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04-3684 (SFD)T4hf 4 4 a" ox 1504 CALLE TAMPICO INTA, CALIFORNIA 92253 l-ppNumber . . 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 C-04=0.0003684 Date 4/28/04 . . . 50913 EL DORADO DR 772-250-96 -197 -31349 - . . . DWELLING - SINGLE FAMILY DETACHED . . . LOW DENSITY RESIDENTIAL . . . 376373 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 Unit Charge Per Extension WCC: ROGAL & HAMILTO WC: WA264DO0472301 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 FIRE SPRINKLERS NO GARAGE SQ FTG 730.00 PATIO SQ FTG 650.00 NUMBER OF UNITS 1.00 FIRST FLOOR SQ FTG 4374.00 -------------------------- Permit . . . . . --------------------------------- BUILDING PERMIT ----------------- Additional desc . . Permit.Fee 1609.00 Plan Check Fee 1045.85 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 . . . . 156.50 Plan Check Fee 39.13 Issue Date . . . . Valuation . . . . 0 Unit Charge Per Extension P.O. Box 1504 • �� VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 0 (10 10/1-17,Date: •�'/O • U� Applicant: Architect or Engineer Applicant's Mailing Address: cit ct ngine s dyes : 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 n II force and effect. ^� se Class o. / r 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 wi1J 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 wo for which this permit is issued. I have and II 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. I (v o kers' co ation insycance carrier a� nd po nyre��arQ: � e 6,1c Number LL/ ` _ I certify t at, in t e erformance of the work for which this p it is issued. I s all not emplo any person in any manner so as to become subject to the workers' com nsation 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 forth 'th comply with those proyJ S. 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, indemnify 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 160 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 ente pon the ab 13 ed property for inspection purposes. Date v 10�,a gnature (Applicant or Agent): Page 2 Application Number . . . . . 04-00003684 Date 4/28/04 Qty Unit Charge Per Extension BASE FEE 15.00 3.00 9.0000 EA MECH FURNACE <=100K 27.00 3.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU 49.50 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 45.67 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 48.38 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 1.00 .9.0000 EA PLB LAWN SPRINKLER SYSTEM 9.00 10.00 .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 197 VENTANA-A/4'/CASITA. Fee summary Charged Permit Fee Total 2179.19 Plan Check Total 1179.03 Other Fee Total 3012.03 Grand Total 6370.25 Paid Credited Due ---------- ---------- ---------- .00 .00 2179.19 .00 .00 1179.03 .00 .00 3012.03 .00 .00 6370.25 Page 3 Application Number . . . . 04-00003684 Date 4/28/04 ---------------------------------------------------------------------------- Special Notes and Comments PERMIT DOES NOT INCLUDE BLOCK WALLS, POOL, SPA OR DRIVEWAY APPROACH ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ART IN PUBLIC PLACES -RES 440.93 DIF COMMUNITY CENTERS -RES 97.00 DIF CIVIC CENTER - RES 366.00 ENERGY REVIEW FEE 104.59 DIF FIRE PROTECTION -RES 97.00 GRADING PLAN CHECK FEE 00 . DIF LIBRARIES - RES 225.00 DIF PARK MAINT FAC - RES 16.00 DIF PARKS/REC.- RES 502.00 STRONG MOTION (SMI) - RES 50.51 DIF STREET MAINT FAC -RES 15.00 DIF TRANSPORTATION - RES 1098.00 Fee summary Charged Permit Fee Total 2179.19 Plan Check Total 1179.03 Other Fee Total 3012.03 Grand Total 6370.25 Paid Credited Due ---------- ---------- ---------- .00 .00 2179.19 .00 .00 1179.03 .00 .00 3012.03 .00 .00 6370.25