04-4653 (SFD)4
BUILDING & SAFETY DEPARTMENT
Box 1504 (760).777-7012
r 7 495 E TAMPICO FAX (760) 77777011
A UIN I� CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
1004 1BUILDING PERMIT
Ap ion Number 04-00004653 Date 6/01/04
Property Address . . . . . . 77928 GREY WOLF TR
APN: 658-140-999-89 -29436 -
Application description . . . DWELLING - SINGLE FAMILY DETACHED
Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL
Application valuation 199884
Owner Contractor
IVANHOE LA QUINTA COVE TRANS WEST HOUSING,
INC.
C/O R BARRY MCCOMIC
9968 HIBERT STREET,
STE 4102
7979 IVANHOE AVE STE
550 SAN DIEGO
CA 92131
LA JOLLA
CA 92037 (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
3.00
FIRE SPRINKLERS NO
GARAGE SQ FTG
704.00
PATIO SQ FTG
315.00
NUMBER OF UNITS
1.00
FIRST FLOOR SQ FTG
3180.00
----------------------------------------------------------------------------
Permit . . . . .
BUILDING PERMIT
Additional desc .
Permit Fee
989.50 Plan Check Fee
643.18
Issue Date . . . .
Valuation
199884
Qty Unit Charge
Per
Extension
BASE FEE
639.50
100.00 3.5000
THOU BLDG 100,001-500,000
350.00
----------------------------------------------_--------____----------------------
Permit . . . . . .
MECHANICAL
Additional desc . .
Permit Fee
90.00 Plan Check Fee
22.50
Issue Date
Valuation
0
Qty Unit Charge
Per
Extension
P.O. BOX 1504 +�
VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: - 4(o Date:
Applicant:
Applicant's Mailing Address:
Arc ct or Engineer•
iV1 tAil .
Architect or En in er's Address:
5 2d
Lic. No.: 01 CO-3 C
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
1 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
ode, and my Liken s in full force and effect. }
License Elass License No V
�OateIWO ractor V, [�
OWNER43UII DER DECLARATION
I hereby affirm under penally of perjury that I am exempt from the Contractors' State License Law for the fallowing reason (Sec. 7031-5, Business and Professions Code: Any
city a county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to As issuance, also requires fhe applicant for the permit to file a signed
statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the 8usiness
and Pmfescinnc Code) or the{ he or she is exempt therefrom and the basis for the alleged exuunptioo. Any vioiabon of Section Jo31,3 by any applicant for a permit subjects
the applicant to a civil penalty of not more than five hundred dollars ($500),)I
U 1, as owner of the property, or my employees wish wages as their sale compensation, MIl 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 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 will have the burden of proving that he or she did not build or improve for the purpose of sale.)
�} !, as owner of She property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code. The Contractors'
State License Law does nat 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' Stale License Law-).
( j I am exempl under Sec. , SA P-C, for this reason
WORKERS' COMPENSATION DECLARATION
I hereby affrn 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 orkerscompensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
u v worke anon nce carrier and pgli nu be a
artier Policy Number
I c rtify that, in the pe ormance of the work for which this pe it s issued, s all 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
forthwith comply with those provisions.
Date f.` 142
ppficanl,
WARNIN 'FAIL'LIRL TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CNIL 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,
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 IN
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to tha Director of BuBdinu and Safety for a permit subject to the ccnditlans and restrictions set forth on this application,
1- Each person upon whose behalf Ihis application is made, each person at whose request and for whose benefit work is performed under a pursuant to any permit
issued as a result of this application, the owner, and the applicant, each agrees to. and shall, defend, indemnity and hold harmless the City of La quints, its
officers. agents and employees far any act or amission related to the work being performed under or following issuance of this permit.
2- Any permit issued as a result of this applicaIIan becomes nu11 and void if work is not commenced within 190 dayi from date of issuance of ch permit, or
cessation of work for 180 days will subject permit to cancellation. su
I certify that I have read this application and state that the above information is correct. f agree to comply with ail city and county ordinances and state laws relating to building
con structio %and h reby auIhonxe representatives of this county to enter upon the above-fnentionad property for inspection purposes.
�Sle l ignature (Applicant or Agent):
Page
2
Application Number
04-00004653 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
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Permit .
. . . . .
ELEC-NEW RESIDENTIAL
Additional
desc . .
Permit Fee
. . . .
140.38 Plan Check Fee
35.10
Issue Date
. . . .
Valuation . . . .
0
Qty
Unit Charge
Per
Extension
BASE FEE
15.00
3180.00
.0350
ELEC NEW RES - 1 OR 2 FAMILY
111.30
704.00
.0200
ELEC GARAGE OR NON-RESIDENTIAL
14.08
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Permit .
. . . . .
PLUMBING
Additional
desc . .
Permit Fee
178.50
Plan Check Fee
44.63
Issue Date
Valuation
0
Qty
Unit Charge
Per
Extension
BASE FEE
15.00
18.00
6.0000
EA
PLB FIXTURE
108.00
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
89 PLAN 1CR
3180
SF. PERMIT
Page 3
Application Number
. . . . .
04-00004653 Date
6/01/04
----------------------------------------------------------------------------
Special Notes and
Comments
DOES NOT INCLUDE BLOCK
WALLS,
POOL, SPA
OR DRIVEWAY APPROACH.
----------------------------------------------------------------------------
Other Fees . . .
. . . . . .
ART IN PUBLIC PLACES-RES
.00
DIF COMMUNITY CENTERS-RES
97.00
DIF CIVIC CENTER - RES
366.00
ENERGY REVIEW FEE
64.32
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
19.98
DIF STREET MAINT FAC-RES
15.00
DIF TRANSPORTATION - RES
1098.00
Fee summary
Charged
Paid Credited
Due
Permit Fee Total
1413.38
.00 .00
1413.38
Plan Check Total
745.41
.00 .00
745.41
Other Fee Total
2489.30
.00 .00
2489.30
Grand Total
4648.09
.00 .00
4648.09