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05-2642 (SATT)P.O BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 05-00002642 Property Address: 80292 VIA TESORO APN: 772-250-019-1 -30357 - Application description: DWELLING - SINGLE FAMILY Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 195692 Applicant: T4ht 4 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT OOwner: OLL CA V C. KEVIN D DUERMIT ATTACHED �Uj 890 E MOUNTAIN VIEW 200 C ( T ALE, AZ 85258 4712 Architect or Engineer: -------------------------------------------------- UCENSED C NTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am lic sed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Pr essionals Code, and my License ' t full force and effect. License CI �:: El License No.: 77769 Date: !/r/ 4 ontractor: OWNER -BUILDER DECLARATION hereby affirm under penalty of perjury hat I am exempt from the Contractor's State License Law for the following reason (Sec. 7031 .5, Busin sand 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 Contractor's 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).: 1 _ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and 100 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 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 contractors) licensed pursuant to the Contractors' State License Law.). 1 _) I am exempt under Sec. , B.&P.C. for this reason Date: Owner: 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: LQPERMIT roL S, INC. 3 ED WARING DRIVE, 4100 PALM ESERT, CA 92260 (7 )674-9699 C. No.: 777699 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 ------------------ WORKER'S COMPENSATION DECLARATION Date: 6/29/05 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 Kissued. 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 issued. My workers' compensation insurance carrier and policy number are: Carrier LIBERTY MUTUAL Poli y Number WA762DO04723014 _ I certify that, in the performance of th ork for which this permit is issued, I shall not employ any person in any manner so as to bec a subject to the workers' compensation laws of California, and agree that, if I should becom `subject to the workers' compens ion provisions of Section 00 o�Labor Code, I all o with cc ply with those prov' �e: lir' �7 plicant: WARNING: FAILURE TO SECURE WO ERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMIN 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. 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 Quinta, 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 Wabove r cessation of work for 18 days will subject permit to cancellation. I certify that I have read this application and state thmation is correct. I agre to comply with all city and county ordinances and state laws relating totion, andhereby author' a representatives' ofthisy to nter upon th above-mentioned pri u eats: ature (Applicant or Agent): LQPERMIT Application Number . . . . . 05-00002642 Structure Information Construction Type . . . . . TYPE V - 1 HR Occupancy Type . . . . . . DWELLG/LODGING/CONG <=10 Flood Zone . . . . . NON -AO FLOOD ZONE Other struct info . . . . . CODE EDITION 200'1 # BEDROOMS 2.00 FLOOD ZONE NO GARAGE SQ FTG 901.00 PATIO SQ FTG 156.00 TOT ELIGIBLE. NO - NUMBER OF UNITS 1.00 1ST FLOOR SQUARE FOOTAGE 2110.00 ---------------------------------------------------------------------------- Permit . . . . Additional desc Permit Fee Issue Date Expiration Date BUILDING PERMIT 975.50 Plan Check Fee . . 634.08 Valuation . . . . 19569.2 12/26/05 Qty Unit Charge Per Extension BASE FEE 639.50 96.00 ---------------------------------------------------------------------------- 3.5000 THOU BLDG 100,001-500,000 336.00 Permit . . . MECHANICAL Additional desc . . Permit Fee . . . . 91.50 Plan Check Fee 22.88 Issue Date . . . . Valuation . . . . 0 Expiration Date 12/26/05 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 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 . . . . 110.07 Plan Check Fee 27.52 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 12/26/05 Qty Unit Charge Per Extension BASE FEE 15.00 • Application Number . . . . . 05-00002642 Permit . . . . . . ELEC-NEW RESIDENTIAL Qty Unit Charge Per Extension 2110.00. .0350 ELEC NEW RES - 1 OR 2 FAMILY 73.85 1061.00 .0200 ---------------------------------------------------------------------------- ELEC GARAGE OR NON-RESIDENTIAL 21.22 Permit . . . PLUMBING Additional desc . . Permit Fee . . 173.25 Plan Check Fee 43.31 Issue Date . . . . Vaivatibn . . . 0 Expiration Date . . 12/26/05 Qty Unit Charge Per Extension BASE FEE 15.00 16.00 6.0000 EA PLB FIXTURE 96.00 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 7.5000 EA PL•B OTHER BACKFLOW <=2 INCH 7.50 7.00 .7500 EA PLB GAS PIPE >=5 5.25 1.00 15.0000 EA PLB GAS METER 15.00 ---------------------------------------------------------------------------- Special Notes and Comments SFA - PLAN TYPE Al - GRND FLOOR UNIT 2,110 SF LIVING, R-3 OCCUPANCY, TYPE V-1HR CONSTRUCTION, 2001 CODES. [PLAN TYPE B2 GARAGE ATTACHED TO THIS PLAN TYPE] **PERMIT DOES NOT INCLUDE TEMP POWER, TRASH ENCLOSURE, BLOCK WALLS AND SITE LIGHTING** -------------------------------=-------------------------------------------- Other Fees . . . . . . . . . DIF COMMUNITY CENTERS -RES 68.00 DIF CIVIC CENTER - RES 229.00 ENERGY REVIEW FEE 63.41 DIF FIRE PROTECTION -RES 78.00 DIF LIBRARIES - RES 158.00 DIF PARK MAINT FAC - RES 3.00 DIF PARKS/REC - RES 352.00 STRONG MOTION (SMI) - RES 14.05 DIF STREET MAINT FAC -RES 15.00 DIF TRANSPORTATION - RES 1098.00 Fee summary Charged --------------------------- Paid Credited ------------------------------ Due Permit Fee Total 1350.32 .00 .00 1350.32 Plan Check Total 727.79 .00 .00 727.79 LQPERMIT Application Number Other Fee Total Grand Total LQPERAIIT . . . . 05-00002642 2078.46 .00 4156.57 .00 00 2078.46 00 4156.57