04-4670 (SFD)Tihf 4 4 a"
9 w`` P.O. BOX 1504
LLE TAMPICO
Iril .A U A, CALIFORNIA 92253
J� N 14 2004 BUILDING PERMIT
CITY OF LA QUI14TA
miner i . .
Property Address . . .
APN:
Application description
Property Zoning
Application valuation
Owner
IVANHOE LA QUINTA COVE
C/O R BARRY MCCOMIC
7979 IVANHOE'AVE STE 550
LA JOLLA CA 92037
BUILDING & SAFETY DEPARTMENT
(760).777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
04-00004670 Date 6/01/04
77921 GREY WOLF TR
658-140-999-99 -29436 -
DWELLING - SINGLE FAMILY DETACHED
LOW DENSITY RESIDENTIAL
217237
Contractor
TRANS WEST HOUSING, INC.
9968 HIBERT STREET, STE #102
SAN DIEGO CA 92131
(858) 653-3003
WCC: STATE FUND
WC: 1648813
10/01/04
CSLB: 701039
01/31/05
CCC: B
--------------------------
Structure Information ---- ---------------------
Construction Type . .
. . . TYPE V - NON RATED
Occupancy Type . . .
. . . DWELLG/LODGING/LONG <=10
Flood Zone . . . . .
. . . NON -AO FLOOD ZONE
Other struct info . .
. . . CODE EDITION
2001 CRC
# BEDROOMS
4.00
FIRE SPRINKLERS
NO
GARAGE SQ FTG
603.00
PATIO SQ FTG
487.00
NUMBER OF UNITS
1.00
FIRST FLOOR SQ FTG
3478.00
----------------------------------------------------------------------------
Permit . . . . . .
BUILDING PERMIT'
Additional desc . .
Permit Fee
1052.50 Plan Check Fee
171.03
Issue Date . . . .
Valuation
217237
Qty Unit Charge
Per
Extension
BASE FEE
639.50
118.00 3.5000
THOU BLDG 100,0017500,000
413.00
----------------------------------------------------------------------------
Permit . . . . .
MECHANICAL
Additional desc .
Permit Fee . . . .
90.00 Plan Check Fee
5.63
Issue Date
Valuation
0
Qty Unit Charge
Per
Extension
P.O. BOX 1504 _ a�
78-495 CALLE TAMPICO VOICE (760) 777-7012
LA QUINTA, CALIFORNIA 92253 44FAX (760) 777-701 1
INSPECTIONS (760) 777-7I53
BUILDING & SAFETY DEPARTMENT
Application Number: d 4- Ll& 70 Dater:
Applicant:;te..►
Applicant's Mailing Address:
r_
or
No. 3
BUILDING PERMIT DECLARATIONS
2015
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
�e, and Class
Licans 3 in full force and effect —� c�
License Class License No. .
ate f Cont� ICI
OWNER43UILDER DEC TION
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 of county that requires a permit to Construct. alter, improve, demolish, or repair any structure, prior to is issuance. also raquires the applicant for the permit to file a signed
statement that he or she is licensed pursuant to the provisions of the Contractors' Stale License Law (Chapter 9 (commencing with Section 70Do) Of Division 3 of the Business
and Professlons Cede) or that he or she is exempt therefrom and the basis far the alleged examption. Any violation of Section 7031.5
the applicant to a civil penalty of not mare than five hundred dollars (350D).): by any applicant for a permit subjects
U I, as owner of the property, or my employees with wages as Iheir sole compensation, will do the work, and the structure is not intended or offered for sale (Set. 7044,
Business and Professions Cade The Contractors' State License Law does not apply to an owner of property who builds Or improves thereon, and who does "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 wi€1 have the burden of proving that he or she did not build or improve fvr thB 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 bullds or improves thereon, and who Contracts for the projects with f contractor(s) o de licensed ntrrsuan! to
the Contractors' State License Law.).
u I am exempt under Sec , 6.8 P.0 for this reason
Date
Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of penury 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
1 have and will ma plain 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 w ors' mpensattbmce carrier and Ditty n r
�arfer Policy Number
_ I certify that, in the perfdmnance of the work for which this It i issue , 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
forth(w�ith comply with those provisions.
�15ate I V Applicant
WARNI G: 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 AiTORNEY'S FEES.
I herebyaffirm under CONSTRUCTION LENDING AGENCY
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 Applion is hereby made to the Director of Build in and a
pti
1. Each person upon whose behalf this application is made. each person a1 whose requ st and for hlose benefiw ork snperformed unde $or pursuant to an
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, fpemiit
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 comrienced within 180 days from date of issuance of such pemmiL or
cessation of work for 180 days will subject permit 10 canceIlalion.
I Certify that I have read this appficaticn and state that the above information is correct. I agree to comply with all city and county ordinances and stale laws rotating to building
construction, and reby authorize representatives Of this county to enter upon the above -mentioned property for inspection u ' � purposes,
ate ig�s nature (Applicant or Agent):
Application Number . . . . . 04-00004670
Page 2
Date 6/01/04
Qty Unit
Charge
Per
Extension
BASE FEE
15.00
2.00
9.0000
EA
MECH FURNACE <=100K
18.00
2.00
9.0000
EA
MECH B/C <=3HP/100K BTU
18.00
5.00
6.5000
EA
MECH VENT FAN
32.50
1.00
6.5000
EA
MECH EXHAUST HOOD
6.50
----------------------------------------------------------------------------
Permit . . .
. . . ELEC-NEW RESIDENTIAL
Additional desc
. .
Permit Fee
148.79
Plan Check Fee
9.30
Issue Date .
. . .
Valuation
0
Qty Unit
Charge
Per
Extension
BASE FEE
15.00
3478.00
.0350
ELEC NEW RES - 1 OR 2 FAMILY
121.73
603.00
.0200
ELEC GARAGE OR NON-RESIDENTIAL
12.06
----------------------------------------------------------------------------
Permit . . .
. . .
PLUMBING
Additional desc
. .
Permit Fee .
. . .
196.50
Plan Check Fee
12.28
Issue Date .
. . .
Valuation
0
Qty Unit
Charge
Per
Extension
BASE FEE
15.00
21.00
6.0000
EA
PLB FIXTURE
126.00
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
8.00
.7500
EA
PLB GAS PIPE >=5
6.00
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
-----------------------------------------------------------------------------
Special Notes
and Comments
SFD - LOT 99 PLAN
3B
3478
SF. PERMIT
Page
3
Application Number
04-00004670 Date
6/01/04
----------------------------------------------------------------------------
Special Notes and Comments
DOES NOT INCLUDE BLOCK WALLS,
POOL, SPA
OR DRIVEWAY APPROACH. 75% PLAN
CHECK FEE
REDUCTION APPLIED FOR MULTIPLE
ISSUANCE
OF SAME PLAN TYPE.
----------------------------------------------------------------------------
Other Fees . . . . . . . . .
ART IN PUBLIC PLACES-RES
43.09
DIF COMMUNITY CENTERS-RES
97.00
DIF CIVIC CENTER - RES
366.00
ENERGY REVIEW FEE
17.10
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
21.72
DIF STREET MAINT FAC-RES
15.00
DIF TRANSPORTATION - RES
1098.00
Fee summary
-----------------
Permit Fee Total
Plan Check Total
Other Fee Total
Grand Total
Charged Paid
1502.79
.00
198.24
.00
2486.91
.00
4187.94
.00
Credited Due
.00
1502.79
.00
198.24
.00
2486.91
.00
4187.94