3:23:13 PM 4 of 4 SYSTEMS