05-3210 (SFD)P.O. BOX 1504
78-495 CALLE TAMPICO .
LA QUINTA, CALIFORNIA 92253
Application Number: 0003210-7
Property Address: 50944 VIA ANCANTARA
APN: 772-250-018-24 -31349 -
Application description: DWELLING --SINGLE FAMILY
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 241854
.Applicant:
BUILDING & SAFETY DEPARTMENT,
BUILDING PERMIT
DETACHED
rchitect or Engineer:
C Z..3 77f
--------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
1 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
/Date: Y) -7 Tactor: Tl') L L
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 .00
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.).
(_ 1 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.).
(_ 1 I am exempt under Sec. , B.&P.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:
10
LQPERMIT
Owner:
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
(760)674-9699
Lic. No.: 777699
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:
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.
l 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
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, 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 L bor. Code, I shall forthwith comply with those provisions.
s� ?
te: U17�� plicant: It DLL IY�
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 u the above-mentioned pr rt for inspection purposes.
iia% tt / Signature (Applicant or Agent): �i2�'M�4.►� A-�t dd.�,,� ,
LQPERMTT
Application Number
. . . 'OS -00003210
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
184.68
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
6.03
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
7.06
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
LQPERMTT
Application Number 05-00003210.
Permit . . . . . . 'ELEC-NEW RESIDENTIAL
Qty Unit Charge: Per
Extension
610.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL
.12.20
Permit . . . PLUMBING
Additional desc .
Permit Fee . . . . 189.0.0 Plan Check Fee
11.81
Issue Date Valuation
0
Expiration Date 1/22/06
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
Expiration Date 1/22/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
Special Notes and Comments
SFD - LOT 24.:2800 S.F.
SEDONA-CONT. PERMIT DOES NOT INCLUDE
BLOCK WALLS, POOL/SPA, OR DRIVEWAY
APPROACH. 75% PLAN CHECK FEE DISCOUNT
APPLIED FOR MULTIPLE ISSUANCE OF SAME
PLAN TYPE.
----------------------------------------------------------------------------
Other Fees -. ART IN PUBLIC PLACES -RES
104.63
DIF COMMUNITY CENTERS -RES
97.00
DIF CIVIC'CENTER - RES
366.00
ENERGY REVIEW'FEE
18.47
DIF FIRE PROTECTION -RES
97.00
GRADING PLAN CHECK FEE.
.00
DIF LIBRARIES - RES
225.00
DIF PARK MAINT FAC - RES
5.00
LQPERMIT - _
LQPERMIT
Application Number
. . . .. .
05-00003210
-----------------_-------------------------------.---------------------------
'Other Fees . .
. . . . .
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
209.58
.00 .00
209.58
Other Fee Total
2552.28
.00 .00
2552.28
Grand Total
4324.06
.00 00
4324.06.
LQPERMIT