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08-0627 (SFD)N �� fG�ftiGV P.O. BOX 1504 4 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT Application Number: Property Address: APN: Application description Property Zoning: Application valuation: Applicant: BUILDING PERMIT _08 0000062.7_ Owner: 52725 HUMBOLDT BLVD EAST OF MADISON LLC 767-200-091-14 -34968 - PO BOX 1482 DWELLING - SINGLE FAMILY DETACHED LA QUINTA, CA 92247 LOW DENSITY RESIDENTIAL 467734 Architect or Engineer LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class: B C10 License No.: 746198 Date: Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, 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 ($5001.: (_ 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 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.). (_ 1 I am exempt under Sec. , BAP.C. for this reason caner. / 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: LQPERMIT Contractor: A & M CONSTRUCTION P.O. BOX 366 LA QUINTA, CA 92247 (760)564-4832 Lic. No.: 746198 VOICE {760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/28/08 WORKER'S COMPENSATION DECLARATION 1 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 STATE FUND Policy Number 044-0028137-07 I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner to become subject to the workers' compensation laws of California, and agree that, i s ould beco a subject to the workers' compens on provisions of Section -3700 of the L or Code, I sh forthwit ly wit ose prov' i S. aU te:l7 licant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, 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 t information is correct. I ree to comply with all city and county ordinances and'state laws rOatrng to building con uctio ereby a th rize representatives of tJa�' county to enter upo he above -m boned property for i ecti purp s. Date: � / Z -U nature (Applicant or Agent): Application Number . . . . 08-00000627 Permit . . . BUILDING PERMIT -Additional desc . . Permit Fee 1927.50 Plan Check Fee 313.22 Issue Date . . . .� Valuation 467734 Expiration Date 10/14/08 Qty Unit Charge Per Extension BASE FEE 639.50 368.00 ------------=---------------------------------------------------------------- 3.5000 THOU BLDG 100,001-500,000 1288.00 Permit . . . MECHANICAL Additional desc . Permit Fee _ 143.00 Plan Check Fee.. 8.94 Issue Date . . . . Valuation 0 Expiration Date 10/14/•08 Qty Unit Charge Per - Extension BASE FEE 15.00 3.00 11.0000 EA MECH FURNACE >100K 33.00 3.00 16.5000 EA - MECH B/C >3-15HP/>100K-500KBTU 49.50 6.00' 6.5000 EA MECH VENT FAN 39.00 1.00 ---------------------------------------------------------------------------- 6.5000 EA. MECH EXHAUST HOOD 6.50 Permit ELEC-NEW RESIDENTIAL Additional desc . . Permit Fee . . . . 223.32 Plan Check Fee 12.70 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 10/14/08 Qty Unit Charge Per • Extension BASE FEE 15.00 5296.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 185.36 1148.00 ---------------------------------------------------------------------------- .0200 ELEC GARAGE OR NON-RESIDENTIAL 22.96 Permit . . . PLUMBING Additional desc . . Permit Fee . . . . 223.50 Plan Check Fee 13.97 Issue Date . . . . Valuation . . . . 0 Expiration Date 10/14/08 Qty Unit Charge Per Extension BASE FEE 15.00 25.00 6.0000 EA PLB FIXTURE 150.00 1.00 15.0000 EA PLB BUILDING SEWER 15.00 LQPERMIT LQFERMIT Application Number . . . . . 08-00000627 ' Permit . . . . PLUMBING Qty Unit Charge Per Extension 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 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 .. 10/14/08 Qty Unit Charge Per Extension BASE FEE 15.00 ---------------------------------------------------------------------------- Special Notes and Comments SFD - LOT 14, PLAN 1R, 5296 SF. PERMIT DOES NOT INCLUDE POOL, SPA, BLOCK WALLS OR DRIVEWAY APPROACH. 75% TO PLAN CHECK FEES DUE TO MULTIPLE ISSUANCE OF SAME PLAN TYPE. 2001 CBC, CMC, CPC, 2004 CEC, 2005 ENERGY CODES ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ART IN PUBLIC PLACES -RES 569.52 DIF COMMUNITY CENTERS -RES 74.00 DIF CIVIC•CENTER - RES 995.00 ENERGY REVIEW FEE 31.32 DIF FIRE PROTECTION -RES 140.00 GRADING PLAN CHECK FEE .00 - DIF LIBRARIES - RES 355.00 DIF PARK MAINT FAC - RES 22.00 DIF PARKS/REC - RES 892.00 STRONG MOTION (SMI) - RES 42.78 DIF STREET MAINT'FAC-RES 67.00 DIF TRANSPORTATION - RES 1930.00 , Fee summary Charged Paid Credited --------------------------------------------------------- Due Permit Fee Total 2532.32 .00 .00 2532.32 Plan Check Total 348.83 .00 .00 348.83 Other Fee Total 5118.62 .00 .00 5118.62 Grand Total 7999.77 .00 .00 7999.77 LQFERMIT