14-0353 (SFD) Revision 2Building .53- Ov
Address
• Mailing
Address
TWT 4 4 "
P.O. BOX 1504
78-495 CALLE TAMPICO
Ia, ,9_� LA QUINTA, CALIFORNIA 92253
city Ip lel. 7,/p
City Izip JTel. V .2S
State Lic. City I
& Classif. n ... _ .✓ Lic. #
rirarl., olyr.,
Designer B 441Z z2'
Address Tel. 74 D
9.3 G-2/_ 777=G6o
..• O .e . Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000)
of Division 3 of the Business and Professions Code, and my license is. in full force and effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following reason:
(Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct,
alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for
such permit to file a signed statement that he is licensed pursuant to the provisions of the Contrac-
tor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professions Code, or that he 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 Profes-
sions Code: The Contractor's License Law does not apply to an owner of property who builds or
improves thereon and who does such work himself or through his own employees, provided that
such 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 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 Contractor's License Law does not apply
to an owner of property who builds or improves thereon, and who contracts for such projects with
a contractor(s) licensed pursuant to the Contractor's License Law.)
01 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKER'S COMPENSATION DECLARATION
hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's
Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑Copy is filed with the city. ❑Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less).
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 Workers' Compensation Laws of California.
Date Owner
NOTICE TO APPLICANT. If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the work for
which this permit is issued.. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
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 hereby authorize representatives of this city to enter the above-mentioned
property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
I sm N PtU4*- Tto IS4%46 •t�
�t3 c,.olG aft/Kc- ralt 0v4,11,11,4T
APPLICATION ONLY &TC*AS%4b►4
BUILDING: TYPE
�C,rONST. OCC. GRP.
A.P. Number_ _ , %r%— 1t0/a —10.2 9 G�
Legal Description 26,14- 3l.1 %/f 1
Project Description
Sq. Ft. , , , . , _ No.
No. Dw.
Nei " Add ❑ Alter ❑ Repair ❑ Demolition ❑
I Estimated Valuation % /Soi e OD
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
AMOUNT
Grading
Driveway Enc. 2015
Infrastructure
CITY t 4.= i A r)I ITS
QMMI Illr flPvX:1 D r
TOTAL
CONTACT INFORMATION
NAME:
PHONE:
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line _
Side Street Setback from Center Line
Side Setb om Prooertv
FINAL DATE
Issued by:
Validated by:
Validation:
WHITE = BUILDING DEPARTMENT YELLOW =
Description: NEW SINGLE FAMILY DWELLING
-
Type: BUILDING, RESIDENTIAL Subtype: DWELLING - SINGLE Status: APPROVED
Applied: 4/1/2014
' FAMILY DETACHED
Approved: 6/25/2014
Parcel No: 777160029 Site Address: 53389 VIA BELLAGIO LA QUINTA,CA 92253
Subdivision: TR 29894-2 . Block: Lot: 312
Issued:
Lo;q Ft-- Building Sq Ft: Zoning: - -
Finaled:
Valuation: $394,784:00 Occupancy Type: - Construction Type: -
Expired:
No. Buildings: No. Stories: No. Unites:
-
Details: NEW SFD WITH CASITA. THIS PERMIT DOES NOT INCLUDE POOL, SPA, BLOCK WALLS, DRIVEWAY APPROACH,
BBQ OR FIRE -PIT. HOME
IS FIRE SPRINKLED PER 2013 CRC CODES.
HAD TO OVERRIDE P/C FEES FOR BUILDING TO INDICATE $1462.88 not $1200. $263.15 DIFFERANCE.
CONDITIONS
PERMIT FEE UPDATED TO POST JULY 1ST, 2014 FEE UPDATES DETERMINED AT PERMIT ISSUANCE.
85 .
C:y Applied to Approved
FINANCIAL INFORMATION
Printori• Thiircriov K1nvnmhur nF. 7n1A R-C;A-19 ARA. of
ADDITIONAL
CHRONOLOGY
CHRONOLOGY TYPE STAFF NAME
ACTION DATE
COMPLETION DATE
NOTES
PLAN CHECK
COMPLETE/READY FOR PICK Al ORTEGA
UP
11/6/2014
APPLICANT TO COMPLETE NEW SUB -LIST SHEET PRIOR TO
- ISSUANCE OF. PERMIT
'.,
CONDITIONS
CONTACTS
NAME TYPE NAME
ADDRESSI
CITY
STATE
ZIP PHONE FAX EMAIL
APPLICANT JEHA CONSTRUCTION, MICHAEL
0 OUTSIDE CITY LIMITS
LA QUINTA
CA
92253
CONTRACTOR JEHA CONSTRUCTION, MICHAEL
0 OUTSIDE CITY LIMITS
LA QUINTA
CA =
92253 -
OWNER. FORD, BOBBY & JAYE
28 RED OAK CT
LAKE JACKSON
TX
77566
FINANCIAL INFORMATION
Printori• Thiircriov K1nvnmhur nF. 7n1A R-C;A-19 ARA. of
Printori• Thiircrlw KInvomhor n, 701a A•CF•1F Ann
CLTD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
BY
ART IN PUBLIC PLACES -
270-0000-43201
0
$486.96
$0.00
RESIDENTIAL
Total Paid forART IN PUBLIC PLACES - AIPP: $486.96 $0.00
BLDG PC 200K -1M
10160003428200
1
1 $1,200.00
$1,200.00
4/2/14
Total Paid for BLDG PC 200K -IM: $1,200.00 $1,200.00
BSAS SB1473 FEE
101-0000-20306
1 0
$16.00
$0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION $16.00 $0.00
BSA:
DIF CIVIC CENTER - RES
F 252-0000-43200
$942.00
Total Paid forDIF CIVIC CENTER - RES: $942.00
DIF COMMUNITY
254-0000-43200
$129.00
CENTERS -RES
Total Paid for DIF COMMUNITY CENTERS -RES: $129.00
DIF FIRE PROTECTION-
257-0000-43200
$433.00
RES
Total Paid forDIF FIRE PROTECTION -RES: $433.00
DIF LIBRARIES- RES
253-0000-43200
1
$344.00
Total Paid forDIF LIBRARIES - RES: $344.00
DIF PARK MAINT FAC -
256-0000-43200
$40.00
RES
Total Paid for DIF PARK MAINT FAC - RES: $40.00
DIF PARKS/REC - RES
251-0000-43200
$2,048.00
Total Paid forDIF'PARKS/REC - RES: $2,048.00
DIF STREET MAINT FAC-
255-0000-43200
$116.00
RES
Total Paid for DIF STREET MAINT FAC -RES: $116.00
Printori• Thiircrlw KInvomhor n, 701a A•CF•1F Ann
Drintori- ThurcAmu Kimiamhor nr ')ni a Q•CF•1 F. aKA 2 nF C
CLTD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
_
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
BY
DIF TRANSPORTATION -
250-0000-43200
$2,842.00
RES -
—
-
-
Total Paid for DIF TRANSPORTATION - RES: $2,842.00 t
RESIDENTIAL,'EA
101-0000-42403
0
$60.80
$0.00
{
ADDITION 1,000SF
_
RESIDENTIAL, EA
101-0000-42600
0
$25.05
$0.00
-
ADDITION 1,000SF, PC
RESIDENTIAL, FIRST
101-0000-42403
0
$143.00
$0.00
1,000SF
RESIDENTIAL, FIRST
101-0000-42600
0
$47.19
$0.00
1,000! PC
Total Paid for ELECTRICAL - NEW CONSTRUCTION: $276.04 $0.00
RESIDENTIAL FINISH
101-0000-42600
0
$143.00
$0.00
GRADING PC
-
`
-Total Paid forGRADING: -$143.00 - $0.00 - - -
CONDENSER/COMPRES
101-0000-42402
0
$178.75
_$178 .7S
$0.00
SOR
CONDENSER/COMPRES
'SOR
101-0000-42600 .
0
$119.15.
$0.00_-
PC
EXHAUST HOOD
101-0000-42402
0
$11.92
$0.00
EXHAUST HOOD PC
101-0000-42600
0
$4:77
$0.00
FURNACE
101-0000-42402
0
$178.75
$0.00
FURNACE PC
101-0000-42600
0
$119.15
$0.00
VENT FAN -
101-0000-42402
0-
$119.20
$0.00 -
- -
-
VENT FAN PC
.101-0000-42600
•0
'$47.70
$0.00
Total Paid for MECHANICAL: $779.39' $0.00 -
Drintori- ThurcAmu Kimiamhor nr ')ni a Q•CF•1 F. aKA 2 nF C
PrintoriF�
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A R•F•1DAA n f C r"Nwi
CLTD
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
BY
NEW CONSTRUCTION
101-0000-42400
0
$682.63
$0.00
PERMIT
Total Paid forNEW CONSTRUCTION PERMIT: $682.63 $0.00
NEW CONSTRUCTION
101-0000-426000
$263.15
$0.00
PLAN CHECK
Total Paid forNEW CONSTRUCTION PLAN CHECK: $263.15 $0.00
BACKFLOW DEVICE
101-0000-42401
0
$11.92
$0.00
BACKFLOW DEVICE PC
101-0000-42600
0
$4.77
$0.00
BUILDING SEWER
101-0000-42401
0
$11.92
$0.00
BUILDING SEWER PC
101-0000-42600
0
$11.92
$0.00
FIXTURE/TRAP
101-0000-42401
0
$309.92
$0.00
FIXTURE/TRAP PC
101-0000-42600
- 0
$309.92
$0.00
GAS SYSTEM, 5+
101-0000-42401
0
$35.75
$0.00
OUTLETS
GAS SYSTEM, 5+
101-0000-42600
0
$23.83
$0.00
OUTLETS PC
ROOF DRAIN
101-0000-42401
0
$35.76
$0.00
ROOF DRAIN PC
101-0000-42600
0
$35.76
$0.00
WATER HEATER/VENT
101-0000-42401
0
$23.84
$0.00
WATER HEATER/VENT
101-0000-42600
0
$14.30
$0.00
PC
WATER SYSTEM
101-0000-42401
0
$11.92
$0.00
INST/ALT/REP
.
WATER SYSTEM
101-0000-42600
0
$11.92
$0.00
INST/ALT/REP PC
Total Paid for PLUMBING FEES: $853.45 $0.00
PrintoriF�
• Ttircrlov Alnvomhor fly, )MGF .,
A R•F•1DAA n f C r"Nwi
.DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
CLTD
BY
SMI - RESIDENTIAL
101-0000-20308
0
$51.32
$0.00
Total Paid forSTRONG MOTION INSTRUMENTATION SMI: $51.32 -$0.00
TUMF: RESIDENTIAL
224-0000-20320,
$1,837.44
-
Total Paid forTUMF: RESIDENTIAL: $1,837.44
TOTALS:$1,200.00