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12-0499 (SFD),�: .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: T4bt 4 4 QuAZ BUILDING & SAFETY DEPARTMENT BUILDING PERMIT 12�-000060499 52595—HUMBOLDT BLVD 767-200-091-16 -34968 - DWELLING - SINGLE FAMILY DETACHED LOW DENSITY RESIDENTIAL 440770 Architect or Engineer: LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury the I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busines PIs Code, and my License is in full force and effect. License CI ss: AB r siona �J License No.: 915336 ate: �` ntra OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury thatm exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business an rofessions 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 ($500).: (_ 1 I, 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.). (_) 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 contractors) licensed pursuant to the Contractors' State License Law.). (_ 1 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: Q Lender's Address: f - LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/07/12 Owner: EAST OF MADISON LLC PO BOX 1482 LA QUINTA, CA 9 Contractor: DBCA INC P.O. BOX 1482 LA QUINTA, CA 9 2;? LrU MAY 2 3 2011 CITY OF LA QUIRTA 22 FINANCE DEPT. (760)393-5271 - Lic. No.: 915336 ----------------------------------------------- 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 1' issued. IC I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor YYY"' Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier TRAVELERS Policy Number YJUB282D7797-12 I certify that, in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so become subject to the workers' compensation laws of California, and agree that, if I should ome$Gboct to the workers' compensation provisions of Section 0 of the Labor Code, all f mply with those provisions. ate• Z �4�ca WARNING: FAILURE TO SECURE WORKE COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P LTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO E 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 Quints, 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 abov i orm ion is correct. I agree to comply with all city and county ordinances and state laws relating to building co uct n, d hereby authorize representatives of ts c to nter hiupon eabove-mentioned property for in cti purp as. , a.ature (Applicant or _OIL. Application Number . . . . . .12-00000499 Permit . . . BUILDING PERMIT Additional desc . Permit Fee . . . . 1833.00 Plan Check Fee 1191.45 Issue Date . . . . Valuation . . . . •440770 Expiration Date 11/03/12 Qty Unit Charge Per Extension BASE FEE 639.50 341.00 ---------------------------------------------------------------------------- 3.5000 THOU BLDG 100,001-500,000 1193.50 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 165.50 Plan Check Fee 41.38 Issue Date . . . . Valuation . . . . 0 Expiration Date .11/03/12 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 1.00 6.5000 EA MECH AH <=10K CFM 6.50 8.00 6.5000 EA MECH VENT FAN .52."00 1.00 --------------------------------------- 6.5000 EA MECH EXHAUST HOOD z 6.50 . . . ELEC-NEW RESIDENTIAL Additional desc . Permit Fee . . . . 205.49 Plan Check Fee 51.37 Issue Date Valuation . . . 0 Expiration Date 11/03/12 Qty Unit Charge Per Extension BASE FEE 15.00 4859.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 170.07 1021.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 20.42 Permit . . . PLUMBING ' Additional desc . Permit Fee . . . . 264.00 Plan Check Fee 66.00 Issue Date . . . . Valuation . . . . 0 Expiration Date 11/03/12 ti Qty Unit Charge Per Extension BASE FEE 15.00 LQPERMIT Application Number . . . . . 12-00000499 Permit . . . . . . PLUMBING Qty Unit Charge Per Extension 32.00 6.0000 EA PLB FIXTURE 192.00 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 11/03/12 Qty Unit Charge Per Extension BASE FEE 15.00 ---------------------------------------------------------------------------- Special Notes and Comments SFD - LOT 16 PLAN 2 WITH CASITA - 4859 SF LIVING, 1365 SF PATIOS', 1021 SF GARAGE (INCLUDES 99 SF TRASH SHED).PERMIT DOES NOT INCLUDE POOL, SPA, BLOCK WALLS OR DRIVEWAY APPROACH. 2010 CODES. ---------------------------------------------------------------------------- Other Fees ART IN PUBLIC PLACES -RES 597.59 BLDG STDS ADMIN (SB1473) 18.00 DIF COMMUNITY CENTERS -RES 74.00 DIF CIVIC CENTER - RES 995.00 ENERGY REVIEW•FEE 119.15 DIF FIRE PROTECTION -RES 140.00 DIF LIBRARIES— RES 355.00 MULTI -SPECIES (MSHCP) FEE 1254.00 DIF PARK MAINT FAC - RES 22.00 DIF PARKS/REC - RES 892.00 STRONG MOTION (SMI) - RES 43.90 DIF STREET MAINT FAC -RES 67.00 DIF TRANSPORTATION - RES 1930.00 Fee summary Charged Paid Credited Due --------------------------- Permit Fee Total ------------------=----------- 2482.99 .00 .00 2482.99 Plan Check Total 1350.20 .00 .00 •1350.20 Other Fee Total 6507.64 .00 .00 6507.64 LQPERMIT Application Number . . . . 12-00000499 Grand Total 10340.83 .00 .00 10340.83