11-0637 (SFD).Z? — Q
P.O. BOX 1504
78-495.CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application'valuation:
Applicant:
X11-000063
0-�
52745 HUMBOLDT BLVD
767-200-091-13 -34968 -
DWELLING - SINGLE FAMILY
LOW DENSITY RESIDENTIAL
376454
T`4t
BUILDING & SAFETY DEPARTMENT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Owner:
EAST OF MADISON LLC
PO BOX 1482 ; O
DETACHED LA QUINTA, CA 92247
Architect or Engineer:
Date: 6/15/11
Contractor. y j
DBCA INC
' P.O. BOX 1482 •.; �.,.;:�9;�
a l� LA QUINTA, CA 92247
__ _-. - ---- -- (760)393-5271
Lic. No.: 915336'
-------------------------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I a li sed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and r f ssi Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License C ass: Lice o.: 915336 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
{u� issued.
Date: ontract & 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
0R -BUILDER DECLARATION insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am a pt from the Contractor's State License Law for the Carrier TRAVELERS PROP Policy Number YEUB282D779711
following reason (Sec. 7031 .5, Business and Profes ns Code: Any city or county that requires a permit to _ I certify that, in the performance the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any st ture, prior to its issuance, also requires the applicant for the person in any manner so as o come subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should b c e suPiect4Qthe workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I a ort ith com ly with those provisions.
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).: ate plica
(_ ), I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and 011
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The WARNI G: /FAILURE TO SECURE WORKERS' MPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PEN IES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO TH ST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTE E , AND ATTORNEY'S FEES.
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.). APPLICANT ACKNOWLEDGEMENT
1 _ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractors) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application,
( _ 1 I am exempt under Sec. , B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
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: Q
Lender's Address: ( �
LQPERMIT
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 abo i ormation is correct. I agree to comply with all
city and county ordinances and state laws relating to building c n uct' and hereby authorize representatives
offtthis co ty enter upon the above-mentioned property for i s cti n pu s.
Date: / S' ature (Applicant or
Application Number.'. . . . 11-00000637
Permit . . .
BUILDING PERMIT
Additional-desc .
Permit Fee
1609.00
Plan Check Fee
1045:85
Issue Date . . . .
Valuation . . . .
376454
Expiration Date
12/12/11
Qty Unit Charge
Per
Extension
BASE
FEE
639.50
277.00 3.5000
------------=---------------------------------------------------------------
THOU BLDG
100,001-500,000.
969.50
Permit . . . MECHANICAL"
Additional desc .
Permit Fee . . . .
147.50
Plan Check Fee
36.88,
Issue Date . . . .
Valuation
0
Expiration Date
12/12/11
`
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
1.00 9.0000
EA MECH
FURNACE <=100K
9.00
2.00 11.0000
EA MECH
FURNACE >100K
22.00
3.00 16.5000
EA MECH
B/C >3-15HP/>100K=500KBTU
49.50
7.00 _ 6.5000
EA MECH
VENT FAN
45.50
1.00 6.5000
----------------------------------------------------------
EA MECH
EXHAUST HOOD
------------------
6.50
Permit . . . ELEC-NEW RESIDENTIAL
Additional desc .
Permit Fee
181.64
Plan Check Fee
45.41
Issue Date . . . .
Valuation . . . .
0
Expiration Date
12/12/11
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
4244.00 .0350
ELEC
NEW RES - 1 OR 2 FAMILY
148.54
905.00 .0200
--------------------------
ELEC
-----------
GARAGE OR NON-RESIDENTIAL
----------------------------
18.10
-=---------
Permit PLUMBING
Additional desc .
Permit Fee
240.00
Plan Check Fee
60.00
Issue Date . . . .
Valuation
0
Expiration Date
12/12/11
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
28.00 6.0000
EA PLB FIXTURE
168.00
LQPERMIT
LQPERMIT
Application Number .
. . . . 11-00000637
Permit . . . .
PLUMBING
Qty Unit Charge
Per
Extension
1.00 15.0000
EA PLB BUILDING SEWER
15.00
1.00 7.5000
EA PLB WATER HEATER/VENT
7.50
1.00 3.0000
EA PLB WATER INST/ALT/REP
3.00
1.00 9.0000
EA PLB LAWN SPRINKLER SYSTEM
9.00
10.00 .7500
EA PLB GAS PIPE >=5
7.50
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 1, LOT 13
4244 SF. LIVING,
1188 SF. PATIOS, 905
SF GARAGE. PERMIT
DOES NOT INCLUDE POOL,
SPA, BLOCK WALLS
OR DRIVEWAY APPROACH.
2007 CODES.
DEVELOPER IMPACT FEES
CARRIED OVER FROM
OLD PERMIT #08-626.
----------------------------------------------------------------------------
Other Fees . . .
. . . . ART IN PUBLIC PLACES -RES
441.14
BLDG STDS ADMIN (SB1473)
15.00
ENERGY REVIEW FEE
104.59
GRADING PLAN CHECK FEE
.00
MULTI -SPECIES (MSHCP) FEE
1284.00
STRONG MOTION (SMI) - RES
37.65
_ Fee summary Charged Paid Credited
--------------------
Due
---------------------------
Permit Fee Total
----------
2193.14 .00 .00
2193.14
Plan Check Total
1188.14 .00 .00
1188.14
Other Fee Total
1882.38 .00 .00
1882.38
Grand Total
5263.66 .00 .00
5263.66
DATE: 12/2/2011 STRUCTURAL OBSERVATION REPORT
Re Unit 1A (52-745 Humbolt Blvd, La Quinta, Ca.)
@ Madison Con, ntry Club
Job #11.007
- This letter advises that we have observed the structural requirements that are visible
during construction at the time of our final site visit (Dated 12.2.2011) as follows:
I observed the building in its framed condition prior to installation of drywall and stucco.
We observed the visible and accessible structural required elements & members.
(Exclusions are items such size of footings, foundation reinforcement, roof sheathing, &
roof/floor trusses by others).
- The eneineer believes -:that the as -built construction at the time of our visit is in general
conformance with structural plans & calculations and relevant correspondence issued by
Abraham Structural & Plans Inc. of Fullerton, Ca. relatine to the above referenced
structure.
This report is understood to an expression of professional opinion by this engineer, which
is based on his best knowledge, information and beliefs. As such; it consists of a report
for only structural elements (as above outlined) and is neither a guarantee nor a warranty,
expressed or implied for other trades or requirements of subject structure. .
The abovecomments and recommendations may have other than structural ramifications, which we have
not addressed. Be advised that changes to the construction :documents or the as -built conditions need
approval of the Building Official. Our firm is not authorized to act as the owner's agent. This letter shall
not be construed as authorizing the expenditure of additional funds.
Respectfully submitted:
Thank you.
Cliff Hattar, SE Q�OFESS/
PF CAV
TEL: 949-910-3607
EMAlL:cliffph.se@gmail.com
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