04-3996 (SFD)Tduc�
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504. (760),777-7012
OFT 9 A8495 ALLE T� �MPICO FAX (760) 777-7011
LA TNTA, CALL+PFORNIA 92253 INSPECTION REQUESTS (760).777-7153
JUL 14 20,04 BUILDING PERMIT .
c�ry c� QUINTA
App 1_ic a-to"n��Tu�rnb Date 5./10/C4
Property Address . . . . . 80440 TORREON WY
APN: 772-250-997-111 -31349
Application description . . DWELLING - SINGLE FAMILY DETACHED
Property Zoning . LOW DENSITY RESIDENTIAL .
Application valuation 227594.
Owner Contractor
TOLL, CA V TOLL BROS,-INC..
C/O. KEVIN D DUERMIT 73121 .FRED WARING DRIVE,, #100-
8901.E MOUNTAIN VIEW 200 PALM DESERT', CA '92260.
SCOTTSDALE ..AZ 85258
WCC: ROGAL & HAMILTO
WC':' WA26D004723013 09/01/.04
CSLB: 777699 04/30/06
CCC B
---------=-------------- 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 495.00.
PATIO SQ FTG 399.00
NUMBER OF UNITS 1.00
FIRST FLOOR SQ FTG 263'1.00
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Permit . . . . BUILDING PERMIT
Additional desc
.Permit Fee i087.50 Plan Check Fee 176.72
Issue Date Valuation 227594
Qty Unit Charge Per Extens=on
BASE FEE 639.50
128.00 3".5000 THOU BLDG 10.0,001-500,000 448.00
Permit. . . MECHANICAL
Additional desc .
Permit Fee . . . . 109.50 Plan Check Fee 6.85
Issue"Date Valuation 0
Qty Unit Charge Per Extens=on
' N J
•
P.O. Box 1504 VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011.
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760)'777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: �� 3 QQ� Date:
Applicant: A ect or Engineer:"
SAI&
Applicant's Mailing Address: Architect or Engineer's Address:
V.
Lic. No.: Co23 7 7 %
BUILDING PERMIT DECLARATIONS
LICEN ED CONTRACTOR'S DECLARATION
I her affirm under penalty of perjury that I am license=1cense
ions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
C e, and ss Lic se is in full force and elle7 i 7 6 5,,
icense ss '�
ate /' ntrector4 . �� 15Fix.i�
OWNER-BUILDER DECLARATION
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. B.& P.C. for this reason
Date
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.
1 have and will maintain workers' compens tKon insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
,�I issued. My workers' c�o9'�pensation i urance carrier and policy nu)r)¢er
arrier�2y fi+r'L olicy Numberko26 �Ot/Y 1�1�/ -a.
_ I certify that, in the performance of fhe 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, 1 shall
forthwith comply with thgse provisions.
WARNING: FAILURE TO SECURE WORKERS' COl PENSATION 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 3708 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, 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 it 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 r "resentatives of this county to enter upon the above-mentioned property for inspection purposes.
ate ignature (Applicant or Agent).
Page
2
Application Number .
. . . . 04-00003996 Date
5/10/04
Qty Unit.Charge
Per
Extens=on
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
8.00
6.5000
EA MECH VENTFAN
52.00
1.00
6.5000.EA
MECH EXHAUST HOOD
6.50
Permit
ELEC-NEW RESIDENTIAL
Additional desc
Permit Fee .
. . .
116.99 Plan Check Fee
7.31
Issue Date .
. . .
Valuation . . . .
0
Qty Unit
Charge
Per
Extens_on
BASE FEE
15 00
2631.00
.0350
ELEC NEW RES' - 1 OR 2 FAMILY
92 09
495.00
.0200
ELEC GARAGE OR NON-RESIDENTIAL
9 90
---------------------------------
Permit . . .
. . .
-------------------------------------------
PLUMBING
Additional desc
Permit Fee
189.00 Plan Check Fee
11.81
Issue Date .
. . .
Valuation . .
0
Qty Unit
Charge.
..Per
Extens=on
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
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Special Notes
and Comments
LOT 111. 2631
S.F. SFD.
LAMINA
.i
Page 3
Application Number
04-00003996 Date
5/10/04
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Special ' Notes and Comments
SB. PERMIT DOES NOT INCLUDE
BLOCK WALLS, POOL/SPA-, OR DRIVEWAY
APPROACH. 75% PLAN CHECK FEE
REDUCTION
APPLIED FOR MULTIPLE.ISSUANCE
OF SAME
PLAN TYPE.'
---------------------------------------------------
Other Fees .. . . . . . . . .
---------------.--
ART IN PUBLIC PLACES -RES
--------
68.98
DIF COMMUNITY CENTERS -RES
97.00
DIF CIVIC CENTER - RES
366.00
ENERGY REVIEW FEE
17.67
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
22.15
DIF STREET MAINT FAC -RES,
15.00
DIF TRANSPORTATION - RES
1098.00
Fee'summary Charged
-----------------
Paid Credited
Due
----------
Permit Fee Total *1517.99
------------------------------
.00 .00
1517.99
Plan Check Total 202.69
.00 .00
202.69
Other Fee Total 2514.40
.00 00
2514.40
Grand Total 4235.08
.00 .00
4235.08.