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11-0526 (SFD)P.O. BOX 1504 78-495 CALL -E TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 11.-000005.2.6 Property Address: 52849 ROSS'AVE APN: 767-670-017-21 -33076 - Application description: DWELLING - SINGLE FAMILY DETACHED ' Property Zoning: RL AG/EQ- OVERLAY Application valuation: 477140 Applicant: Architect or Engineer: - --------------------------------------------- LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (_commencing with Section 7000) of Division 3 of the Business and Pr sionals Code, and my License is in full force and effect. . icenseClass: B /License No.: 915336 Date: —� Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 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).: (_) 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 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 anowner.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.). (_ 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: LQPERi111T Owner: M&B SUGARMAN FAMILY 9440 SANTA MONICA B BEVERLY HILLS', CA 9 Contractor: DBCA INC P.O. BOX 1482 LA QUINTA, CA 92247 (760)393-5271, Lic. No.: 915336 VOICE (760) 777-7012 FAX (760). 777-7011 INSPECTIONS (760) 777-7153 Date: 1/03/12 TRUST LVD 4407 ?DO AN 0 C 2012 CITY OF, A QUINTA FW NCE P'EPTv_ WORKER'S 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 issued. My workers' compensation insurance carrier and policy number are: Carrier TRAVELERS PROP. Policy Number YEUB282D779711 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 shout o subject to the workers' compensation provisions of Section �C/ /33700. of the Labor C , I sha r oort ith comply with those pr vis. S. �oeDate: `! & Applicant: WARNING: FAILURE TO SE RE 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. ' ' 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 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 i auo is correct. I agree to comply with all city and county ordinances and state laws relating to buildin nstruction, nd hereby authorize representatives oyfiis county to enter upon the above-mentioned propert r inspec on ur ses. ,Date: ( I� �L� Signature (Applicant or Agentl: Application Number .. . . . . 11-00000526 LQPERIN4IT Structure Information Construction Type TYPE V, UNPROTECTED Occupancy Type . . . . . DWELLG/LODGING/CONG <=10 Other struct info CODE EDITION 2010 #.BEDROOMS 4.00 FIRE SPRINKLERS YES GARAGE SQ FTG 1124.00 PATIO SQ FTG 1621.00 NUMBER OF UNITS 1.60 -------------------------------------------------------------------- 1ST FLOOR SQUARE FOOTAGE 5232.00 Permit . . . BUILDING PERMIT Additional desc . Permit Fee 1962.50 Plan Check Fee 1275.63 Issue Date Valuation 477140 Expiration Date 7/01/12 Qty Unit' Charge Per Extension BASE FEE 639.50 378.00 3.5000 ---------------------------------------------------------------------------- THOU BLDG 100,001-500,000 1323..00 Permit ELEC-NEW RESIDENTIAL Additional desc . Permit Fee . . . . 268.02 P1an..Check Fee 67.01 Issue Date... Valuation . . . . 0 Expiration Date 7/01/12 Qty Unit Charge Per Extension BASE FEE 15:00 5232.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 183.12 2745.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 54.90 1.00 15.0000 ---------------------------------------------------------------------------- EA ELEC-TEMPORARY POWER POLE 15.00 Permit . .". . . GRADING PERMIT Additional desc . Permit Fee . . . . 15.00 Plan Check Fee .00 Issue Date . . . . Valuation . . 0 Expiration Date 7/01/12 Qty Unit Charge Per Extension BASE FEE 15.00 Permit MECHANICAL LQPERIN4IT Application Number . . . . . 11-00000526 Permit . . . MECHANICAL Additional desc Permit Fee . . . . 259.50 Plan Check Fee 64.88 Issue Date Valuation . . . . 0 Expiration Date 7%01/12 Qty Unit Charge Per Extension BASE FEE 15.00 1.00. 9.0000 EA MECH FURNACE <=100K 9.00 4.00 11.0000 EA MECH FURNACE >100K 44.00 5.00 9.0000 EA MECH SUSP/WALL HEATER 45.00 1.00 9.0000 EA MECH B/C <=3HP/100K BTU 9.00 4.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU 66.00 10.00 6.5000 EA. MECH VENT FAN 65.00 1.00 6.5000 ---------------------------------------------------------------------------- EA MECH EXHAUST'HOOD 6.50 Permit . . . . . . PLUMBING Additional. desc . Permit Fee 354.75 Plan Check Fee 88.69 Issue Date . . . . Valuation . . . . 0 Expiration Date 7/01/12 Qty 'Unit Charge .Per Extension BASE FEE 15.00 28.00 6.0000 EA PLB.FIXTURE 168.00 1.00 15.0000 EA' PLB BUILDING SEWER 15.00 17.00 6.0000 EA PLB ROOF DRAIN 102.00 2.00 7.5000 EA PLB WATER HEATER/VENT 15.00 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 1.00 9.0000 EA PLB LAWN SPRINKLER SYSTEM 9.00 17.00 .7500 EA PLB GAS PIPE >=5 12.75 1.00 15.0000 EA PLB GAS METER 15.00 Special Notes and Comments 5232 SF SFD. R-3 OCCUPANCY, TYPE V -B CONSTRUCTION W/ FIRE SPRINKLERS. 2010 CODES. **PERMIT DOES NOT INCLUDE BLOCK WALLS, FENCES, SWIMMING POOLS,' SPA, BBQ'S and DRIVEWAY APPROACH** ENGINEER: REZA ASHGHARPOUR C67613 ---------------------------------------------------------------------------- 'Other Fees . . . .. . . . . . ART IN PUBLIC,PLACES-RES 692.85 BLDG STDS ADMIN (SB1473) 19.00 DIF COMMUNITY CENTERS -RES 74.00 DIF CIVIC CENTER - RES 995.00 ENERGY REVIEW FEE 127.56 DIF FIRE PROTECTION -RES 140.00 LQPERNQT