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04-7526 (SFD)s P.O. Box 1504 49-5 CAl1IE TAMPICO —1-�4Qfi�--NI�a,°CALIFORNIA 92253 iL App==1-rc-'at-i�n� -.-u e=r— Property Address . . . APN: Application description Property Zoning . . . . Application valuation Owner BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760):777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 . . . `Y04=000.00_7526 J Date 12/02/04 . . . 80445 CAMARILLO WY 772-250-997-115 -31349 - DWELLING - SINGLE FAMILY DETACHED . . . LOW DENSITY RESIDENTIAL . . 241854 TOLL CA V C/O KEVIN D DUERMIT 8901 E MOUNTAIN VIEW 200. SCOTTSDALE AZ 85258 Contractor ------------------------ TOLL BROS, INC. 73121 FRED WARING DRIVE, #100 PALM DESERT CA 92260 WCC: MARSH USA INC. WC: WA762DO04723014 09/01/05 CSLB: 777699 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 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 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 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 P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: pcf_ Date: 2 'frtJ Applicant: Architect or Engineer: Applicant's Mailing Address: Architect or Engineer's Address: IC. 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 C de, and my License is full force and effect. ense Class --L-icense No. —177:7tn 99 ate /L l Lev c� �L-I- 1612oTN�R-s SNG - 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 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).): 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.). U 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 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. 11� 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 work rs' compensation i ce carrier and policy number are: /, crier /Q rtS�t/ prs c Sense olicy Number UJA 7,[ Z DOO y�Z301T _ 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 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. 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 lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's 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 Ouinta, 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 the above-mentioned propert for inspection purposes. ate �z y lure (Applicant or Agent): Page 2 Application Number . . . . . 04-00007526 Date 12/02/04 Qty Unit Charge Per Extension 6.00 6.5000 EA MECH VENT FAN 39.00 1.00 6.5000 EA MECH EXHAUST HOOD 6.50 --------------7------------------------------------------------------------- Permit . . . . . . ELEC-NEW RESIDENTIAL Additional desc Permit Fee . . . . 125.20 Plan Check Fee 28.25 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 2800.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 98.00 610.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 12.20 ---------------------------------------------------------------------------- Permit . . . . . . PLUMBING Additional desc.. Permit Fee . . . . 189.00 Plan Check Fee 47.25 Issue Date . . . . Valuation . . . . 0 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 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 Plan Check Fee .00 Issue Date Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 ---------------------------------------------------------------------------- Special Notes and Comments SFD - LOT 115. 2800 SF, SEDONA SB.PERMIT DOES NOT INCLUDE BLOCK WALLS, POOL/SPA, OR DRIVEWAY APPROACH. ---------------------------------------------------------------------------- Other Fee's . . . . . . . . . ART IN PUBLIC PLACES -RES 104.63 DIF COMMUNITY CENTERS -RES 97.00 DIF CIVIC CENTER - RES 366.00 J , '* Page 3 Application Number . . . . . 04-00007526 Date 12/02/04 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . 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 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