04-7102 (SFD)i
T4hf 4 4 a"
BUILDING & SAFETY.DEPARTMENT
P.O. Box 1504 (760).777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number . . . . .I 04=0-0007102 Date 11/23/04
Property Address . . . . . . 80859 VIA PUERTA AZUL
APN: 762-240-003-81 -300962-
Application description . . . DWELLING - SINGLE FAMILY DETACHED
Property Zoning . . . . . . . MEDIUM DENSITY RES
Application valuation . . . . 112634
Owner
------------------------
PUERTA AZUL PARTNERS
17700 SW UPPER BOONES FERRY RD
SUITE 100
PORTLAND OR 97224
Contractor
DAVIS/REED CONSTRUCTION INC
16.9 SAXONY ROAD, STE 4105
ENCINITAS CA -92024
(760) 634-2350
WCC: STATE FUND
WC: WC298892003
06/12/05
CSLB: 813480
10/31/06
CCC: B
--------------------------
Structure Information -------------------------
Construction.-T-ype . . . . .—TYPE V - NON RATED
Occupancy Type
. . . . . . DWELLG/LODGING/CONG <=10
Flood Zone
NON -AO FLOOD ZONE
Other struct info
. . . . . CODE EDITION 2001 CRC
# BEDROOMS
1.00
FIRE SPRINKLERS NO
GARAGE SQ FTG
250.00
PATIO SQ FTG
617.00
NUMBER OF UNITS
1.00
1ST FLOOR SQUARE FOOTAGE
1740.00
----------------------------------------------------------------------------
Permit . . . .
. . BUILDING PERMIT
Additional desc
. .
Permit Fee . .
. . 685.00 Plan Check Fee
111.31
Issue Date
Valuation . . . .
112634
Qty Unit
Charge Per
Extension
BASE FEE
639.50
13.00
3.5000 THOU BLDG 100,001-500,000
45.50
----------------------------------------------------------------------------
Permit . . . .
. . MECHANICAL
Additional desc
Permit Fee . .
. . 78.50 Plan Check Fee
4.91
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
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
Applicant's Mailing Address:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date:
Engineer: . R M �,3
or Engineer's Address:
Lic. No.: C�Z'_53i+7 cl
MUILUINU I'LKMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perl'ury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Code— and my Lic `r> is in full force and effect. / �& 13 ` Q0
License Class i15� License No. �-1 J
Date Q -V1 -p4 ✓contractor 1. /_ C.L�i 1 S 1 i e 2� �V" % A_1C_C_TLO�
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 fora 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.).
(, 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 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
issue . My workers' co m ensatio;n carrier and policy ape re:
Carrier c c�k� ��(� o� licy Number 1.�� C`(gqiZQ[�'�
_ I certify that, in the performance of the work for which•this permit is issued, 154@11 not employ any person in any manner so as to become subject to the workers'
compensation laws of California, andaoree`tg t, if I shout corpa�Ti t to t orkers' mpensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provi.5i s.
WARNING: FAILURE TO SECURE WORKERS'Cg&ENSATION COVERAGHS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAN OLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTERIR�§_f, 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
ACKNOWLEDGEMENTAPPLICANT
IMPORTANT Application is hereby made to the Director of Building and Safetyfor permiit
uo 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-f6r`w ose ene i w ormed under or pursuant to any permit
issued as a result of this application, the owner, and the applicant, each_agrees'to, and shall, defend, indemnity and hold ha s 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 pe
2. Any permit issued as a result of,this application becomes 90t-a—nd void if work is n mme within 180 days from date of issuantce 0f such permit, or
cessation of work for 180 days will subject permit to ca ellation.
I certify that I have read this application and state that the abov nformation is come ag y with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this county' nter upon abov d prop or inspection purposes.
f S/ignafure (Applicant or Agent):
Page 2
Application Number . . . . . 04-00007102 Date 11/23/04
Qty
Unit Charge
Per
Extension
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
_
80.90 Plan Check Fee
5.06
Issue Date
. . . _
Valuation . . . .
0
Qty
Unit Charge
Per
Extension
BASE FEE
15.00
1740.00
.0=50
ELEC NEW RES - 1 OR 2 FAMILY
60.90
250.00
.0100
ELEC GARAGE OR NON-RESIDENTIAL
5.00
------------------------------------------------------------------'----------
Permit .
. . . .
PLUMBING
Additional
desc
Permit Fee
. . . .
146.25 Plan Check Fee
9.14
Issue Date
Valuation . . . .
0
Qty
Unit Charge
Per
Extension
BASE FEE
15.00
13.00
6.0)00
EA PLB FIXTURE
78.00
1.00
15.0D00
EA PLB BUILDING SEWER
15.00
1.00.
7.5D00
EA PLB WATER HEATER/VENT
7.50
1.00
3.0300
EA PLB WATER INST/ALT/REP
3.00
1.00
9.0300
EA PLB LAWN SPRINKLER SYSTEM
9.00
5.00
.7-000
EA PLB GAS PIPE >=5
3.75
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
81. PLAID 4AR, 1740 SF. PERMIT
DOES NOT INCLUDE
FLOCK
WALLS, POOL, SPA .
OR DRIVEWAY
APPROKCH.
75% PLAN CHECK FEE
REDUCTION
APPLIED FOR
MULTIPLE ISSUANCE
OF SAME PLAN TYPE.
---------------
Other Fees
-----------
. . . . .
---------------------------------------
. . . . ART IN PUBLIC PLACES -RES
-----------
.00
Page 3
Application Number
04-00007102, Date
11/23/04
----------------------------------------------------------------------------
Other Fees . . .
. . . . . ..
DIF COMMUNITY CENTERS -RES
97.00
DIF CIVIC CENTER'- RES
366.00
ENERGY REVIEW FEE
11.13
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
11.26
DIF STREET MAINT FAC -RES
15.00
DIF TRANSPORTATION -.RES
1098.00
Fee summary
-----------------
Charged
Paid Credited
Due
Permit Fee Total
----------
1005.65
------------------------------
.00 .00
1005.65
Plan Check Total
130.42
.00 .00
130.42
Other Fee Total
2427.39
.00 .00
2427.39
Grand Total
3563.46
.00 .00
3563.46