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SFD (04-5082)BUILDING.& SAFETY DEPARTMENT (760).777-.7012 FAX (760) 777-7011 A 92253 INSPECTION REQUESTS (760) 777-7153 WING PERMIT Applicat on N$rnb-� ,04=0000-50'82; -_ s- . Date ,6/25/04 Property -mess . . -- -- . . . . . 56255 MOUNTAIN VIEW APN: 762-410-016- - - Application description DWELLING - SINGLE .FAMILY DETACHED Property Zoning . . . . . .-. LOW DENSITY RESIDENTIAL Application valuation . . . . 376373 Owner Contractor S.RHI ---------------- TOLL BROS, INC. C/O RIELLY HOMES ,INC 73121 FRED WARING DRIVE., -#100 . 3 CORPORATE.PLAZA DR 210 PALM DESERT CA 92260 'NEWPORT BEACH CA 92660 WCC: LIBERTY MUTUAL - WC: WA26DO04723013 09/01/04 CSLB: 777.699 04/30/06 CCC: B --------------------------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 CRC FIRE SPRINKLERS NO GARAGE SQ FTG 730.00 - PATIO SQ FTG 650.00 NUMBER OF UNITS 1.00. FIRST FLOOR SQ FTG 4374.00 - ----------------------------------------------7------------------------------- Permit . . . . .. BUILDING PERMIT Additional desc Permit Fee 1609.00 Plan Check.Fee 261.46 Issue Date Valuation . . . : 376373 Qty Unit Charge Per Extension BASE FEE 639.50 277.00 .3.5000 THOU BLDG 100,001-500,000. 969.50 Permit MECHANICAL Additional desc Permit Fee 134.00 Plan Check Fee 8.38 Issue Date Valuation 0 Qty Unit Charge Per. Extension. P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253. INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number:�L% ,� �� 2 Date: Applicant: Applicant's Mailing Address: chitect or Engineer: Architect or Engineer's Address: I—Lic. No.: BUILDING PERMIT DECLARATIONS 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. 7 7-745" % License Class_ F /License No. ��. Date -7 O ontractor. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Busi ess 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).): U 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 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.). (, 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.). U I am exempt under Sec. , BA P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm 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 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 irk nce carrier and policy number are: /-Carrier. )mi l i M SA) policy Number t-yA 2 6 r2 e, z) 4 7Z7,o (3 _ I certifyFthat, 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 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::ZZZ / b 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. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lendingagency for the performance of the work for which this g �' � permit is issued (Sec. 3097, Civ. C.). Lender's Name Lenders Address 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, indemnity and hold harmless the City of La Quints, 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 applicafion 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 the above-mentioned property for inspection purposes. -Bate Z7 0 � ignature (Applicant or Agent): v Page 2 , ,Applicat,ion-Numb.er 04-00005082 Date 6/25/04 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 9.00 6.5000 EA MECH•VENT FAN 58:50` 1.00 6.5000 EA MECH EXHAUST HOOD 6.50 Permit ELEC-NEW RESIDENTIAL Additional desc Permit Fee 182.69 Plan Check Fee 11.42 Issue Date . . . . Valuation . . , 0 Qty Unit Charge "Per Extension BASE FEE 15.00 4374.00 .0350 ELEC NEW RES'- 1 OR 2 FAMILY 153.09 730.00 .0200 . ELEC GARAGE OR NON-RESIDENTIAL 14.60 Permit ". . . . . . PLUMBING" Additional desc Permit Fee 216.00 Plan Check Fee.. 13.50" Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE - 15.00 24.00 6.0000 EA , PLB FIXTURE 144.00 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 '1.100 9.0000 EA PLB LAWN SPRINKLER SYSTEM 9.00 10.0.0 .7500 EA PLB GAS. PIPE >=5 7.50 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 16 -PLAN VENTANA SB W/CAS-ITA &"; " Page 3 Application Number . . . '--------- 04-00005082 Date -'------ 6/25/04 ---------------- ----------- Special-Notes and Comments ---------------------------------- EXT PATIO 4374 S.F. PERMIT DOES NOT INCLUDE-BLOCK,WALL, POOL, SPA OR DRIVEWAY APPROACH. 75% PLAN CHECK FEE: REDUCTION APPLIED FOR MULTIPLE ISSUANCE 4 OF -SAME PLAN TYPE. ----------------------------- Other Fees. . . . . ---------------------------------------------- . . . . . •ART IN PUBLIC PLACES -RES 440.93 DIF COMMUNITY CENTERS -RES 97'.00 "� .. DIF CIVIC CENTER - RES 366_00 ENERGY REVIEW FEE 26.15 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 37.63 DIF STREET MAINT FAC -RES 15.00 DIF TRANSPORTATION - RES 1098.00 Fed summary Charged Paid Credited Due. Permit Fee Total 2156'.69 .00 .00 2156.69 Plan Check Total 294.76 .00 .00 294.76 - Other Fee Total, 2909.71 ..00 .00 2909.71 Grand Total. 5361.16 .00 .00 5361.16