10-1150 (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:
10-00001150 .
81184 LAGUNA CT
764-280-004-8 -35996 -
DWELLING - SINGLE FAMILY
LOW DENSITY RESIDENTIAL
174086
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
SHEA LA QUINTA
60800 TRILOGY PARKWAY
DETACHED LA QUINTA, CA 92253
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 70 0) :visio�3thre usine s andProfessionals ode, and my License is in full force and effect.
Lice Cie70 sr: c se No.: 672285
Date y o
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 contractors) licensed
pursuant to the Contractors' State License Law.)..
(_ 1 I am exempt under•Sec. , BAP.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: P
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/03/10
Contractor:
SHEA HOMES, INC. G (j
60800 TRILOGY PARKWAY D u
LA QUINTA, CA 92.253
(760)777-6032 f��} !n� 99
Lic. No.: 672285 I.'� 1 lJ 1 2Q10
CITY Ac U1 GU NTA
FWANOE DEPT.
---------------------------------------------
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 LIBERTY MUTUAL Policy Number WA266D066115030
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,
�41agree that, if I should become subject to the workers' compensation provisions of Section
pofthe Labor Code, I shall forthwith comply with those provisions.Ul plicant:
WARNING: FAILURE TO SECURE WORKERS' CO ENSATION 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 uponwhose 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 information is correct. I agree to comply with all
city and cou ty dinances and state laws relating to building construction, and hereby authorize representatives
of this cou y to enter upon the above-mentioned property for inspection: purposes.
ate' Si ature (Applicant or Agent):
Application Number . . . . . 10-00001150
Permit
BUILDING PERMIT
Additional
desc .
Permit Fee
.. . . .
902.00
Plan Check Fee
146.57
Issue Date
. . . .
Valuation . . . .
174086
Expiration
Date
5/01/11
Qty Unit Charge
Per
Extension
BASE
FEE
639.50
75.00
----------------------------------------------------------------------------
3.5000
THOU BLDG
100,001-500,000
262.50
PermitMECHANICAL
Additional
desc .
Permit Fee
. . . .
82.00
Plan Check Fee
6.09
Issue Date
. . . .
Valuation . . . .
0
Expiration
Date
5/01/11
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
1.00
16.5000
EA MECH
B/C >3-15HP/>100K-500KBTU
16.50
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
. . . .
95.54
-Plan Check Fee
5.97
Issue Date
. . . .
Valuation . . . .
0
Expiration
Date
5/01/11
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
1972.00
.0350
ELEC
NEW RES - 1 OR 2 FAMILY
69.02
576.00
.0200
ELEC
GARAGE OR NON-RESIDENTIAL
11.52
Permit
PLUMBING
'
Additional
desc
Permit Fee
. .4.. .
153.00
Plan Check Fee
9.56
Issue Date
. . . .
Valuation . . . .
0
Expiration
Date
5/01/11
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
14.00
6.0000
EA PLB FIXTURE
84.00
LQPERMIT
P-2..
LQPERMIT
Application Number .
. . . .
10-00001150
BASE
Permit .
. . . . .
PLUMBING
Qty
Unit Charge
Per
INCLUDES 255 SF. CASITA. 26 SF..
Extension
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
6.00
.7500
EA PLB
GAS'PIPE >=5
4.50
1.00
----------------------------------------------------------------------------
15.0000
EA PLB
GAS METER
15.00
Permit'
. . .
GRADING PERMIT
Additional
desc .
DIF LIBRARIES - RES
355.00
Permit Fee
MULTI -SPECIES (MSHCP) FEE
15.00
Plan Check Fee
.00
Issue Date
. . . .
DIF PARKS/REC - RES
Valuation . . .
. 0
Expiration
Date
5/01/11
DIF TRANSPORTATION - RES
1930.00
Qty Unit Charge Per
Extension
BASE
FEE
15.00
----------------------------------------------------------------------------
Special Notes and Comments
SFD - LOT 8, PLAN 4520C, 1972
SF.
INCLUDES 255 SF. CASITA. 26 SF..
BOX BAY @ MBR & 88 SF. GARAGE
EXTENSION. `
PERMIT DOES NOT INCLUDE POOL,
SPA, BLOCK
WALLS OR DRIVEWAY APPROACH.75a
REDUCTION
TO PLAN CHECK FEES DUE TO MULTIPLE
ISSUANCE OF SAME PLAN TYPE.
'
2007/2008 CODES. 2010 PLAN UPDATE.
---------------------------------_-------------------------------------------
Other Fees . . . . .
BLDG STDS ADMIN (SB1473)
7.00
DIF COMMUNITY CENTERS -RES
74.00
DIF CIVIC CENTER - RES
995.00
ENERGY REVIEW FEE
14.66
DIF FIRE PROTECTION -RES
140.00
GRADING PLAN CHECK FEE
.00
DIF LIBRARIES - RES
355.00
MULTI -SPECIES (MSHCP) FEE
1284.00
DIF PARK MAINT FAC - RES
22.00
DIF PARKS/REC - RES
892.00
DIF STREET MAINT FAC -RES
67.00
DIF TRANSPORTATION - RES
1930.00
Fee summary. Charged
Paid Credited
Due
Permit Fee Total 1247.-54
.00 .00
1247.54
Plan Check Total 168.19
.00 .00
168.19
Other Fee Total 5780.66
.00 .00
5780.66
V
Application Number . . . . . 10-00001150
Grand Total 7196.39 .00 .00 7196.39