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04-4824 (SFD)D '��I�II AUS a- 1 200 ►' 'w • 4Q" 4 CITY OF LA 9.14 � I tYl'AIANC:t u'rz". BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUIN,TA, CALIFORNIA` 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number. 04-00004824 Date 8/05/04 Property Address,°. ' 52465 VIA DONA APN: 772-480-007- - - Application description . . . DWELLING - SINGLE FAMILY DETACHED Property Zoning . . . . . . . LOW DENSITY RESIDENT=AL Application valuation . . . . 448787 Owner Contractor DUANE JENSON OWNER 8842 HIGHFIELD RD. PARK CITY UT-. PARK CITY UT 84068 ------ Structure Information 4982 SQ. FT. SFD ----- Construction Type . . . . . TYPE V - NON RATED Occupancy Type . . . . . . DWELLG/LODGING/LONG <=10 Flood Zone . . . . . . NON -AO FLOOD ZONE Other struct info . . . . . CODE.EDITION 2001 CBC # BEDROOMS 4.00 FIRE SPRINKLERS NO GARAGE SQ FTG 1283.00 PATIO SQ FTG 1586.00 NUMBER OF UNITS 1.00 FIRST FLOOR SQ FTG 4982.00 ---------------------------------------------------------------------------- Permit . . . . . . BUILDING PERMIT Additional desc Permit Fee . . . . 1861.00 Plan Check F=e 1209.65 Issue Date . . . . Valuation . . . . 448787 Qty Unit Charge Per Extension BASE FEE 639.50 349.00 3.5000 THOU BLDG 100,001-500,000 1221.50 ---------------------------------------------------------------------------- Permit . . . . . . ELEC-NEW RESIDENTIAL Additional desc Permit Fee . . . . 230.03 Plan Check Fee 57.51 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 4982.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 174.37 1283.00: .0200 ELEC GARAGE OR NON-RESIDENTIAL 25.66 ,e P.O. Box 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: K e - Applicant: 1-)llAn1/;_�: S- Jr7_� Applicant's Mailing Addre s: SIL(- 4,0&,5 61T�9� y Date: Ariter oginee5y/A1�L,'0r7) - Lic. NO.: C 8 3 9z BUILDING PERMIT DECLARATIONS 2223 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class License No. Date Contractor OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury that I 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. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civif penalty of not more than five hundred dollars ($500).): U 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 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 U I am exempt under Sec. B.& .C. for this reason Date - Owner W RKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the follow6ntto cl rations: _ I have and will maintain a certificate of cons elf -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: Cartier Policy Number I certify that, in the performance oft 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 Californ' : an agree that, if I should b o e subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those p wsion Date Applica WARNING: FAILURE TO SECURE WORKERS' COMPENSAT COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLA ( 00,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AN A ORNEY'S FEES. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lendingagency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's 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 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 tonc Ilanon. I certify that I have read this application and state that the abo nfornlationis correct. I agree to ply with all city and county. ordinances and state laws relating to building construction, and hereby authorize representatives of this cou t to enller up on the above-rg*ntig d property for inspection purposes. Date Signature (Applicant or Agent): Page 2 Application Number 04-00004824 Date 8/05/04 Qty Unit Charge Per Extension 1.00 15.0000 EA ELEC TEMPORARY POWER POLE 15.00 ---------------------------------------------------------------------------- Permit GRADING PERMIT Additional desc . . Permit Fee 15.00 Plan Check F`ee .00 Issue Date Valuation 0 Qty Unit Charge Per Extension =---------------------------------------------------------------------------- BASE FEE 15.00 Permit . . . . . . MECHANICAL Additional desc . Permit Fee 139.00 Plan Check Fee 34.75 Issue Date Valuation 0 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 - 7.00 - 6-.5000 EA MECH VENT FAN - - - - - 45.50- .1.00 6.5000 EA MECH EXHAUST HOOD 6.50 ------------------- Permit ------- ----------- PLUMBING ---------------------------- ----------- Additional desc . Permit Fee 252.75 Plan Check Fee 63.19 Issue Date . . . . Valuation 0 Qty Unit .Charge Per Extension BASE FEE 15.00 26'.00 6.0000 EA PLB FIXTURE 156.00 1.00 15.0000 EA PLB BUILDING SEWER 15.00 1.00 6.0000 EA PLB ROOF DRAIN 6.00 2.00 7.5000 EA PLB WATER HEATER/VENT 15.00 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 1.00 9.0000 EA PLB LAWN SPRINKLER SYSTEM 9.00 4.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 12.00 9.00 .7500 ,EA PLB GAS PIPE >=5 6.75 1.00 ------------------------7--------------------------------------------------- 15.0000 EA PLB GAS METER 15.00 Special Notes and Comments - NEW 4982 SQ. FT. SFD. THIS -PERMIT DOES - -- l Page 3 Application Number 04-00004824 Date 8/05/04 ------------------------7--------------------------------------------------- Special Notes and Comments NOT INCLUDE POOLS & SPA, BLOCK WALLS AND DRIVEWAY APPROACH.PERMIT WAS ADJUSTED TO SHOW'$500 PLAN CHECK DEP. ---------------------------------------7------------------------------------ Other Fees . . . . . . . ART IN PUBLIC PLACES -RES 621.96 DIF COMMUNITY CENTERS -RES 97.00. DIF CIVIC CENTER - RES 366.00 ENERGY REVIEW FEE 120:97 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 44.87 DIF STREET MAINT FAC -RES 15.00 DIF TRANSPORTATION - RES 1098.00 Fee summary Charged Paid Credited Due ----------------- Perm t _Fee_Total__.._____ ---------- 24:97.,78.. ------------------------------ -. 0.0:=.__-._.__..__:.. ..0�). —_-2492..78 _. _ ..._. Plan Check Total 1365.10 500.00 .01) 865.10 Other Fee Total 3192.80 .00 .01) 3192.80 Grand Total 7055.68 500.00 .01) 6555.68 Total Permit Fees s'# City of La Quin -.a Building at Safety Division Permit # P.O. Box 15041, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and T-acking Sheet Jf Project Address: - 5 r's Name: A. P. Number. TAddress: ?' deloLeeal Description: X-07- l0�[v 0T. Zip:Contractor: nOct v� -C- tT rL)S�one: 7 - 3 g x Address: - S Q / kk e✓ Q 0 SJ Project Description: ]� City? ST. Zip: X Telephone: State Lic. it - Citv Lic. : Arch.. Engr., Designer: G Address: City. ST. Zip: Telephone:- _ Construction Type: Occupancy: State Lic. #: Project" (circle one): New Add'n Alter Repair Demo X Name of Contact Person: Sq. Ft.: # Stories: is # Units: Telephone # of Contact Person: �� 3 �� stimated Value of Proiect: 3 APPLICANT: DO NOT WRITE BELOW THIS LINE Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Structural Cales. Amount Reviewed. ready for corrections Plan Check Deposit Truss Calcs Called Contact Person Plan Check Balance Energy Cales. Plans picked up Construction Flood plain plata Plans resubmitted hfeckanical Grading plan 2' Review, ready for correctionslissuc Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up SA1.L H.O.A. Approval Plans resubmitted Grad ng IN HOUSE:- a"' Review, ready for correctionsfissue Developer Impact Fee Planning Approval Called Contact Person A.I.PP. Pub. Wks. Appr Date of permit issue School Fee::s Total Permit Fees Ull I. Y Ur LH UUIIV 1 H �U13-1.U1V 1 MALA 1 UK L10 1 oft JOB ADDRESS .S �- �i'6 � 11i,4 DOW 4- PERMIT NUMBER Cpl - V YiY OWNER --!Q vANE. BUILDER o w�� ✓�.+'/"�� This form shall be posted on the job with the Building Inspection Card at all times in a corigbicuous place. Only persons appearing on this list or their employees are authorized to work on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance OWNER/BUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as "Owner/ you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a businesslicense from the City or County. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the State and Federal Government as an employer and you are subject to several obligations including State and Federal income tax withholding, federal social security taxes, worker's compensation insurance, disability insurance costs and unemployment compensation contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance. For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under Stare Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/Builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N. Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, CITY OF LA QUINTA DEPT. OF BUILDING AND SAFETY 78-495 Calle Tampico La Quinta, CA 92253 06-0�777-7012 FAX 760) 777-7011 OWNER'S SIGNATURE/DATE ,201 PROPERTY A699 SS PERMIT NUMBER(s) WEDDLE SURVEYING MAPPING, INC. Boundary • Construction • Topographic • Aerial Surveys • ALTA Surveys • GPS • Consulting October 15, 2004 Mr. Timothy R. Jonasson Public Works Director / City Engineer City of La Quinta 78-495 Calle Tampico La Quinta, CA 92253-1504 Re: Pad/Form Grade Verification City of La Quinta Lot 123 Tract No. 29894-2 Amended THE HIDEAWAY APN 772-480-029 Dear Mr. Jonasson: 0 Flo S 44 km We have performed a field survey to determine the vertical location of the building pad and form for the above referenced project. The elevation's observed are as follows: PAD (DESIGN) PAD (AS -BUILT) 1008.2 1008.3 FORM (DESIGN) FORM (AS -BUILT) 1008.70 1008.80 These field observations are in substantial conformance with the precise grading plan prepared by ESSI SHAHANDEH, CIVIL ENGINEER, dated 10/14/04, approved by the City of La Quinta Building & Safety Department 10/14/2004 and the building horizontal location substantially conforms to the required setbacks and site layout as shown on the approved site plan. Sincerely, �p \�qND ,& WEDDLE SURVEYING MAPPING, INC. O NO. 6570 m EXP. 09/30/05 David L. Weddle, President L.S. 5570, Exp 9/30/05 �oFCA��F� P.O. Box 10418 • Palm Desert, CA 92255-0418 73-960 Hwy. 111, Ste. 6 • Palm Desert, CA 92260 • 760.346.3748 E -Mail: WedSury@aol.com • Fax 760.346.3749