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13-1111 (SFD)T4ht 4 P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 3/05/14 Application Number: 13-00001111 Owner: Property Address: 53725 HUMBOLDT BLVD EAST OF MADISON LLC APN: 767-200-998-71 -330762- PO BOX 1482 Application description: DWELLING - SINGLE FAMILY DETACHED LA QUINTA, CA 92247 Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 474268 Contractor: D Applicant: Architect or Engineer: DBCA INC Lj P.O. BOX 1482 Via �� LA QUINTA, CA 92247 i*11��! {) r , U1j �r)N� `2� � 1 L+� (760) 393-5271 Lic. No.: OOR SQUARE FOOT Lic. No.: 915336 CIT4'0FLAQUINTA LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty 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 my License is in full force and effect. License Class: B canna N .: 915336 Dater ContrActor; OW W4,13ER 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).: 1 _ 1 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.). (_ 1 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.). (_ 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 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 Policy Number YJUB282D7797-12 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 the workers' compensation provisions of Section 3700 of the Labor Code, I shall tonhwl ca ply wlth osa provisions. Date: 3� Applicant. WARNING: FAILURE TO SECUR�WO1K1RS'CqMF,9N&ON 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 Quints, 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 information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and y authors representatives 9T this county to ontor upon the above, moniloned ptOperI for inspection pLur as. Data: Signature (Applicant or Agan11- Application Number . . . . . 13-00001111 Permit BUILDING 2013 Additional desc . . Permit Fee 727.43 Plan Check Fee 00 Issue Date . . . Valuation . . . . 474268 Expiration Date . . 9/01/14 Qty Unit Charge Per Extension BASE FEE 573.43 275.00 .5600 THOU BLDG $200,001-$1M 154.00 Permit . . Additional desc . Permit Fee . . . Issue Date . . . Expiration Date . ELECTRICAL 2013 275.29 9/01/14 Plan Check Fee .00 Valuation 0 Qty Unit Charge Per Extension 1.00 23.8300 LS ELEC FIXTURES, FIRST 20 23.83 1.00 23.8300 EA ELEC SERVICES 23.83 1.00 23.8300 EA ELEC TEMP POWER POLES 23.83 1.00 143.0000 LS ELEC NEW RES, FIRST 1 KSF 143.00 5.00 12.1600 EA ELEC NEW RES, ADD'L 1 KSF 60.80 Permit . . . MECHANICAL 2013 Additional desc . . Permit Fee 440.94 Plan Check Fee .00 Issue Date Valuation 0 Expiration Date 9/01/14 Qty Unit Charge Per Extension 5.00 35.7500 EA MECH FURNACE 178.75 5.00 35.7500 EA MECH CONDENSER/COMP 178.75 6.00 11.9200 EA MECH VENT FAN 71.52 1.00 11.9200 EA MECH EXHAUST HOOD 11.92 Permit . . . PLUMBING 2013 Additional desc . . Permit Fee 500.63 Plan Check Fee .00 Issue Date Valuation . . . . 0 Expiration Date 9/01/14 Qty Unit Charge Per Extension 25.00 11.9200 EA PLBG FIXTURE/TRAP 298.00 1.00 11.9200 EA PLBG BUILDING SEWER 11.92 LQPERMIT Application Number . . . . . 13-00001111 Permit . . . . . . PLUMBING 2013 Qty Unit Charge Per Extension 10.00 11.9200 EA PLBG ROOF DRAIN 119.20 2.00 11.9200 EA PLBG WATER HEATER/VENT 23.84 1.00 11.9200 LS PLBG GAS SYS, 1-4 OUTLETS 11.92 1.00 35.7500 LS PLBG GAS SYS, 5+ OUTLETS 35.75 ------------------------------------- Special Notes and Comments NEW SFD AT 5190 SQ. FT. GARAGE 1198 SQ. FT. AND PATIO 1547 SQ. FT. THIS PERMIT DOES NOT INCLUDE POOL SPA, BLOCKWALLS, OR DRIVEWAY APPROACH, FIRE -PIT, BBQ. HOME HAS FIRE SPRINKLED PER 2010 CALIF. RES. CODES December 10, 2013 1:39:06 PM JJOHNSON. --------------------------------------------------- _...._... Other Fees . . . . . . . . ART IN PUBLIC PLACES -RES 687.15 BLDG STDS ADMIN (SB1473) 19.00 DIF COMMUNITY CENTERS -RES 129.00 DIF CIVIC CENTER - RES 942.00 DIF FIRE PROTECTION -RES 433.00 HOURLY PLAN CHECK 882.00 DIF LIBRARIES - RES 344.00 PLAN CHECK, ELECTRICAL 104.63 DIF PARK MAINT FAC - RES 40.00 PLAN CHECK, MECHANICAL 252.61 PLAN CHECK, SFD GRADING 143.00 PLAN CHECK, PLUMBING 491.08 DIF PARKS/REC - RES 2048.00 BLDG PC 200K -1M 1279.00 STRONG MOTION (SMI) - RES 47.49 TUMF: RESIDENTIAL 1837.44 DIF STREET MAINT FAC -RES 116.00 DIF TRANSPORTATION - RES 2842.00 Fee summary Charged Paid Credited ---------------------------- Due ------------------------------ Permit Fee Total 1944.29 .00 .00 1944.29 Plan Check Total .00 .00 .00 .00 Other Fee Total 12637.40 1000.00 .00 11637.40 Grand Total 14581.69 1000.00 .00 13581.69 LQPERMIT