11-0636 (SFD)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
T4'yl 4 �(P Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
11-00000636
52765-HUMBOLDT BLVD
767-200-091-12 -34968 -
DWELLING - SINGLE FAMILY DETACHED
LOW DENSITY RESIDENTIAL
428833
Architect or Engineer:
------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I a i -nsed nder provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business an r fessi na ode, and my License is in full force and effect.
License C ss: Licen No.: 915336
a, frac t -
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, alter, improve, demolish, or repair any tructure, 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—) 1, 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 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: J "
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: 6/15/11
------------------
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 YEUB282D779711
_ 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 t b!!ii ome 'ect to the workers' compensation laws of California,
and agree that, if I should bert�ub' ct to a workers' compensation provisions of Section
P700 of the Labor Code, I sh j1I i1 h comp with those provisions.
WARNING: (FAILURE TO SECURE WORKERS' YES.
PENSATION COVERAGE IS UNLAWFUL, AND SHALL
PENHSUBJECT AN EMPLOYER TO CRIMINAL AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (S100,000). IN ADDITION TO THET OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTERND 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 ab a for tion is correct. I agree to comply with all
city and county ordinances and state laws relating to building o ru ion, hereby authorize representatives
of thispCoLvityter upohe above-mentioned property fo in ect purpos
Date:gnature (Applicant or Agent):
Application Number . . . . . 11-00000636
Permit
BUILDING PERMIT
Additional
desc .
Permit Fee
. . . . •
17.91.00
Plan Check Fee
1164.15
Issue Date
. . . .
Valuation
428833
Expiration
Date
12/12/11
Qty Unit Charge
Per
Extension
BASE
FEE
639.50
329.00
----------------------------------------------------------------------------
3.5000
THOU BLDG
100,001-500,000
1151.50
Permit
. . .
MECHANICAL
Additional
desc .
Permit Fee
. .
172.00
Plan Check Fee
43.00
Issue Date
. . . .
Valuation
0
Expiration
Date
12/12/11
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
3.00
9.0000
EA MECH
FURNACE <=100K
27.00
1.00
9.0000
EA MECH
B/C <=3HP/100K BTU
•9.00
3.00
.16.5000
EA MECH
B/C >3-15HP/>100K-500KBTU
49.50
10.00
6.5000
EA MECH
VENT FAN
65.00
1.00
-------------------
6.5000.EA
---------------------------------------------------------
MECH
EXHAUST HOOD
6.50
Permit W
. . .
ELEC-NEW RESIDENTIAL
Additional
desc..
Permit Fee
. . . .
203.51
Plan Check Fee
50.88
Issue Date
. . . .
Valuation
0
Expiration'Date
12/12/11
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
Permit . . . PLUMBING
Additional desc .
Permit Fee . . . . 273.00
Issue Date . . . .
Expiration Date . . 12/12/11
Qty Unit Charge Per
BASE FEE
32.00 6.0000 EA PLB FIXTURE
LQPERMIT
Plan Check Fee . -
Valuation . . . .
68.25
0
Extension
15.00
192.00
Application_Number . . . . . 11-00000636
'
Permit . . . . . . PLUMBING
Qty Unit Charge Per
Extension
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 12/12/11
Qty Unit Charge Per
Extension
` BASE FEE
,
15.00
-----------------------------------------------------------------------------
Special Notes and Comments
SFD, PLAN 2 WITH CASITA - 4859 SF
LIVING, 1365 SF PATIOS, 922 SF GARAGE.
PERMIT DOES NOT INCLUDE POOL, SPA, BLOCK
WALLS OR DRIVEWAY APPROACH. 2007 CODES.
DEVELOPER IMPACT FEES CARRIED OVER FROM
OLD PERMIT #08-630.
----------------------------------------------------------------------------
Other Fees . . . ... . ART IN PUBLIC PLACES -RES
572.08
BLDG STDS;ADMIN (SB1473)
14.00
ENERGY REVIEW FEE
116.42
GRADING PLAN CHECK -FEE
.00
MULTI -SPECIES (MSHCP) FEE
1284.00
STRONG MOTION (SMI) - RES
42.88
Fee summary Charged Paid Credited
Due
Permit Fee Total 2454.51 .00 .00
2454.51
Plan Check Total 1326.28 .00 .00
1326.28
Other Fee Total 2029.38 •.00 .00
2029.38
Grand Total 5810.17 .00 .00
5810.17
LQPERMIT