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SFD (05-3189)BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Applicant: ',�Architect or Engineer:. �/' r✓! C 2 z 771 ----------------- LICENSED CONTRACTOR'S DECLARATION y' P.O �3OX 1504 78-495 CALLE TAMPICO TOLL CA V LA QUINTA, CALIFORNIA 92253 Application Number: 05-00003189 Property Address: 80161 MIRAMONTE LN APN: 772-250-018-17 731349 - �Application description: DWELLING - SINGLE FAMILY Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 241854 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Applicant: ',�Architect or Engineer:. �/' r✓! C 2 z 771 ----------------- LICENSED CONTRACTOR'S DECLARATION y' Owner: TOLL CA V C/O KEVIN D DUERMIT 8901 E MOUNTAIN VIEW 200 A' SCOTTSDALE, AZ 85258 Contractor: ®®� TOLL BROS, INC. 73121 FRED WARING DRIVE, #100 PALM DESERT, CA 92260 T (760)674-9699 Lic. No.: 777699 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. License Class: B License No.: 777699 ate: It -7 0:Y .tractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from 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 ($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 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 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.). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the'project (Sec. 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 contracts for the projects with a contractor(s) licensed 'pursuant to the Contractors' State License Law.l. I—) I am exempt under Sec. , BAP.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: 7/26/05 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: - _ Ihave -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. 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 insurance carrier and policy number are: Carrier LIBERTY MUTUAL Policy Number WA762DO04723014 _ 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 forthwith comply with those provisions. te: 111j�l�7 ant: WARNING: 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 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 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 county to enter upon t above-mentioned property for inspection purposes. ' - / ( JO ignature (Applicant or Agent): Ct".{,..,.� Application Number . . . 05-00003189 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 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 1/22/06 Qty Unit Charge Per Extension BASE FEE 639.50 142.00 3.5000 ------------------------------------------------------------------------------ THOU BLDG 100,001-500,000 497.00 Permit MECHANICAL Additional desc . Permit Fee 96.50 Plan Check Fee 24.13 Issue Date . . . . Valuation . . . . 0 Expiration Date 1/22/06' 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 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 1/22/06 Qty Unit Charge Per Extension ' BASE FEE - 15.00 2800.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 98.00 LQPERMIT LQPERAIIT Application Number 05-00003189 = ,. Permit . . . . . . ELEC-NEW RESIDENTIAL , Qty Unit Charge Per r Extension 610:00 _ .0200 ELEC GARAGE OR NON-RESIDENTIAL ------------------------------ ---------------------------------------------- - 12.20 _ t Permit . . . PLUMBING Additional desc . Permit Fee 189.00Plan. Check"Fee...-. 47.25' Issue�Date Valuation . . . . 0 Expiration Date 1/22/06 Qty Unit Charge Per Extension - BASE FEE 20.00 6.0000 EA PLB FIXTURE 120.60 - 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 6.00 , .7500.EA PLB GAS'PIPE >=5 4.50 ' 1.00"15.0000 EA PLB.GAS METER - -------"-------------------------------------•--------------- 15.00 ----------- - ----- - Permit . . . GRADING PERMIT - Additional desc . ' Permit Fee 15.00 P1an.Check Fee .00 r Issue Date Valuation . . . . 0 Expiration Date 1/22/06 Qty ' Unit Charge 'Per Extension ' BASE FEE 15.00 -------------------------=------=-----_------------------------- Speciil'Notes'and Comments. SFD.- LOT 17..2800 SF, SEDONA SB.PERMIT DOES NOT INCLUDE BLOCK WALLS, POOL/SPA, - ' OR•DRIVEWAY-APPROACH. Other Fees . . . ... . . . ART.IN PUBLIC PLACES -RES, 104.63 DIF COMMUNITY CENTERS -RES 97.00 DIF CIVIC CENTER - RES 366.00 - ENERGY REVIEW FEE 73.87 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 24.18 DIF STREET MAINT FAC -RES 15.00 LQPERAIIT LQPERMIT Application Number05-00003189 Other _Fees DIF TRANSPORTATION - RES 1098.00 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 2607.68 .00 .00• 2607.68 Grand Total 5008.24 .00 .00 5008.24 LQPERMIT