04-8076 (SFD)0
BUILDING & SAFETY DEPARTMENT
P.O.•Box 1-504. '(760),777-7012
C� .0F 9`• 78-495 CALLE TAMPICO 4' FAX"(760),777-7011
LA QUINTAt,,CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
�- �- Application Number . . . X04= 0 -00 -68_0 --Ji Da'.te. 1/12/05
Property Address;,.. 51518 VIA SORRENTO
�APN: . ;', 772-250-997-145 -31349
` Application description DWELLING.' --SINGLE FAMILY DETACHED
Property Zoning . LOW.DENSITY RESIDENTIAL
Application valuation 262610
` yrs
Owner Contractor-
---------------
ontractor ---------- -- — ---------— — — — — — _ ' 1 — — — ----
C/O KEVIN D_•DUERMIT 73.121 FRED WARING DRIVE, #100
8901 E.MOUNTAIN VIEW 200 PALM DESERT, CA 92260
SCOTTSDALE, AZ .85258 WCC`: -MARSH USA INC_
WC-:
- WC-: WA762D004723014 09./01/05
CSLB: 77.7699 04/30/06
rANCECCC: B . i 't05 LA 9LUINTA
�FDEPT
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P.O. BOX 1504 �� •
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78-495 CALLS TAMPICO VOICE (760) 777-7012
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
IN(760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: t7%(o Date: 51
Applicant:
Applicant's Mailing Address:
Archit f o n inet
hitect or Engineer's Address:
c. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under pe el 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 ss License i t'll force and effect. — �� ��^ Q /�
,cense Class_ v / cense No. I/ ( 7
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 Owner.
�.. J, '
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.
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
iss d. y s' co p sation i ce cam r o�'y n befrg�
er a� l.( -nL ol'ts icy Number" 1 . Yd D Y ? � 14
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 I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Date��� / �O plicant
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, indemnity and hold harmless the City of La Ouinta, its
officers, agents and employeesfor 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, and hereby authorize representatives of this coun iter pon the above-mentipned property for inspection purposes.
ate Sig/ nature (Applicantor Agent):
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Application Number 04-00008076
:! -- --- ------------------------------------------------------------
Structure Information
Construction Type
.,.. TYPE V, -,-NON RATED
Occupancy
Type . . .
DWELLG/LODGING/LONG <=10
Flood ZoneNON-AO
FLOOD ZONE
Other struct info . .
. . . CODE EDITION 2001 CBC
# BEDROOMS
3.00
FIRE SPRINKLERS NO
GARAGE SQ FTG
625.00
PATIO SQ FTG
233.00
NUMBER OF UNITS
1.00
1ST FLOOR SQUARE FOOTAGE
3047.00'
Permit
BUILDING PERMIT
Additional
desc
Permit Fee
1210.00 Plan Check Fee
196.63
Issue Date
Valuation . .
262610
Qty,
Unit Charge
Per
Extension
BASE FEE
639.50`
163.00
3.5000
THOU BLDG 100,001-500,000
570.50
Permit
MECHANICAL
Additional
desc
Permit Fee
127.50 Plan Check Fee
7.97
Issue Date
Valuation . . . .
0
Qty
Unit Charge
Per
Extension
BASE" FEE
15.0,0
3.00
9.0000
EA MECH FURNACE <=100K
27.00
3.00
9.0000
EA MECH B/C <=3HP/100K BTU
27.00
8.00
6.5000
EA MECH VENT FAN
52.00
1.00
6.5000
EA MECH EXHAUST HOOD.
6.50
Permit .
. . . . .
ELEC-NEW RESIDENTIAL .
Additional
desc
Permit Fee
. . . .
134.15 Plan Check Fee
8:39
Issue Date
Valuation
.0
Qty
Unit Charge
Per
Extension
BASE FEE
15.00
3047.00
.0350
ELEC NEW RES - 1 OR 2 FAMILY
106.65
625.00
.0200,
ELEC GARAGE OR NON-RESIDENTIAL
12.50
Permit .
. .
PLUMBING
Additional
desc
Permit Fee
. . . .
207.75 Plan Check Fee
12.99
Issue Date
. . . .
Valuation
0
Qty
Unit Charge
Per
Extension
BASE FEE
15.00
23.00
6.0000
EA PLB FIXTURE
138.00
1.00
15.0000
EA PLB BUILDING SEWER
15.00
1.00
7.5000
EA PLB WATER HEATER/VENT
7.50
1.00
3.0.000
EA PLB WATER INST/ALT/REP
3.00
1.00
.9.0000
EA PLB LAWN SPRINKLER SYSTEM-
9.00
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Application Number 04-0.0008076
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--
Permit . . . . . PLUMBING j
Qty Unit Charge Per
Extension
7.00 .7500 EA PLB GAS PIPE >=5
5.25
.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
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Special Notes and Comments
SFD - LOT 145. 3047 S.F. SFD. BELIZE/SB ..
+4. PERMIT DOES NOT INCLUDE
BLOCKWALLS,POOL/SPA,OR DRIVEWAY.
APPROACH. *75% REDUCTION TO PLAN CHECK
FEE DUE TO MULTIPLE ISSUANCE OF SAME
PLAN TYPE.
Other Fees . . . . . . ART IN`PUBLIC PLACES -RES
153.86
DIF "COMMUNITY CENTERS -RES
97.00
DIF CIVIC CENTER - RES
366.00
ENERGY REVIEW FEE
19.66
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
26.15
DIF STREET MAINT FAC -RES
15.00
DIF TRANSPORTATION - RES
1098.00
Fee summary Charged Paid Credited
Due
Permit Fee Total .1694.40 .00 .00
1694.40
Plan Check Total 225.98 .00 .0,0
225.98
Other Fee -.'Total 2604.67 .00 .00
2604.67
Grand Total 4525.05 .00 .00
4525.05..