04-3936 (SFD)BUILDING & SAFETY DEPARTMENT
P.O. BOx 1504(760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7 15 3
Qty Unit Charge Per Extension
BASE FEE 15.00
BUILDING PERMIT
Application Number .
. . . 04-00003936 Date
5/10/04
Property Address . .
. . 79827 DEREK ALAN DR
APN:
649 -520 -014 -2 -290532. -
Application description
DWELLING - SINGLE FAMILY DETACHED
Property Zoning . . .
... . . LOW DENSITY RESIDENTIAL
Application valuation
163482
Owner
Contractor
------------------------
PM RENAISSANCE, LLC
------------------------
- TRANS WEST HOUSING,
INC.
9968 HIBERT STREET, STE.
SAN DI GO
102 9968 HIBERT STREET,
CA 92131 SAN DIEGO
STE #102
CA 92131-
'
(858) 653-3003
�1
WCC: STATE FUND
WC: 1648813
10/01/04
C�yZ 1209
CSLB: 701039
01/31/05
CCC: B
------�,� --------------
-------------------------
Structure Information ------------------
-----Construction
Cons c ionType . .
. . . TYPE V - NON RATED
Occupance . . .
... . DWELLG/LODGING/LONG <=10
Flood Zone . . . . .
NON -AO FLOOD ZONE
Other struct info . .
. . . CODE EDITION 2001CBC
FIRE SPRINKLERS NO
!GARAGE SQ FTG
589.00
PATIO SQ FTG
328.00
NUMBER OF UNITS
1.00
FIRST FLOOR SQ FTG
2580.00
--------------------------
Permit . . . . . .
-------------------------------------
BUILDING PERMIT
-------------
Additional desc
Permit Fee . . . .
863.50 Plan Check Fee
561.28
Issue Date . . . .
Valuation . . . .
163482
Qty Unit'Charge
Per
Extension
BASE FEE
639.50
64.00 3.5000
THOU BLDG 100,001-500,000
224.00
----------------------------------------------------------------------------
Permit . . .
MECHANICAL
Additional desc
Permit Fee . . . .
92.00 Plan Check Fee
23.00
Issue Date . . . .
Valuation . . . .
0
Qty Unit Charge Per Extension
BASE FEE 15.00
1
d
A w
P.O. Box 1504 • VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 04-3 f 34 Date: J-11-04
Applicant: Architect epr:
or ngin
mvl- C,
Applicant's Mailing Address: lip Architect or Engineer's Address:
Lic. No. L_.
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed�unr provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
�i0de, and ss License iii full force and effect.76lo39
r/License Class ,�! nse No.
Date -�i` /! 04 Contractor We.' /YOL(SN_S' Jze-
/ OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 am exempt from the Contractors' 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 Contractors' 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. Arry 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).):
U 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 or 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.).
U 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.).
U I am exempt under Sec. , BA P.C. for this reason
Date Owner
WORKERS' 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.
1 have and will maintain workers' compensatio insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
� �Syed. �1Yy wo ' compensation i nce carrier
Carrier 7`� fT�r olicv Number �� ��
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
A� /^4-4d�r !�•�` /3`a��i✓^�c
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.
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
Lenders Address
/ 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 Ouinta, 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 ISO 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 information is I agree to Comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this county to e r' t ab ve-mentioned property for inspection purposes.
j
/ate/ ignature (Applicant or Agent): �! _1`
Application Number . . . . . 04-00003936
Page 2
Date 5/10/04
Qty
Unit Charge
Per 4
Extension
2.00
9.0000
EA MECH
FURNACE <=100K
18.00
2.00
16.5000
EA MECH
B/C >3-15HP/>100K-500KBTU
33.00
3.00
6.5000
EA MECH
VENT FAN
19.50
1.00
6.5000
EA MECH
EXHAUST HOOD
6.50
----------------------------------------------------------------------------
Permit .
. . . . .
ELEC-NEW RESIDENTIAL
Additional
desc
Permit Fee
. . . .
117.08
Plan Check Fee
29.27
Issue Date
. . . .
Valuation . . . .
0
Qty
Unit Charge
Per
Extension
BASE
FEE
15.00
2580.00
.0350
ELEC
NEW RES - 1 OR 2 FAMILY
90:30
589.00
.0200
ELEC
GARAGE OR NON-RESIDENTIAL
11.78
--------------------------------------7-------------------------------------
Permit .
. . . . .
PLUMBING
Additional
desc
Permit Fee
. . . .
178.50
Plan Check Fee
44.63
Issue Date
. . . .
Valuation
0
Qty
Unit Charge
Per
Extension
BASE
FEE
15.00
18.00
6.0000
EA PLB
FIXTURE
108.00
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
8.00
.7500
EA PLB
GAS PIPE >=5
6.00
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
Qty
Unit Charge
Per
Extension
BASE
FEE
15.00
----------------------------------------------------------------------------
Special Notes
and Comments
SFD - LOT
2. PLAN 2B.
PERMIT DOES
NOT
r 14
Page 3
Application Number
. . . . .
04-00003936 Date
5/10/04
---------------------------------
Special Notes and
-------------------------------------------
Comments
INCLUDE BLOCK WALLS,
POOL, SPA
OR
DRIVEWAY APPROACH
----------------------------------------------------------------------------
Other Fees . . .
. . . . .
ART IN PUBLIC PLACES -RES
.00
DIF COMMUNITY CENTERS -RES
97.00
DIF CIVIC CENTER - RES
366.00
ENERGY REVIEW FEE
56.13
DIF'FIRE PROTECTION -RES
97.00
GRADING PLAN CHECK FEE
.00
DIF LIBRARIES - RES
225.00
DIF.PARK MAINT FAC - RES
5.00
DIF PARKS/REC - RES
502.00
STRONG MOTION (SMI) -.RES
16.34
DIF STREET MAINT FAC -RES
15.00
DIF TRANSPORTATION - RES
1098.00
Fee summary.
-----------------
Charged
Paid Credited
Due
Permit Fee Total
----------
1266.08
------------------------------
.00 .00
1266.08
Plan Check Total
658.18
.00 .00
658.18
Other Fee Total
2477.47
.00 .00
2477.47
Grand Total
4401.73
.00 .00
4401.73