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04-7401 (SFD)Tihf 4 4 Q*M P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760).777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 Application Number . . . . .. --0"0 700 401—Date 11/23/04 Property Address . . . . . . 80817 VIA PUERTA AZUL APN: 762-240-003-76 -300962- Application description . . . DWELLING - SINGLE FAMILY DETACHED Property Zoning . . . . . . . MEDIUM DENSITY RES Application valuation . . . . 99599 Owner PUERTA AZUL PARTNERS 17700 SW UPPER BOONES FERRY RD SUITE 100 PORTLAND ::"•.OR 97224 Contractor DAVIS/REED CONSTRUCTION INC 169 SAXONY ROAD, STE #105 ENCINITAS CA 92024 (760) 634-2350 WCC: STATE FUND C) WC: WC298892004 06/12/05 CSLB: 813480 10/3.1/06 CCC: B ---��` ' S-tructure Information Construct on Type . . . . . TYPE V - NON RATED Occupancy Type . . . . . . DWELLG/LODGING/CONG <=10 Flood Zone . . . . . . . . NON -AO FLOOD ZONE Other.struct info . . . . . CODE EDITION 2001 CRC # BEDROOMS 2.00 FIRE SPRINKLERS NO GARAGE SQ FTG 255.00 PATIO SQ FTG 451.00 NUMBER OF UNITS 1.00 1ST FLOOR SQUARE FOOTAGE 1549.00- ---------------------------------------------------------------------------- Permit , . . . . . BUILDING PERMIT Additional desc Permit Fee . . . . 639.50 Plan Check Fee 415.68 Issue Date . . . . Valuation . . . . .99599 Qty Unit Charge Per Extension BASE FEE 414.50 50.00 4.5000 THOU BLDG 50,001-100,000 225.00 ---------------------------------------------------------------------------- Permit . . . . MECHANICAL Additional desc . . Permit Fee . . . . 85.00 Plan Check Fee 21.25 Issue Date . . . . Valuation . . . . 0 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 P.O. Box 1504 • VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: _ 0 4- 1740 1 Date: Applicant: Applicant's Mailing Address: Architect or Engineer: fsm�- ,—Architect or Engineer's Address: Lic. No.: 1 2 �� 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) f Division 3 of the Business and Professionals Code, and my License is i ull force and effect. cense Class Jeen -ise No. Date actor OWNER -BUILDER DECLARATION I hereby a 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 Cou ty 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 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 wo ch this permit is issued. havewill maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the'performance of the work for which this permit is iss ers' compensation�'Dsuiance carrier and policy number are: /r[�✓ / �Ca er --Policy Number C'V—��2_�� I cert' that, in the performance of the work for t prtni is i I shall not employ any erson m any manner so as to become subject to the workers' mpen ion laws of California, and e t t, if I should become subjec o the workers' compensation provisions of Section 3700 of the Labor Code, I shall �j rthwi comwith those pr ons. Date Applica WARNIN F LURE O SECURE W ERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL F ES P TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION.3 6 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY 1 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�e edeaes or following issuance of this permit. 2. Any permit issued as a result of this application becomes null a d vatU if work is commenced within days from date of issuance of such permit, or cessation of work for 180 days will subject permit to can ion. I certify that I hav rea his application and state that the abov if, i frect. I agree to comply with all city and c unty ordinances and state laws relating to building construction, a /hie by a orize representatives of this my to enter�o�nthrve-m oned property for in on purposes. Dat !! S ure (Applicant or Ag Page 2 Application Number . . . . . 04-00007401 Date 11/23/04 Qty Unit Charge Per Extension 7.00 6.5000 EA MECH VENT FAN 45.50 1.00 ------------------------------------- 6.5000 EA MECH EXHAUST HOOD 6.,50 Permit . . . . . . --------------------------------------- ELEC-NEW RESIDENTIAL Additional desc Permit Fee . . . . 74.32 Plan Check Fee 18.58 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 1549.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 54.22 255.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL .5.10 ---------------------------------------------------------------------------- Permit . . . . . . PLUMBING Additional desc Permit Fee . . . . 151.50 Plan Check Fee 37.13 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 14.00 6.0000 EA PLB FIXTURE 84.00 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 1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 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.76. PLAN 2AR, 1549 SF. PERMIT DOES NOT INCLUDE BLOCK WALLS, POOL, SPA OR DRIVEWAY APPROACH. ---------------------------------------------------------------------------- Other Fees . . . . . . . ART IN PUBLIC PLACES -RES .00 DIF COMMUNITY CENTERS -RES 97.00 DIF CIVIC CENTER - RES 366.00 Page 3 Application Number 04-00007401 Date 11/23/04 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ENERGY REVIEW FEE 41.57 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 9.95 DIF STREET MAINT FAC -RES 15.00 DIF TRANSPORTATION - RES 1098.00 Fee summary Charged Permit Fee Total 965.32 Plan Check Total 492.64 Other Fee Total 2456.52 Grand Total 3914.48 . Paid Credited. Due ---------- ---------- ---------- .00 .00 965.32 .00 .00 492.64 .00 .00 2456.52 .00 00 3914.48