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09-1324 (SFD)NZ1— i P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 09-00001324 Property Address: 52865-HUMBOLDT BLVD APN: 767-880-012- - - Application description: DWELLING - SINGLE FAMILY DETACHED Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 430774 Applicant: Architect or Engineer: -------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I a ens ed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business an r fessionals Code, and my License is in full force and effect. License Class: B nse No.: 915336 ate: ontractor: NER-BUILDER DECLARATION I hereby affirm under penalty of perjury that I a xempt from the Contractor's State License Law for the following reason (Sec. 7031 .5, Business and Pr ssions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair an tructure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she i licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 70001 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 155001.: 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 _) 1, 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.). 1 _) 1 am exempt under Sec. , BAP.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: r LQPERMIT Owner: EAST OF MADISON LLC PO BOX 1482 LA QUINTA, CA 92247 Contractor: DBCA INC P.O- BOX 1482 LA QUINTA, CA 92247 (760)393-5271 Lic. No.: 915336 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/22/10 ,�n 3 � a toLir.r sp 1 2 la �1 ------------------ 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 TRAVELERS PROP Policy Number YEUB282D779708 I certify that, in the performance he work for which this permit is issued, I shall not employ any person in any manner so as t come subject to the workers' compensation laws of California, and agree that, if I should be a su to the workers' compensation provisions of Section 3700 of the Labor Code, I sh If Orth ith c ply with those provisions. Date: r /WARNING: FAILURE TO SECURE WORKERS' MPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PEN IES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO TH ST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTER , 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. 11 I certify that I have read this application and state that the above in.tion .s correct. I agree to comply with all city and county ordinances and state laws relating to building const ion, d eby authorize representatives of this county to enter upon the above-mentioned property for insp c i n pu poses. ate: t r S' ture (Applicant or Age Application.Number . . . 09-00001324 ------ Structure Information VILLA .2 - 4287 SF LIV. 2 STORY SFD ----- - Other struct info . . . . . CODE EDITION 2007- # BEDROOMS 4.00 FIRE SPRINKLERS NP GARAGE SQ FTG 1021.00 PATIO SQ FTG 1365.00 NUMBER OF UNITS 1.00 1ST FLOOR SQUARE FOOTAGE 3586.00 ---------------------------------------------------------------------------- 2ND FLOOR SQUARE FOOTAGE 1273.00 Permit . . . BUILDING PERMIT - Additional desc . . Permit Fee . . . . 1798.00 Plan Check Fee 1168.70 Issue Date . . . . Valuation . . 430774 Expiration Date 3/21/11 Qty Unit Charge Per Extension BASE FEE. 639.50 331.00 3.5000 -----------------------------------'----------------------------------------- THOU BLDG 100,001-500,000 1158.50 Permit . . . MECHANICAL Additional.desc . Permit Fee . . . . 179.50 Plan Check Fee 37.50 Issue Date . . . . Valuation 0 Expiration Date 3/21/11 L Qty Unit Charge Per Extension BASE FEE 15.00 3.00 9.0000 EA MECH FURNACE <=100K 27.00 4.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU 66.00 10.00 6.5000 EA MECH VENT FAN 65.00 1.00 6.5000 ---------------------------------------------------------------------------- EA MECH EXHAUST HOOD 6.50 Permit . . . . . . ELEC-NEW RESIDENTIAL Additional desc . Permit Fee . . . 220.49 Plan Check Fee . Issue Date Valuation . . . Expiration Date 3/21/11 Qty Unit Charge Per BASE FEE 4859.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 1021.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 1.0.0 15.0000 EA ELEC TEMPORARY POWER POLE LQPERAIIT 49.50 0 Extension 15.00 170.07 20.42 15.00 Application Number . . . 09-00001324 -------------------------------------------------------------- Permit . . . PLUMBING -------------- Additional desc . Permit Fee 273.00 Plan Check Fee 57.00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 3/21/11 Qty Unit Charge Per Extension BASE FEE 15.00 32.00 6.0000 EA PLB FIXTURE 192.00 1.00 15.0000 EA 'PLB BUILDING SEWER 15.00 2.00 7.5000 EA PLB WATER HEATER/VENT" 15.00 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 1.00 9.0000 EA PLB LAWN SPRINKLER SYSTEM 9.00 12.00 .7500 EA PLB GAS PIPE >=5 9.00 1.00 15.0000 EA PLB GAS METER ---------------------------------------------------------------------------- 15.00 Permit . . . . . . GRADING PERMIT Additional desc . Permit Fee . . . . 15.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 3/21/11 Qty Unit Charge Per Extension BASE FEE 15.00 ---------------------------------------------------------------------------- Special Notes and Comments SFD, PLAN 2 WITH CASITA-4859 SF LIVING, 1365 SF PATIOS,1021 SF GARAGE (INCLUDES 99 SF TRASH SHED). PERMIT DOES NOT INCLUDE BLOCK WALLS, POOL, SPA, DRIVEWAY APPROACH. 2007 CODES. DEVELOPER IMPACT FEES CARRIED OVER FROM OLD PERMIT #08-628. September 22, 2010 12:53:38 PM KHENSEL ---------------------------------------------------------------------------- Other Fees . . . . . . . . ART IN PUBLIC PLACES -RES 576.94 BLDG STDS ADMIN (SB1473) 18.00 ENERGY REVIEW FEE 116.87 STRONG MOTION (SMI) - RES 37.93 Fee summary Charged Paid Credited ----------------- Due ---------------------------------------- Permit Fee Total 2485•.99 .00 .00 2485.99 Plan Check Total 1312.70 750.00 .00 562.70 Other Fee Total 749.74 .00 .00 749.74 LQPERMIT Application Number 09-00001324 Grand Total 4548.43 750.00 .00 3798.43 LQPERMIT