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04-6570 (SFD)4 ��ry 4 4 Q" P.O. Box 1504 78-495 CALLE TAMPICO -p LA QU NTA, CALIFORNIA 92253 BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760).777'-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 A'j Application"Number . . . . . 04-00006570 Date 10/01/04 Property Addre—sjs . . . . 50175 VIA PUENTE APN: 772-370-011- - - Application description . . . DWELLING - SINGLE FAMILY DETACHED Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation . . . . 280144 Owner Contractor. - - - - - - - - - - - - - - - - - - - - - - - - ----------- ---------R J T HOMES RJT HOMES LLC 1425 E UNIVERSITY DR 1425 E. UNIVERSITY DRIVE PHOENIX AZ 85034 PHOENIX AZ 85034 Qty Unit Charge Per Extension BASE FEE 15.00 WCC: STATE FUND WC: 1583906 10/01/05 CSLB: 690645 06/30/06 CCC: A -B -------------------------- Structure Information ----=-------------------- Construction Type . . . . . TYPE V - NON RATED Occupancy Type . . . . . . DWELLG/LODGING/CONG <=10 Flood Zone . . . . . . NON -AO FLOOD ZONE Other struct info . . . . . CODE EDITION 2001 CBC FIRE SPRINKLERS NO GARAGE SQ FTG 763.00 PATIO SQ FTG 1248.00 NUMBER OF UNITS .1..00 FIRST FLOOR SQ FTG 4346.00 ---------------------------------------------------------- Permit . . . . . . -------------------- BUILDING PERMIT Additional desc Permit Fee . . . . 1273.00'- Plan Check Fee 827.45 Issue Date . . . . Valuation . . . . 280144 Qty Unit Charge Per Extension BASE FEE 639.50 181.00 3.5000 ---------------------------------------------------------------------------- THOU BLDG 100,001-500,000 633.50 Permit . . . . .. MECHANICAL Additional desc Permit Fee . . . . 114.50 Plan Check Fee 28.63 Issue Date. Valuation . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 P.O. BOX 1504 • VOCE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 04 — &5 70 Date: Applicant:—Architect or Engineer: Applicant's Mailing Address: Architect or Engineer's Address: 1100wn.C1.1 _rh01 4L ic. No.: _ 13 60 -;- BUILDING PERMIT DECLARATIONS 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's in II force and effect. / cense Class_�'� License No. (� / Date/0 -at • lo C actor G. L d OWNER -BUILDER DECLARATION I 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 civil 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 Law.). U I am exempt under Sec. , BA P.C. for this reason Date WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain acertificate 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 1 i ued. work compensation�asfirance carder�n�ppli num r are: /Carrier Y eU_ Policy Number jj_i'�i' g 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, and agree that, if*l should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. T cant 1 —r �'Q�%yf,Qy "fL L, e— 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. 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 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 Ouinta, 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 county ordinances and state laws relating to building construction, aand hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes. ignature (Applicant or Agent): Page 2 Application Number . . . . . 04-00006570 Date 10/01/04 Qty Unit Charge Per Extension 3.00 9.0000 EA MECH FURNACE <=100K 27.00 3.00 9.0000 EA MECH B/C <=3HP/100K BTU 27.00 6.00 6.5000 EA MECH VENT FAN 39.00 1.00 6.5000 EA MECH EXHAUST HOOD 6.50 ---------------------------------------------------------------------------- Permit ELEC-NEW RESIDENTIAL Additional desc Permit Fee . . . . 182.37 Plan Check Fee 45.59 Issue Date . . . . Valuation 0 Qty Unit Charge Per Extension BASE FEE 15.00 4346.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 152.11 763.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 15.26 ---------------------------------------------------------------------------- Permit . . . . . . PLUMBING Additional desc . . Permit Fee . . . . 240.00 Plan Check Fee 60.00 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 24.00 6.0000 EA PLB FIXTURE 144.00 1.00 15.0000 EA PLB BUILDING SEWER 15.00 4.00 6.0000 EA PLB ROOF DRAIN 24.00 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 10.00 .7500 EA PLB GAS PIPE >=5 7.50 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 Qty Unit Charge Per Extension BASE FEE .15.00 ------------------------------------------------_---------------------------- Special Notes and Comments SFD - LOT 21, PLAN SF3AC5, 4346 SF. Fee summary Charged Permit Fee Total 1824.87 Plan Check Total 961.67 Other Fee Total 2716.12 Grand Total 5502.66 Paid Credited Due ---------- ---------- ---------- .00 .00 1824.87 .00 .00 961.67 .00 .00. 2716.12 .00 .00 5502.66 Page 3 Application Number . . . . . 04-00006570 Date 10/01/04 ---------------------------------------------------------------------------- Special Notes and Comments PERMIT DOES NOT INCLUDE POOL, SPA, BLOCK WALLS, OR DRIVEWAY APPROACH ---------------------------------------------------------------------------- Other Fees . . . . . . . . ART IN PUBLIC PLACES -RES 200.36 DIF COMMUNITY CENTERS -RES 97.00 DIF CIVIC CENTER - RES 366.00 ENERGY REVIEW FEE 82.75 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 28.01 DIF STREET MAINT FAC -RES 15.00 DIF TRANSPORTATION - RES 1098.00 Fee summary Charged Permit Fee Total 1824.87 Plan Check Total 961.67 Other Fee Total 2716.12 Grand Total 5502.66 Paid Credited Due ---------- ---------- ---------- .00 .00 1824.87 .00 .00 961.67 .00 .00. 2716.12 .00 .00 5502.66