10-1122 (SFD)P.O. BOX 1504 4
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: C10-00001122 Owner:'
Property Address: 81187�LAGUNA—CT SHEA LA QUINTA
APN: 764-280-004-18 -35996 - 60800 TRILOGY PARKWAY
Application description: DWELLING - SINGLE—FAMILY DETACHED LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 173501
Contractor: O
Applicant: Architect or Engineer: SHEA HOMES, INC.
60800 TRILOGY PARKWAY
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/27/10
n: r., p 12010 t
(760) 777-6032 __ J
Lic. No.: 672285 C�yQF�pQUINTA
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LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7 0) Division 3 of the Business nd Profes 'on Is Code, and my License is in full force and effect.
Lice
nse C ss: License No.: 672285
DatQ:r ntractor:
1IVV 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 ISec. 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 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 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:
LQPERMIT
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 LIBERTY MUTUAL Policy Number WA-266DO66115030
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
p rson in any manner so as to become subject to the workers' compensation laws of California,
a d agree that, if I should become subject to the workers' compensation provisions of Section
0 f the Labor Code, I ff o hwith comply with those provisions.
� Yr)
Date: pplicant:
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 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 th ItI
ave read this application and state that the above information is correct. I agree to comply with all
city and c un ordinances and state laws relating to building construction, and hereby authorize representatives
o, o ty en r upon the above-mentioned property fo' r spection purposes.
Da c Si ature (Applicant or Agent):
Application Number . . . . . 10-00001122
Permit
. .
BUILDING PERMIT
Additional
desc .
`. Permit Fee
. . . .
898.50
P1an'Check Fee
584.03
Issue Date
. . . .
Valuation . . . .
173501
Expiration
Date
4/25/11
Qty
Unit Charge
Per
Extension
BASE
FEE
639.50
74.00;,
-----------------------------------------------------------------------
3.5000
THOU BLDG
100,001-500,000
259.00
Permit
MECHANICAL
Additional
desc . .
Permit Fee
. . . .
97.50
Plan Check Fee
24.38
Issue Date
. . . .
Valuation . . . .
0
Expiration
Date
4/25/11
Qty
Unit Charge
Per
Extension
BASE
FEE
15.00
2.00
9.0000
EA MECH
FURNACE <=100K
18.00
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
2.00
-----------------------------------------------------7----------------------
6.5000
EA MECH
EXHAUST HOOD
13.00
Permit
. . .
ELEC-NEW RESIDENTIAL
Additional
desc .
Permit Fee
. . . .
95.54
Plan Check Fee
23.89
Issue Date
. . . .
Valuation . . . .
0
Expiration
Date..
4/25/11
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
. . . .
153.00
Plan Check Fee
38.25
Issue Date
. . . .
Valuation . . . .
0
Expiration
Date
4/25/11
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
14.00
6.0000
EA PLB FIXTURE
84.00
LQPERMIT
4
Application Number . . . . . 10-00001122
Permit . . . . . PLUMBING
Qty Unit Charge Per
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 .
Permit Fee . . . . 15.00 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date 4/25/11
Qty Unit Charge Per.
Extension
BASE FEE
15.00
Special Notes and Comments
SFD. - LOT 18, 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.
2007/2008 CODES. 2.010 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
58.40
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 1259.54 .00 .00
1259.54
Plan Check Total 670.55 .00 .00
670.55
Other Fee Total 5824.40 .00 .00
5824.40
Grand Total 7754.49 .00 .00
7754.49
LQPERMIT