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BRES2016-0062 Revision 178-495 CALLE TAMPICO D 4 Q" LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BRES2016-0062 Property Address: 81600 SHACKLETON WY APN: 767870020 Application Description: MADISON / SUMMERS / SINGLE FAMILY Property Zoning: Application Valuation: $530,781.90 Applicant: � � - L FRANK STOLZ (11 13 CORPATE PLAZA NEW PORT BEACH, CA 92660 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am lice ed under p ovisions of Chapter 9 {commencing with Section 70001 of Division 3 ofth usiness an rofessions Code, and my License is in full force and effect. License Class: B License No.: 799449 r D �< Contractor: OWNER -BUILDER DECL.ARN I hereby affirm under penalty of perjury that I am exe t 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 a al leged 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 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.). (_) 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 Na Lender's VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/12/j2017 Owner: I S54d 61I � 71 114 V/ SUMMERS FAMILY TRUST - ROBERT & CAROL 81600 SHACKLETON WAY LA QUINTA, CA 92253 Contractor: PETER JACOBS HOMES INC P 0 BOX 356 LA QUINTA, CA 92247 —� (760)880-1761 Llc. No.: 799449 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-imurefor workers' comp- sation, as provided for by Section 3700 of the Labor Code, fwthe performance of the k r which this permit is issued. have and will maintain workers' compensation insurance, as required by Secti n 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: STATE COMPENSATION INSURANCE FUND Policy Number: 9013633 1 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 subjectto the workers' compensation laws of California, and agree that, if 1 Quid beta a subject to the workers' compensation provisions of Section 370 # Labor ode, I shall forthwith comply with those provisions. _ r j Dat'e"� �` Applicant: 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. APPLICANT ACKNOWLEDGEMENT IMPORTANT: Application is hereby made to the Building Official 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 in ormation is correct. I agree to comply with all city and county ordinances and state I s r lating to building construction, and hereby authorize representatives of this tit er u the above - mentioned property for inspection purposes. Date: rJ 7inature(Applicant or Agent Date: 7/3/2017 Application Number: BRES2016-0062 Property Address: 81600 SHACKLETON WY APN: 767870020 Application Description: MADISON / SUMMERS / SINGLE FAMILY Property Zoning: Application Valuation: $530,781.90 Applicant: FRANK STOLZ 13 CORPATE PLAZA NEW PORT BEACH, CA 92660 Owner: SUMMERS FAMILY TRUST- ROBERT & CAROL 81600 SHACKLETON WAY LA QUINTA, CA 92253 Contractor: PETER JACOBS HOMES INC P 0 BOX 356 LA QUINTA, CA 92247 (760)880-1761 Llc. No.: 799449 Detail: 5,968 SF 2 STORY SINGLE FAMILY DWELLING. R-3 OCCUPANCY, TYPE V-B CONSTRUCTION W. FIRE SPRINKLER PER 2013 CODES. PERMIT DOES NOT INCLUDE BLOCK WALLS, POOL/SPA, FIRE PIT AND WATER FEATURES. �� •�.�ry� �c�.n ��1 �1�'( ,2�a� Lit �Ql►il .b P-CvAf &1�1' a-v"'4 / 6 VEA " Ixe) , FINANCIAL•• • DESCRIPTION ACCOUNT CITY AMOUNT ART IN PUBLIC PLACES - RESIDENTIAL 270-0000-43201 0 $826.95 Total Paid for ART IN PUBLIC PLACES - AIPP: $826.95 DESCRIPTION ACCOUNT QTY AMOUNT HOURLY CHARGE - CITY BUILDING STAFF 101-0000-42600 2 $304.00 DESCRIPTION ACCOUNT QTY AMOUNT HOURLY PLAN CHECK - YES 101-0000-42600 2.5 $175.00 Total Paid for BLDG CITY STAFF - PER HOUR: $479.00 DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $22.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $22.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF - CIVIC CENTER 252-0000-43200 0 $942.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF - COMMUNITY CENTERS 254-0000-43200 0 $129.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF - FIRE PROTECTION 257-0000-43200 0 $433.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF - LIBRARIES 253-0000-43200 0 $344.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF - PARK MAINTENANCE 256-0000-43200 0 $40.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF - PARKS/REC 251-0000-43200 0 $2,048.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF - STREET MAINTENANCE 255-0000-43200 0 $116.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF-TRANSPORTATION 250-0000-43200 0 $2,842.00 Total Paid for DIF - SINGLE FAMILY DWELLING: $6,894.00 DESCRIPTION ACCOUNT QTY AMOUNT TEMP POWER SERVICE 101-0000-42403 0 $24.17 DESCRIPTION ACCOUNT QTY AMOUNT TEMP POWER SERVICE PC 101-0000-42600 0 $16.92 Total Paid for ELECTRICAL: $41.09 DESCRIPTION ACCOUNT QTY AMOUNT RESIDENTIAL, EA ADDITION 1,000SF 101-0000-42403 0 $98.64 DESCRIPTION ACCOUNT QTY AMOUNT RESIDENTIAL, EA ADDITION 1,000SF, PC 101-0000-42600 0 $40.64 DESCRIPTION ACCOUNT QTY AMOUNT RESIDENTIAL, FIRST 1,000SF 101-0000-42403 0 $145.03 DESCRIPTION ACCOUNT QTY AMOUNT RESIDENTIAL, FIRST 1,000SF, PC 1 101-0000-42600 I 0 $47.86 1 Total Paid for ELECTRICAL - NEW CONSTRUCTION: $332.17 DESCRIPTION ACCOUNT CITY AMOUNT RESIDENTIAL PRECISE GRADING - CUSTOM HOME LOT >7KSF 101-0000-42408 0 $36.26 DESCRIPTION ACCOUNT QTY AMOUNT RESIDENTIAL PRECISE GRADING - CUSTOM HOME LOT>7KSF PC 101-0000-42600 0 $181.29 Total Paid for GRADING: $217.55 DESCRIPTION ACCOUNT QTY AMOUNT CONDENSER/COMPRESSOR 101-0000-42402 0 $290.08 DESCRIPTION ACCOUNT QTY AMOUNT CONDENSER/COMPRESSOR PC 101-0000-42600 0 $193.36 DESCRIPTION ACCOUNT QTY AMOUNT EXHAUST HOOD 101-0000-42402 0 $12.09 DESCRIPTION ACCOUNT QTY AMOUNT EXHAUST HOOD PC 101-0000-42600 0 $4.83 DESCRIPTION ACCOUNT QTY AMOUNT FURNACE 101-0000-42402 0 $253.82 DESCRIPTION ACCOUNT QTY AMOUNT FURNACE PC 101-0000-42600 0 $169.19 DESCRIPTION ACCOUNT QTY AMOUNT VENT FAN 101-0000-42402 0 $169.26 DESCRIPTION ACCOUNT QTY AMOUNT VENT FAN PC 101-0000-42600 0 $67.62 Total Paid for MECHANICAL: $1,160.25 DESCRIPTION ACCOUNT QTY AMOUNT NEW CONSTRUCTION PERMIT 101-0000-42400 0 $766.93 Total Paid for NEW CONSTRUCTION PERMIT: $766.93 DESCRIPTION ACCOUNT QTY AMOUNT NEW CONSTRUCTION PLAN CHECK 101-0000-42600 0 $1,500.00 DESCRIPTION ACCOUNT QTY AMOUNT NEW CONSTRUCTION PLAN CHECK 101-0000-42600 0 $135.96 Total Paid for NEW CONSTRUCTION PLAN CHECK: $1,635.96 DESCRIPTION ACCOUNT QTY AMOUNT BUILDING SEWER 101-0000-42401 0 $12.09 DESCRIPTION ACCOUNT QTY AMOUNT BUILDING SEWER PC 101-0000-42600 0 $12.09 DESCRIPTION ACCOUNT QTY AMOUNT FIXTURE/TRAP 101-0000-42401 0 $49S.69 DESCRIPTION ACCOUNT QTY AMOUNT FIXTURE/TRAP PC 101-0000-42600 0 $495.69 DESCRIPTION 1 ACCOUNT QTY AMOUNT GAS SYSTEM, 5+ OUTLETS 101-0000-42401 0 $36.26 DESCRIPTION ACCOUNT CITY AMOUNT GAS SYSTEM, 5+ OUTLETS PC 101-0000-42600 0 $24.17 DESCRIPTION ACCOUNT QTY AMOUNT ROOF DRAIN 101-0000-42401 0 $12.09 DESCRIPTION ACCOUNT QTY AMOUNT ROOF DRAIN PC 101-0000-42600 0 $12.09 DESCRIPTION ACCOUNT CITY AMOUNT WATER SYSTEM INST/ALT/REP 101-0000-42401 0 $12.09 DESCRIPTION ACCOUNT CITY AMOUNT WATER SYSTEM INST/ALT/REP PC 101-0000-42600 0 $12.09 Total Paid for PLUMBING FEES: $1,124.35 DESCRIPTION ACCOUNT QTY AMOUNT SMI - RESIDENTIAL 101-0000-20308 0 $69.00 Total Paid for STRONG MOTION INSTRUMENTATION SMI: $69.00 DESCRIPTION ACCOUNT CITY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 DESCRIPTION ACCOUNT QTY AMOUNT SINGLE FAMILY DETACHED 224-0000-20320 0 $1,837.44 Total Paid for TUMF - RESIDENTIAL: $1,837.44 TOTALS: 9f-Y!`J6h1 "'L Bin pity of LAQUID 3 Building a Safety Division 'Permit ;` 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 � ,10—Building Permit Application and Tracking Sheet Project Address: Owner's Name: v A. P_ Number: Address: G9, Legal Description: r. City, ST, Zip: [ Contractor: d Telephone: k l t'j WIN =icez'• '>: =`_ _`__` Address: . J Project Description: City, ST, Zip: % Telephone: G:fF>:::-::s>>>•. 4f �,. State Lic. # : City Lic. R-_ Arch_, ) ngr., Designer: Address: City, ST, Zip: Telephone: P £ Construction Type: Occupancy: Project e circle one New Add'n Alter Repair Demo State Lic_ #_ ;6`" Name of Contact Person: ) Sq. Ft.: #Stories: #Units: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE t/ Submittal Req'd Rcc'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance • Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Gran( Deed Plans picked up S.M.I. II.O.A. Approval Plans resubmitted Grading IN HOUSE:- Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. 11'14s_ Appr Date of permit issue School Fees, Total Permit Fees r CO O r LL w O a r � N 01 LL d U O N N N x m Q' a U 2 U) N w 0 65 E2 O N d E `E E 06 d o E c z o r — LL 7 �+ m Q- U � v v M LO O O N N (O c m m a (O d a U 0 o E O U W m `m cco W ui N a0 N y i°' n N .� m U) 13 m y to c ea •� d > o V c m c m w j C o o a E y O N o E z y �`0 w E z' d A O cc l6 Z 0) of c as e N 16 E E O z c U O ` a LO h CD r M N Of O O O r r N n N 'a E fn y Q N H o . co � aoca m U7 � N rn U ii 0) C <n O) U U >' 9 Z O u, m M O m Q Z Q Z E z NJ d .` 0 o � U o c a 0. 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