04-4094 (SFD)P.O., Box 1504
78-495 CALLS TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number
Property Address . . .
APN:
Application description
Property Zoning . . . .
Application valuation .
Owner
BUILDING PERMIT
BUILDING & SAFETY DEPARTMENT
(760).777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
_04-_00004094 i Date 5/17/04
. . . 80895 VIA PUERTA AZUL
760-240-003-18 -300961-
. . . DWELLING - SINGLE FAMILY DETACHED
. . . MEDIUM DENSITY RES
. . . 87296
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
WC: WC298892003
06/12/04
CSLB: 813480
10/31/04
CCC: 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
# BEDROOMS
2.00
FIRE SPRINKLERS NO
GARAGE SQ FTG
244.00
PATIO SQ FTG
269.00
NUMBER OF UNITS
1.00
FIRST FLOOR SQ FTG'
1380.00
----------------------------------------------------------------------------
Permit . . . . . .
BUILDING PERMIT,
Additional desc
Permit Fee . . . .
585.50 Plan Check Fee
380.58
Issue Date . . . .
Valuation
87296
Qty Unit Charge
Per
Extension
BASE FEE
414.50
38.00 4.5000
THOU BLDG 50,001-100,000
171.00
----------------------------------------------------------------------------
Permit . . . . . .
MECHANICAL
Additional desc
Permit Fee . . . .
78'.50 Plan Check Fee
19.63
Issue Date
Valuation . . . .
0
Qty Unit Charge
Per
Extension
0
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:
chitect r in er:
Architect or ngin er's ddressL74 r
lcf
:
ic. No.:
CSUILUINU t'EKMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby.affirtn under penalty 11 perjury that I am licensed undetsrovisions Chapter 9 (corer mencing with Section 7000) of Division 3 of the Business and Professionals
Code, and my Lio se is, in full force and effect. �/ �`/j' rv\
License Class _ License No.
l ' ContractorDate A �vv
�.
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 sdle 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 work for which this permit is issued.
I have an 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
i ue My a cgr�pensafon insurance carrier d- olicy rTum�rgare: &� /)
r-arier 7_� 1 �O (�4lQ lr�n .,umber .0� iS3r Z�
/ _I certify that, in the performance of the work for which this permit isIs—sued, 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 I should become subject to the w kers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions. /
pplicant
i
FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
:S UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
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 ,� l
Lender's Address YV
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 applica
, htion.
1. Each person upon whose behalf this application is made each pe hose-rewhose benefit work is performed under or pursuant to any permit
gnesLand for wh
issued as a result of this application, the owner, and the cant, each agrees to, and shat -defend, indemnify and hold harmless the City of La Quinta, its
officers, agents and employees for any act or omis related to the work being performed under or following issuance of this permit.
2. Any permit issued as a result of this application comes null and void q is n - m ncedTall
m'thin 180 days -from date of issuance of such permit, or
cessation of work for 180 days will subject pe it to cancellation. /
I certify that I have r ad this application and state that thea ve informati is port a to
construct:74
nd reby authorize representatives of this county -to -en r,.0 n th Y city and county ordinances and state laws relating to building
_ men pr Zerty for inspection purposes.
D � ig'S nature (Applicant or Agent
Page
2
Application Number
.
. .
. . 04-00004094 Date
5/17/04
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
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
. . .
68.18 Plan Check Fee
17.05
Issue Date
Valuation
0
Qty Unit
Charge
Per
Extension
BASE FEE
15.00
1380.00
.0350
ELEC NEW RES - 1 OR 2 FAMILY
48.30
244.00
.0200
ELEC GARAGE OR NON-RESIDENTIAL
4.88
----------------------------------------------------------------------------
Permit . . .
. . .
PLUMBING
Additional desc
Permit Fee .
. . .
139.50
Plan Check Fee
34.88
Issue Date .
. . .
Valuation . . . .
0
Qty Unit
Charge
Per
Extension
BASE FEE
15.00
12.00
6.0000
EA
PLB FIXTURE
72.00
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
---------------------------7------------------------------------------------
Special Notes
and Comments
SFD - LOT 18.
PLAN 1BR.
PERMIT DOES NOT
Page 3
Application Number
04-00004094 Date
5/17/04
----------------------------------------------------------------------------
. Special Notes and
Comments
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
ENERGY REVIEW FEE
38.06
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
8.72
DIF STREET MAINT FAC -RES
15.00
DIF TRANSPORTATION - RES
1098.00
Fee summary
-----------------
Charged
Paid Credited
Due
Permit Fee Total
-----------
886.68
------------------------------
.00 .00
886.68
Plan Check Total
452.14
.00 .00
452.14
Other Fee Total
2451.78
.00 .00
2451.78
Grand Total
3790.60
.00 .00
3790.60
Cedificate of Occupancy0
T-itf ot
Luro�oenrn `'�
OF Building y p & Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 80-895 VIA PUERTA AZUL
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 04-4094
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RM
PUERTA AZUL PARTNERS, LLC. Address: 17700 SW UPPER BOONES FERRY
City, ST, ZIP: PORTLAND, OR 97224
By: GARY HARTMAN
Date: FEBRUARY 16, 2005
Building Official
POST IN A CONSPICUOUS PLACE