04-3675 (SFD)Td4ul'�trGv
1J BUILDING & SAFETY DEPARTMENT
Box 1504. (760),777-7012
8- 95 CALLS TAMPICO FAX (760) 777-7011
UINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number .
. . . ...;Z 4 003675'��
Date 5/06/04
Property Address . .
. . . . 50969 EL DORADO DR
APN:
772-250-996-195 -31349 -
Application description
. . . DWELLING - SINGLE FAMILY
DETACHED
Property Zoning . . .
. .: LOW DENSITY RESIDENTIAL.
Application valuation
333037
Owner
Contractor
-------------------------
TOLL CA V
------------------------
TOLL BROS, INC.:
C/O KEVIN D DUERMIT
73121 FRED WARING
DRIVE, 4100
8901 E MOUNTAIN VIEW
200 PALM DESERT
CA 92260
SCOTTSDALE
AZ -85258
WCC: ROGAL &
HAMILTO
WC: WA264D00472.301'09/01/04
CSLB: 777699.
04/30/06
CCC: B
-----------=--------------
Structure Information --------------I-----------
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
FIRE.SPRINKLERS
NO
GARAGE SQ'FTG
752.00
PATIO SQ FTG
561.00
NUMBER OF UNITS
1.00
FIRST FLOOR SQ FTG,
3847.00
Permit . . . . .
BUILDING PERMIT
Additional desc
Permit Fee
1458.50' Plan Check Fee
948.03
Issue Date
Valuation
333037
Expiration Date
5/06/05
Qty Unit Charge
Per
Extension
BASE FEE
639.50
234.00 3".5000
THOU BLDG 10.0,001-500,000
819.00
Permit. . .
MECHANICAL
Additional desc
Permit Fee
150.00 Plan Check Fee
37.50
•Issue"Date
Valuation . .
. . 0
Expiration Date
5/06/05
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: Date'. ; D D
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.: (v .� ?
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
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 ' I force and effect. -
cense Class tense No. / 7 :z(42
1
' OWNER -BUILDER DECLARATION
I hereby affirrn'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 contractors) 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
js�ued M ockers' comp_ nsation in�yranCS carrigr and polity um er are:
�'
/Carier�((Z, / %i ) olicy Number /�T�j
I certify fiat in t e performance of the work for which this permt 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 15�04m, plicant
WARNIN : FAILURE TO SECURE WORKERS' COMPENSATION OVERAGE 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
hereby affirm under pen y 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
/ APPLICANT ACKNOWLEDGEMENT
IMPORTANT Apter,
tion 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. Eachon 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
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.
1 certify that I have read this application and state that the above information is correcL I agree to comply with all city and county ordinances and state laws relating to building
construction, nd he by authorize representatives of this county to en u on the above �dropertyor inspection purposes.
1- 114 ign.ture (Applicant or Agent):
M
Qty Unit Charge Per
0
Extension
Page
2
Application
Number .
. . . . 0,4-00003675 Date
5/06/04
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
8.00
6.5000
EA MECH
VENT FAN
52.00
1.00
6.5000
EA MECH
EXHAUST HOOD
6.50
----------------------------------------------------------------------------
Permit . .
. . . .
ELEC-NEW RESIDENTIAL'
Additional
desc
Permit Fee
. . . .
164.69
Plan Check Fee
41.17
Issue Date
. . . .
Valuation . . . .
0
Expiration
Date
5/06/05
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
3.847.00
.0350
ELEC
NEW RES - 1 OR 2 FAMILY
134.65
752.00
.0200
ELEC
GARAGE OR NON-RESIDENTIAL
15.04
------'----------------------------------------------------------------------
Permit . .
. . . .
PLUMBING
Additional
desc
Permit Fee
. . . .
195.00
Plan Check Fee
48.75
Issue Date
. . . .
Valuation . . . .
0
Expiration
Date
5/06/05
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
21.00
6.0000
EA PLB
FIXTURE
126.00
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 . .
5/06/05
Qty Unit Charge Per
0
Extension
9
11
Page 3
Application Number
04-00003675 Date
5/06/04
Qty Unit Charge
Per
Extension
BASE FEE
15.00
----------------------------------------------------------------------------
Special Notes and
Comments
.SFD - LOT 195, MIRAMONTE-A. PERMIT DOES
NOT INCLUDE BLOCK
WALLS, POOL,
SPA OR
DRIVEWAY APPROACH
----------------------------------------------------------------------------
Other Fees . . .
. . .. . . .
ART IN PUBLIC PLACES -RES
332.59
DIF COMMUNITY CENTERS -RES,
97.00
DIF CIVIC CENTER - RES
366.00
ENERGY REVIEW FEE
94.80
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
33.30
DIF STREET MAINT FAC -RES
15.00
DIF TRANSPORTATION - RES
1098.00
Fee summary
-----------------
Charged
----------
Paid Credited
------------------------------
Due
Permit Fee Total
1983.19
.00 .00
1983.19
Plan Check Total
1075.45
.00 .00
1075.45
Other Fee Total
2865.69
.00 .00
2865.69
Grand Total
5924.33
.00 .00
5924.33
9
11