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SFD (06-3296)P.O. BOX 1.504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: .Property Address: APN: Application description: Property Zoning: Application valuation: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT -06-00003296 &?LAIl`A —80143"MIRAMONTE LN 772-250-018-18 -31349 - DWELLING - SINGLE FAMILY'DETACHED LOW DENSITY RESIDENTIAL 262610 Owner: TOLL CA V C/O KEVIN D DUERMIT 8901 E MOUNTAIN VIEW 200 SCOTTSDALE, AZ 85258 Contractor: Applicant: Architect or Engineer: TOLL BROS, INC. 73121 FRED WARING DRIVE, #100 � Q Lk 01 Ll PALM DESERT, CA 92260 WCC: ZURICH AMERICAN Lic. No.: B ----------------------------------------------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with —1 hereby affirm under penalty of perjury one of the following declarations: ' Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Class: — Lige se No.a B for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ate: ��-/ �C ontractor: - 1 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 OWNER -BUILDER D CLARATION insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier WC387821301 0 9 / 0 1 / 0 Policy Number 777699 following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to _ _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if•I should become subject to the workers' compensation provisions of Section License law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the bor Code, 'shall forthwith c ply w1. ', those provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by, •� _ / D any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: ate: G [ plicant: (_ 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- WARNING: FAILURE TO SECURE WORKERS' COMPENSATION LVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own,employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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.). APPLICANT ACKNOWLEDGEMENT (_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 7044. Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application, ( 1 -I am exempt under Sec. , B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and -hold harmless the City VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/11/06 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: L PERMI 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 application and state that the above information is correct. I agree to comply with all city and my ordinances and state laws relating to building construction, and hereby au orize representatives of thi ounty to enter upon t above-mentioned property for irispectiEn purpose . 1 ate:�z / `0 gnature (Applicant or Agent):�� __ lication Number' . . . . 06-00003296pP Structure -Information ti 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 625.00 '. . .,.- PATIO SQ FTG 233.00. �,'-• } NUMBER OF UNITS 1.00 ----------------------------------------------------------- _ 1ST FLOOR SQUARE FOOTAGE x3047.00' -------------- Permit - BUILDING - PERMIT - `:• Additional desc . , Permit Fee . . 1210.00 Plan Check Fee 786.50 Issue Date . . . . Valuation 262610 Expiration Date 3/10/07 Qty 4 Unit Charge Per t Extension BASE FEE 639.50 163.00 3.5000 THOU BLDG 100,0017500,000 570.50 -------------------------------------------------------- ---------- ---------- Permit MECHANICAL ' esc Additional desc- Permit Permit Fee 127.50 Plan Check Fee.. 31.88 • Issue Date -. Valuation_ 0 Expiration Date 3/10/07 Qty Unit Charge 'Per Extension BASE FEE 15.00 3.00 9.0000 EA MECH FURNACE <=100K' 27.00 3.00 9.0000 EA MECH B/C <=3HP/100K BTU 27.00 '8.00 6.5000 EA MECH VENT FAN 52.00 1.00 6.5000 EA . MECH EXHAUST HOOD 6.50 Permit. . . . . . .' ELEC-NEW RESIDENTIAL Additional desc Permit Fee 134.15 Plan Check Fee 33.54 M Issue Date . . . . Valuation 0 ` Expiration Date 3/10/07 Qty Unit Charge. Per Extension BASE. FEE 15.00 3047.00' .0350 ELEC NEW RES - 1 OR 2 FAMILY 106.65 r LQPERbLIT - -Application Number, . . . . . 06-00003296 Permit . . . . . . ELEC-NEW RESIDENTIAL Qty Unit Charge Per Extension 625.0'0 .0200 ELEC GARAGE OR NON-RESIDENTIAL 12.50 Permit . . . PLUMBING, Additional desc.. -" Permit Fee 207.75 -Plan Check Fee 51.94 Issue Date . . . .. Valuation 0 Expiration Date 3/10/07 Qty Unit Charge Per Extension BASE FEE 15.00 23.00 6.0000 EA PLB FIXTURE 138.'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 7.00 .7500 EA PLB GAS PIPE">=5' 5.25, 11.00 15.0000 EA PLP GAS METER 15.00 Permit GRADING'PERMIT Additional desc Permit Fee 15.00 Plan'Check Fee .00 Issue Date Valuation . . 0 Expiration Date- 3/10/07 Qty Unit Charge. Per Extension BASE FEE 15.00• Notes and Comments" .Special SFD - LOT 11S. 3047 S.F. SFD. BELIZE -SC PERMIT DOES NOT INCLUDE BLOCKWALLS,POOL/SPA,OR DRIVEWAY APPROACH.2001 CBC, CMC„ CPC, 2004 CEC, 2005 ENERGY CODES Other Fees . . . . . . . . . ART IN PUBLIC PLACES -RES 153.86 DIF COMMUNITY CENTERS -RES 74.00 - DIF•CIVIC CENTER - RES 480.00 1 ENERGY REVIEW FEE 78.65 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 J LQPERMIT LQPERMIT Application Number . . . . . 06-00003296 -.---------------- Other`Fees ---.--- . . . ------------ -------- - - - - ------ - - - - -- STRONG MOTION (SMI) - RES 26.15 DIF STREET MAINT.FAC-RES 67.00 DIF,TRANSPORTATION -.RES 1666.00 Fee summary Charged paid Credited Due Permit Fee Total 1694.40 .00' .00 1694.40 Plan Check Total 903.86 .00 .00 903.86 Other,Fee Total 3954.66 .00 .00 3954.66 Grand Total 6552.92 •.00 .00 6552.92