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08-0050 (SFD)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description: Property Zoning: Application valuation: Applicant: 08-00000050 81455 GOLDEN POPPY WY 764-280-999-119 -300236- DWELLING - SINGLE FAMILY MEDIUM HIGH DENSITY RES 159387 Tiht 4 etA Q" t BUILDING & SAFETY DEPARTMENT BUILDING PERMIT DETACHED Architect or Engineer: LA SHEA—MOME'S, INC. 81260 AVENUE 62 LA QUINTA, CA 92253 (760)777-6005 Lic. No.: 672285 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1/08/08 ------------------------------------------------------------------------------------------- - - - - - — LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Sec i 70001,of Division 3 of the Bu - e and Prof sionals Code, and my License is in full force and effect. Lic ,Class: B icense No.: 672285 at Contractor: OWNER -BUILDER DECLARATION 1 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).: (_) 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 contractor(s) licensed pursuant to the Contractors' State License Law.). I—) 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: Ilk LQPER111IT 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 AMERICAN HOME Policy Number CA 1593364 _ 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 be me subject to the workers' compensation laws of California, and agree that, if I should becom ubject to the workers' compensation provisions of Section KX700 of the Labor de,�s hwit comply with those provisions. ate u pficam:+` Ir/ Il A WARNING: FAILURE TO SECURE RKERS' 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 cer "fy that 1 have read this application and state that the above inform ti is correct. I agree to comply with all city nd cou ty ordinances and state laws relating to building construction, a d hereby authorize representatives of u y/Eo er upon the above-mentioned prop for•i spe `oses. at U ignature (Applicant or Agertl: J LQPERdI IT Application Number . . . . . 08-00000050 Permit . . BUILDING PERMIT Additional desc . Permit Fee . . . . 849.50 Plan Check Fee 552.18 Issue Date . . . . Valuation . . . . 159387 Expiration Date 7/06/08 Qty Unit Charge Per Extension BASE FEE 639.50 60.00 ---------------------------------------------------------------------------- 3.5000 THOU BLDG 100.,001-500,000 210.00 Permit . . . MECHANICAL Additional desc . Permit Fee 65.50 Plan Check Fee 16.38 Issue Date . . . . Valuation 0 Expiration Date 7/06/08 Qty ' Unit Charge Per Extension BASE FEE 15.00. 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00 9..0000 EA MECH B/C <=3HP/100K BTU 9.00 4.00 .6.5000 EA MECH VENT FAN 26.00 1.00 ---------------------------------------------------------------------------- 6.5000 EA MECH EXHAUST HOOD 6.50 Permit . . . ELEC-NEW RESIDENTIAL Additional desc . Permit Fee 89.84 Plan Check Fee 22.46 Issue Date . . . . Valuation . . . . 0 Expiration Date 7/06/08 Qty 'Unit Charge. Per Extension BASE FEE 15.00 1773.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 62.06 . 639.00 --------------------- .0200 ------------------------------------------------------ ELEC GARAGE OR NON-RESIDENTIAL 12.78 Permit . . . PLUMBING Additional desc . Permit Fee 120.00 Plan Check Fee 30.00 Issue Date Valuation . . . . 0 Expiration Date 7/06/08 Qty Unit Charge Per Extension BASE FEE 15.00 10.00 6.0000 EA PLB FIXTURE 60.00 1.00 15.0000 EA PLB BUILDING SEWER 15.00 Application Number . . . . . 08-00000050 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 6.00 .7500 EA PLB GAS PIPE >=5 4.50 1.00 15.0000 EA PLB GAS METER -----------------------------7---------------------------------------------- 15.00 Permit . . . . . GRADING PERMIT Additional desc . Permit Fee . . . . 15.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 7/06/08 Qty Unit. Charge Per Extension BASE FEE 15.00 ---------------------------------------------------------------------------- Special Notes and Comments SFD - LOT 119, PLAN 4515B, 1773 SF. WITH 4- GARAGE EXT. (103SF) & BOX BAY @ nook (24 SF'.) . PERMIT DOES NOT INCLUDE POOL, SPA, BLOCK WALLS OR DRIVEWAY APPROACH. 2001 CBC, CMC, CPC, 2004 CEC, 2005 ENERGY CODES ---------------------------------------------------------------------------- Other Fees . . . . . . . ART IN PUBLIC PLACES-RES 20.00 DIF COMMUNITY CENTERS-RES 74.00 DIF CIVIC CENTER - RES 995.00 ENERGY REVIEW FEE 55.22 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 15.93 DIF STREET MAINT FAC-RES 67.00 DIF.TRANSPORTATION - RES 1930.00 Fee summary Charged Paid Credited ---------------------------------------- Due ----------------- Permit Fee Total 1139.84 .00 .00 1139.84 Plan Check Total 621.02 .00 .00 621.02 Other Fee Total 4566.15 .00 .00 4566.15 Grand Total 6327.01 .00 .00 6327.01 LQPERA4TT ,