05-2113 (SFD)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4ht
BUILDING & SAFETY DEPARTMENT
BUILDING. PERMIT
Application Number:
05-00002113
Property Address
7843'1 DEACON=DR"W
APN:
770-210-018- - -
Application description:
DWELLING - SINGLE FAMILY DETACHED
Property Zoning: .
LOW DENSITY RESIDENTIAL
Application valuation:
351285
Applicant: 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 70001 of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: B License No.: 862636
Date: r L�" ontractor:
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 ($500).:
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.l.
( 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:
M/M REZNICHEK
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Contractor: i
SUMMIT CONSTRUCTION GROUP INC
802 N TWIN OAKS VALLEY STE 110
SAN MARCOS, CA 92069
(760)744-1181
Lic. No.: 862636
G
Date: .12/16/05
DEC 16 ?005
ry E Q- IJVrA
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.
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 HUNTER INS SVC Policy Number 7131384805
1 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 shoulSAecome subject to the workers' compensation provisions of Section
3700 of the Labor Coshall forthwilhplamgly )Oth those provisions.
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 ifworkis 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 information is correct. I agree to comply with all
city and county ordinances and state laws relating to buildyg7construction, and hereby authorize representatives
of this count to enter upon the above-mentioned prope f r inspection urposes.
, _? 71 o � �a
Application Number .
. . . . 05-00002113
Permit . . .
BUILDING PERMIT
Additional desc .
I� Permit Fee
1521.50
Plan Check Fee
988.98
Issue Date . . . .
Valuation . . . .
351285
Expiration Date
6/14/06
Qty Unit Charge
Per
Extension
BASE
FEE
639.50
252.00 3.5000
----------------------------------------------------------------------------
THOU BLDG
100,001-500,000
882.00
Permit . . .
ELEC-NEW RESIDENTIAL
Additional desc .
Permit Fee . . . .
200.75
Plan Check Fee
50.19
Issue Date . . . .
Valuation
0
Expiration Date
6/14/06
Qty Unit Charge
Pei
Extension
BASE
FEE
15.00
4059.00 .0350
ELEC
NEW RES - 1 OR 2 FAMILY
142.07
1434.00 .0200
ELEC
GARAGE OR NON-RESIDENTIAL
28.68
1.00 15.0000
---------------------------
EA ELEC
-------------=-----------------------------------
TEMPORARY POWER POLE
15.00
Permit . . .
GRADING PERMIT
Additional desc .
Permit Fee
15.00
Plan Check Fee
.00
Issue Date . . . .
Valuation . . . .
0
Expiration Date
6/14/06
Qty Unit Charge
Per
Extension
----------------------------------------------------------------------------
BASE' FEE
15.00
Permit . . .
MECHANICAL
Additional desc .
Permit Fee . . . .
126.00
Plan Check Fee
31.50
Issue Date . .
Valuation . . . .
0
Expiration Date
6/14/06
Qty Unit Charge
Per
Extension
BASE
FEE
15:00
4.00 9.0000
EA MECH
FURNACE <=100K
36.00
4.00 9.0000
EA MECH
B/C <=3HP/100K BTU
36.00
5.00 6.5000
EA MECH
VENT FAN
32.50
1.00 6.5000
-----------------------------------------------------------------------------
EA MECH
EXHAUST HOOD
6.50
LQPERMIT
91
LQPERMIT
Application Number .
. . . . 05-00002113
Permit . . .
PLUMBING
Additional desc .
Permit.Fee . . . .
213.00 Plan Check Fee
53.25
Issue Date . . . .
Valuation
0
Expiration Date..
6/14/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
22.00 6.0000
EA PLB FIXTURE
132.00
1.00 15.0000
EA PLB BUILDING SEWER
15.00
2.00 6.0000
EA PLB ROOF DRAIN
12.00
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
6.00 .7500
EA PLB GAS PIPE >=5
4.50
1.00 15.0000
EA PLB GAS METER
15.00
----------------------------------------------------------------------------
Special Notes and Comments
SFD - 4095 SQ.FT. LIVING
[includes 452
SF CASITA - MUP 2005-
] R-3 TYPE V -N
CONSTRUCTION 2001 CODES.
PERMIT
EXCLUDES WALLS/POOL/SPA/BBQ
AND
DRIVEWAY'APPROACH/COMPLIANCE
WITH ALL
FEDERAL & STATE LAWS,
INCLUDING THE
ENDANGERED SPECIES ACT
OF 1973 IF
APPLICABLE,IS.REQUIRED
--------=-------------------------------------------------------------------
Other. Fees . . . .
. . . ART IN PUBLIC.PLACES-RES
378.21
DIF -COMMUNITY CENTERS -RES
97.00
DIF CIVIC CENTER - RES
366.00
ENERGY REVIEW FEE
98.90
DIF FIRE PROTECTION -RES
97.00
DIF LIBRARIES - RES
225.00
DIF PARK MAINT FAC - RES
' 5.00
DIF PARKS/REC - RES
502.00
STRONG MOTION.(SMI)'- RES
35.12
DIF STREET MAINT FAC -RES
15.00
DIF TRANSPORTATION - RES
1098.00
Fee summary . Charged
Permit Fee Total 2076.25
Plan Check Total 1123.92
Other Fee Total 2917.23
Grand Total 6117.40
Paid Credited Due
.00 .00 2076.25
750.00 .00. 373.92
.00 .00 2917.23
750.00 .00 5367.40
pO
Po. BOX 1504 APPLICATION ONLY
Building �% L' (• 78-495 CALLE TAMPICO
Address t �3 �" VJ Q,CZ��v1 LA OUINTA, CALIFORNIA 92253
Owner
BUILDING: TYPE CONST. OCC. GRP.
Mailing A.P. Number -7'70 - R 10 — a'
Address3`� �
Zip e . I Description LA
�.� Z:PZ
. Contr t Projec Description
C�ft
Address ?
City
Tel.
Sq. Ft.
Size
i No. Dw.
''Stories 1 Units
State Lic,
& Classif.A< Z6
City
Lic. #
Arch., Engr.,
Designer
�C
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
TA
Address e
Z937 ( _e`(�A
71 L -i _ (�
City f
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5, Business and Professions Code: Any city or county which requires a
PERMIT
AMOUNT
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that he is exempt therefrom, and the basis
Plan Chk. Dep.
v
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).
Plan Chk. Bal.
❑ 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 Profes-
Const.
sions Code: The Contractor's License Law does not apply to an owner of property who builds
or improves thereon and who does such work himself or through his own employees, provided
Mech.
Electrical
that such improvements are not intended or offered for sale. If, however, the building or im-
provement is sold within one year of completion, the owner -builder will have the burden of
proving that he 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 Contractor's License Law does
not apply to an owner of property who builds or improves thereon, and who contracts for such
Plumbing
S. M. 1.
Grading
projects with a contractor(s) licensed pursuant to the Contractor's License Law)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner
Infrastructure
WORKER'S COMPENSATION DECLARATION
III FN
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's
Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
Itl
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
TOTAL
REMARKS
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less).
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 Workers' Compensation Laws of
California.
01 U. QUiNTA
QEPT.
—
Date Owner
NOTICE TO APPLICANT.. If, after making this Certificate of Exemption you should become
ZONE: BY:
Minimum Setback Distances:
subject to the Workers' Compensation Provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Front Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the work
for which this permit is issued. (Sec. 3097, Civil Code.)
Rear Setback from Rear Prop. Line
Lender's Name
Side Street Setback from Center Line
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
Side Setback from Property Line
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
FINAL DATE
INSPECTOR
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter the above-mentioned
property for inspection purposes.
Issued by:
Date Permit
Signature of applicant Date
Mailing Address
Validated by:
Validation:
City, State, Zip
WHITE = BUILDING DEPARTMENT YELLOW
= APPLICANT
PINK = FINANCE
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Certificate of Occupancy
G�
OFBuilding & Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 78-431 DEACON DRIVE WEST
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 05-2113
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
Owner of Building: M/M REZNICHEK Address:
,.. By: EDDIE MUIR
Date: MARCH 22, 2007
Building Official
6 POST IN A CONSPICUOUS PLACE