SFD (06-3512)lk
P.O. BOX 1504 '
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
-4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT'
06-00003512��i.Ar4 `rY Owner:
80107 MIRAMONTE LN 1 t TOLL CA V
772-250-018-20 -31349 - C/O KEVIN D DUERMIT
DWELLING - SINGLE FAMILY DETACHED 8901 E MOUNTAIN -VIEW 200
LOW DENSITY RESIDENTIAL SCOTTSDALE, AZ 85258
241854
Contractor:
rchitect or Engineer:
TOLL BROS, INC.
CZ--------------- --------------- — — — — --- — — — — — — — — —
3�7�
ri
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. '
L'C se Class: B Lice se No.: 777699
Date: d ntractor:
OWNER -BUIL ER DECLARATION
I hereby affirm under penalty of perjury that I am exempt fro 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 (5500).:
I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
ti 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,
x 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 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.).
(_) 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/02%06
IDnin.
o�T � 6 Zoos '1L
CITY OF 6A QUINTA
emaaunc nr.,e�a.
7.3121 FRED WARING DRIVE,,
PALM,DESERT, CA 92.260 1.
(760)674-9699
Lic. No.: 777699
WORKER'S COMPENSATION DECLARATION '
I hereby affirm under penalty of perjury one of the following declarations:
x,
_ 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.
V,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 permitis issued. My workers' compensation
insurance carrier and policy number are: '
Carrier ZURICH AMERICAN Policy Number . WC387821301
I certify that, in the performance of the work for which this permit is issued, 1 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 f rthw't comply with those provisions.
WARNING: FAIL EE TRE WORKERS' COMPENSATI N COVERAGE IS UNLAWFUL, AND SHALL '
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND •`
DOLLARS 1$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 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 applicatio and state that the above information is correct. I agree to comply with all
city and county ordinances and st aws relating to building construction , and hereby, authorize representatives
of this co `ty to enter upon t bove-mentioned property f inspection purposes.
c
D : iD'/_ ature (Applicant or Agent): ��
if
Application Number
I. . . . 06-00003512
Structure Information
Construction Type
TYPE V - NON RATED
Occupancy Type . . .
. . . DWELLG/LODGING/CONG <=10
Flood Zone . . . .
. . . NON -AO FLOOD ZONE
Other struct info . .
. . . CODE EDITION
2001 CBC
# BEDROOMS
3.00
FIRE SPRINKLERS
NO
GARAGE -SQ FTG
610.00
PATIO SQ FTG
275.00
NUMBER OF UNITS
1.00
-----------------------------------------------------------------------------
1ST FLOOR SQUARE FOOTAGE
2800.00
Permit . . .
BUILDING PERMIT
Additional desc .
Permit Fee. . .
1136.50 Plan Check Fee
738.73
Issue Date . . . .
Valuation . .
. 241854
Expiration Date
3/31/07
Qty Unit Charge
Per
Extension
BASE FEE.
639.50
142.00 3.5000
----------------------------------------------------------------------------
THOU BLDG 100,001-500,000
4.97.00
Permit . .
MECHANICAL
Additional desc .
Permit Fee . . . .
96.50 Plan Check Fee
24.13
Issue Date . . . .
Valuation . .
0
Expiration Date
3/31/07
Qty Unit Charge
Per r
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
6.00 6.5000
EA MECH VENT FAN
39.00
1.00 6.5000
----------------------------------------------------------------------------
EA MECH EXHAUST HOOD
6.50
Permit . . . . .
ELEC-NEW RESIDENTIAL
Additional desc .
- Permit Fee . . . .
125.20 Plan Check Fee
28.25
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
3/31/07
Qty Unit Charge
Per
Extension
BASE FEE
15.00
2800..00 .0350
ELEC NEW RES.- 1 OR 2 FAMILY
98.00
I
LQPER IIT
I
LQPERAIIT
10
Application Number .
. . . . 06-00003512
Permit . . . . . . I ELEC-NEW RESIDENTIAL
Qty Unit Charge
Per
Extension
610..00 .0200
- - - - - - - - - - - - - - - - - - - - - - - - - - -
ELEC GARAGE OR NON-RESIDENTIAL
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
1 12.20
- - - - - - - - - - - -
Permit . . . . . . PLUMBING
Additional desc
Permit Fee . . . .
189.00 Plan Check Fee
47.25
Issue Date . . .
Valuation . . .
0
Expiration Date
3/31/07
Qty Unit•Charge
Per
Extension
BASE FEE
15.00
20.00 6.0000
EA PLB FIXTURE
120.00
1.00 15.0000
EA PLB BUILDING SEWER
15.00
1.00 7.5000
E:. PLB WATER HEATER/VENT
7.�0
1.00 3.0000
EA PLB WATER INST/ALT/REP
3.00,
1.00 9.0000
EA PLB LAWN SPRINKLER SYSTEM
9.00
6.00 .7500
EA PLB GAS PIPE >=5
4.50
1.00 15.0000
------------- -----------
EA PLB GAS METER
I ---------------- 7 ----------------7-----
15.00
Permit . . . . . GRADING
PERMIT
1
Additional desc
Permit Fee
15.00 Plan Check Fee
.00
Issue Date . . . .
Valuation . . . .
0
gxpiration.Date
3/31/07
Qty, Unit Charge
Per
Extension
BASE FEE
15-.00
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 7 - - - - - - - - - - - - - - - - - - - - - - - -
Special Notes and Comments
- - - - - - - - - - - -
SFD - LOT 20. 2800 SF,
SEDONA-SB. PERMIT DOES
NOT INCLUDE
BLOCK WALLS, POOL/SPA,OR
DRIVEWAY
APPROACH. 2001 CBC, CMC,CPC, 2004 CEC,
2005 ENERGY CODES.
----------------------------------------------------------------------------
Other Fees . . . . .
. . . . ART IN PUBLIC PLACES -RES
104.63
DIF COMMUNITY -CENTERS -RES
74.00
DIF CIVIC CENTER - RES
995.00
ENERGY REVIEW FEE
73.87
DIF FIRE PROTECTION -RES
140.00
GRADING PLAN CHECK FEE
.00
DIF LIBRARIES RES
355.00
DIF PARK MAINT FAC - RES
22.00
DIF PARKS/REC RES
892.00
LQPERMIT
Application Number
. . . . .
06-00003512
-----------------------------------------------------
Other Fees .
. . . .
- ---
STRONG MOTION (SMI)
- RES
--------
24.18
DIF STREET MAINT FAC
-RES
67.00
_
DIF TRANSPORTATION
-,RES
1930.00
Fee summary
Charged
Paid Credited
Due
Permit Fee Total
1562.20
.00
.00
1562.20
Plan Check Total
838.36
.00
.00
838.36
Other Fee Total
4677.68
.00
.00
4677.68
Grand Total
7078.24
.00
.00
7078.24