12-0504 (SFD)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
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BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 12-000 00504
Property Address: 52535 HUMBOLDT BLVD
APN: 767-200-091-19 -34968 -
Application description: DWELLING - SINGLE FAMILY DETACHED
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 438661
Architect or Engineer:
1pr
_ 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 a ofe nals Code, and my License is in full force and effect.
License I s: B ense No.: 915336
ate: Z ontracto -
NEA -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I a xempt 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 ($500)•:
(_) 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.).
(_ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the prbject (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. , 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:
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: 5/09/12
D
I MAY �3 201
1i ,_ —
pInrAMCM
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 Policy Number YJUB282D7797-12
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
persMTH
anner so as t b come subject to the workers' compensation laws of California,
and , if I should b e su ec he workers' compensation provisions of Section
/ 70or Code, I s a o It comp with those provisions.
fDate• .WARNING: FAILURRE WORKERS' MPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLCRIMINAL PEN IES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,00DITION TO TH COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706OF 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 that the above n o mation is correct. I agree to comply with all
city an ounty ordinances and state laws relating to building co t do hereby authorize representatives
of co gtyy t enter upon toe above-mentioned property for in ion urpos .
Date: (/"' ature (Applicant or Agen
Application Number .
. . . . 12-00000504
Permit
.". . BUILDING PERMIT
Additional
desc .
Permit Fee
1826.00
Plan Check Fee
1186.90
Issue Date
. . . .
Valuation
438661
Expiration
Date
11/05/12
Qty Unit Charge
Per
Extension
BASE
FEE
639.50 t
339.00
---------7------------------------------------------------------------------
3.5000
THOU BLDG
100,001-500,000
1186.50
Permit
. . . MECHANICAL
` Additional
desc . .
Permit Fee
. . . .
176.00
Plan Check Fee
44.00
Issue Date
. . . .
Valuation . . . .
0
Expiration
Date
11/05/12
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
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
9.00
6.5000
EA MECH
VENT FAN
58.50
1.00
-----------------------------------------------------------------------------
6.5000
EA MECH
EXHAUST HOOD
6.50
Permit
ELEC-NEW RESIDENTIAL
Additional
desc .
Permit Fee
. . . .
203.51
Plan Check Fee ...
50.88
Issue Date
. . . .
Valuation
0
Expiration
Date
11/05/12
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
. . .289.50
Plan Check Fee
72.38
Issue Date
. . . .
Valuation
0
Expiration Date . . 11/05/12
Qty Unit Charge Per Extension
LQPERMIT
LQPERMIT
Application Number .
. . . . 12700000.504
Permit . . .
PLUMBING
r Qty. Unit Charge
Per
Extension
BASE FEE
15.00
34.00 6.0000
EA PLB FIXTURE
204.00
1.00 15.0000
EA PLB BUILDING SEWER
15.00
6.0000
EA PLB ROOF DRAIN
12.00
,2.00
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
` 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
11/05/12
Qty Unit Charge
Per
Extension
BASE FEE
15.00
---------------------------------------------------------------=------------
Special Notes and Comments
SFD - LOT 19, PLAN 2
WITH CASITA, 4859
S.F. PERMIT DOES NOT
INCLUDE POOL, SPA,
BLOCK WALLS,OR DRIVEWAY APPROACH. 2010
CODES.
----------------------------------------------------------------------------
Other Fees . . . . .
. . . . ART IN PUBLIC PLACES -RES
596.65
BLDG STDS ADMIN (SB1473)
18.00
DIF COMMUNITY CENTERS -RES
74.00
DIF CIVIC CENTER - RES
995.00
ENERGY REVIEW FEE
118.69
DIF FIRE PROTECTION -RES
140.00
GRADING PLAN CHECK FEE
.00
DIF LIBRARIES - RES
355.00
MULTI -SPECIES (MSHCP) FEE
1.254.00
DIF PARK MAINT FAC - RES
22.00
DIF PARKS/REC - RES
892.00
STRONG MOTION (SMI) - RES
.43.87
DIF STREET MAINT FAC -RES
67.00
DIF TRANSPORTATION - RES
1930.00
Fee summary Charged Paid Credited
---------------------------------------------------------
Due
Permit Fee Total
2510.01 .00 .00
2510.01
Plan Check Total
1354.16 .00 .00
1354.16
Application Number 12-00000504
Other Fee Total 6506.21 00 .00 6506.21
Grand Total 10370.38 .00 .00 10370.38
LQPERMIT
PROUDLY SERVING THE
UNINCORPORATED AREAS
OF RrvERs16E COUNTY
AND THE CITIES OF:
BANNING
BEAUMONT
CALIMESA
CANYON LAKE
COACHELLA
DESERT HOT SPRINGS
EASTVALE
INDIAN WELLS
INDIO
LAKE ELSINORE
LA QUINTA
MENIFEE
MORENO VALLEY
PALM DESERT
PERRIS
RANCHO MIRAGE
RUBIDOUx CSD
SAN JACINTO
TEMECULA
WILDOMAR
BOARD OF
SUPERVISORS:
BOB BUSTER
DISTRICT 1
JOHN TAVAGLIONE
DISTRICT 2
JEFF STONE
DISTRICT 3
JOHN BENOIT
DISTRICT 4
MARION ASHLEY
DISTRICT 5
RIVERSIDE COUNTY FIRE DEPARTMENT
IN COOPERATION WITH
THE CALIFORNIA DEPARTMENT OF FORESTRY AND FIRE PROTECTION
77-933 Las Montanas Rd., Ste. #201, Palm Desert, CA 92211-4131 • Phone (760) 863-8886
• Fax (760) 863-7072
www.rvcfire.org
December 11, 2012
Holland Fire
1600 Meadowlark Way
Roseville, CA 95661
Trj J lhe
4� L Od,
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Re: Residential Fire Sprinkler Plan Review
LAQ-12-RS-066 Madison Villas -Gatsby 52-535 Humboldt Blvd. La Quinta, CA
The sprinkler plans you submitted for the above referenced project have been reviewed by
Riverside County Fire Department Planning & Engineering personnel and are approved with
the following conditions:
NOTE: As required by the State of Califomia Business and Professions Code
and the Contractors State Licensing Board (CSLB) only a C-16 Fire Protection
Contractor may install fire sprinklers.
A minimum of three spare fire sprinklers of each type and temperature rating along with a
sprinkler wrench should be located in a spare head cabinet at the system riser or other
approved location.
Permanently marked identification signs shall be attached to all control valves.
The completed Contractor's Material and Test Certificate for Aboveground Piping shall be
provided to the fire inspector prior to a final inspection. A typical certificate is shown in Figure
10.10.1 NFPA13.
A warning sign, with minimum'/ inch letters, shall be affixed adjacent to the main shutoff valve
and shall state the following:
WARNING: The water system for this home supplies fire sprinklers that require certain flows and pressures to fight a
fire. Devices that restrict the flow or decrease the pressure or automatically shut off the water to the fire sprinkler
system, such as water softeners, filtration. systems, and automatic shut-off valves, shall not be added to this system
without a review of the fire sprinkler system by a fire protections specialist. DO NOT remove this sign.
The following inspections/tests are required to be witnessed by the Fire Department Planning
Division staff:
(a) Overhead Rough and Hydro static test: All piping shall be visible and
Pumped at.normal operating pressure:
(b) Final inspection.
The Fire Department job card, approved plans and conditions letter must be at the job site or
NO inspection will be performed. Applicant/installer shall be responsible to contact the Fire
Department to schedule inspection(s) a minimum of 72 hours prior to the requested inspection
date.
All questions regarding the meaning of these conditions should be referred to the Fire
Department Planning & Engineering staff at (760) 863-8886.
Applicantlinstaller shall be responsible to contact the Fire DepartmelAt to schedule inspection.
r
Sincerely,
Jaso tubble
Fire Safety Specialist
L
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1 -WAS 61�r gjz/ ru�r�a�I% Eng i%nmeletj-din)
ff-
78080 Calle Amigo, Suite 102 Phone: (760) 771-9993
Palm Desert, CA 92260 Fax: (760) 771-9998
Cell: (760) 808-9146
STRUCTURAL OBSERVATION REPORT
FOR FRAMING ONLY
December 11, 2012
City Of La Quinta
Building And Safety Department
RE: Modison Club, Lot 19 at
52535 Humboldt Blvd., La Quinta, Ca.
Gentlemen
We have performed structural observation per 2010 C.B.C. section 1710 for the
framing condition prior to drywall and stucco.
Based on our visual observation and to the best of our knowledge and experience, we
believe that the framing that were completed at the time of our visit, per approved plans.
Please note that this letter does not include or waive the responsibility for the City or the
Special Inspectors from determining compliance with the approved plans.
Please contact me should you need additional information regarding this approval.
Respectfully, �p`�PSGHgRA �
Reza Asgharpour, P.E. G
w NO. C 67613
sr civ%V
OF CA���
Field Observation Letter for N-1 1dison Club Lot 19 to 525335 Humboldt Blvd. hi Ouinta. CA. - (Fim it Framing)