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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 Page 1 of 1