10-0927 (SFD)4 P.O. BOX 1504 ^'
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 ` BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number.C10-0_00_00927 Owner:
Property Address: 52805 HUMBOLDT BLVD EAST OF MADISON LLC
APN: 767-880-015- - - PO BOX 1482
Application description: DWELLING - SINGLE FAMILY DETACHED LA QUINTA, CA 92247
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 428833
Contractor:
Applicant: Architect or Engineer: DBCA INC
P.O. BOX 1482
LA QUINTA, CA 92247
(760)393-5271
1j! f Lic. No.: 915336
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty oLBusiness
a I nsed under provisions of Chapter 9 (commencing with
Section 700 f Division 3 of nd fessio Code, and my License is in full force and effect.
Licens ass: B Lice No.: 915336
9 ntrac
/ O ER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am mpt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business and Pro ions Code: Any city or county that requires a permit to
construct, aper, improve, demolish, or repair any cture, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is I ensed 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 [heir 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 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—) 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 agericy for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address: 1� r
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/22/10
(7 �1
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Iy
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ r —
• WORKER'S COMPENSATIO ATION
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 of the work for which this permit is issued, I shall not employ any
person in any manner so as A1��'.'oma subject to the workers' compensation laws of California,
and agree that, if I should b' a bl to the workers' compensation provisions of Section
3700 of the Labor Code, I s for with c ly with those provisions.
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 THE 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.
I certify that I have read this application and state that the above in mati is correct. I agree to comply with all
city and county ordinances and state laws relating to building co st tion an eby authorize representatives
of�this ccloount to enter up the above-mentioned property for in p 'on p rposes.
pate: 1 N �6 ignature (Applicant or
Application Number . . . . 10-00000927
------ 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 922.00
PATIO SQ FTG 1365.00
NUMBER OF UNITS 1.00
'1ST FLOOR SQUARE FOOTAGE 3586.00
2ND FLOOR SQUARE FOOTAGE 1273.00
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Permit BUILDING PERMIT
Additional desc
Permit Fee . . . 1791.00 Plan Check Fee 291.03
Issue Date . . . . I Valuation . . . 428833
Expiration Date 3/21/11
Qty Unit Charge Per Extension
BASE FEE 639.50
329.00 3.5000 THOU BLDG 100,001-500,000 1151.50
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Permit . . . . . MECHANICAL
Additional desc .
Permit Fee . . . . 179.50 Plan Check Fee 9.37
Issue Date Valuation . . . . 0
Expiration Date 3/21/11
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
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Permit . . . ELEC-NEW RESIDENTIAL
Additional desc .
Permit Fee . . . . 218.51 Plan Check Fee 12.37
Issue Date . . . . Valuation 0
Expiration Date 3/21/11
Qty Unit Charge Per Extension
BASE FEE 15.00
4859.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 170.07
922.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 18.44
1.00 15.0000 EA ELEC TEMPORARY POWER POLE 15.00
LQPERMIT
LQPERMIT
Application Number 10-00000927
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Permit . . . PLUMBING
Additional desc .
Permit Fee . . . . 273.00 Plan Check Fee
14.25
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
3.0.0
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
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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
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Special Notes and Comments
SFD, PLAN 2 WITH CASITA GATSBY-4859 SF
LIVING, 1365 SF PATIOS,922 SF GARAGE .
PERMIT DOES NOT INCLUDE BLOCK WALLS,
POOL, SPA, DRIVEWAY APPROACH. 2007
CODES. 75% REDUCTION TO PLAN CHECK FEES
DUE TO MULTIPLE ISSUANCE OF SAME PLAN
TYPE.
DEVELOPER IMPACT FEES CARRIED OVER FROM
OLD PERMIT #08-629.
September 22, 2010 1:00:46 PM KHENSEL.
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Other Fees . . . . . . . . ART IN PUBLIC PLACES -RES
572.08
BLDG STDS ADMIN (SB1473)
18.00
ENERGY REVIEW FEE
29.10
STRONG MOTION (SMI) - RES
37.93
Fee summary Charged Paid Credited
-----------------
Due
----------------------------------------
Permit Fee Total 2477.01 .00 .00
2477.01
LQPERMIT
Application Number . . . . . 10-00000927
Plan Check Total 327.02 .00 .00. 327.02
Other Fee Total 657.11 .00 .00 657.11+
Grand Total 3461.14 .00 .00 3461.14
LQPERMIT