04-3906 (SFD)J�3 BUILDING & SAFETY DEPARTMENT
Box 504. (760),777-7012
ltt`}
A - 95� EA '� E TAMPICO FAX (760) 777-7011
LA QUINl;A�,?CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
�j�y 1 a 2p04 BUILDING PERMIT
5-r-operty Address . . . . .
APN r
Application description .
Property Zoning
Application valuation . . .
C'04==0"0003906 Date 5/06/04
50997 EL DORADO DR
772-250-996-194 -31349 -
DWELLING - SINGLE FAMILY DETACHED
LOW DENSITY RESIDENTIAL
376373
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:. 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
277.0.0 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
_Qty Unit Charge
Per
Extension
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 QED Date: •�'�8 '�
Applicant: cam' ect or Engineer: �+
Applicant's Mailing Address:
or Engineer's Address:
No.: 0— 23
BUILDING PERMIT DECLARATIONS
15,
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under pe alt f perjury that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Code, and my License II force and effect.
/license Class erise No.
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 fora 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
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.
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
ssue . orkers' com ensation insura a cartie�apd pol' y hr ge..
arrter y Number !�—�
I certify that, in the performance of the work for which this permit is issued, r shall no em loy 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.
,---115—iteApplicant
WARNI G: FAIIIURE 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
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.).
,,,--tender's Name
Leader'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 if work is not commenced within 180 days from date of issuance of such permit, or
cessation of work for 180 days will subject pennit 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 nd he by authorize representatives of this county to er upon the above-mentioned property for inspection purposes.
ate S' ature (Applicant or Agent):
Page
2
Application
Number .
. .
. . 04-00003906 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
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
1S.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
194 VENTANA-A/4'/CASITA.
� U t
Page 3
Application Number.
. . . . .
04-00003906 Date
. 5/06/04
----------------------------------------------------------------------------
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
Paid Credited
Due
Permit Fee Total
2179.19
.00 .00
2179.19
Plan Check Total
1179.03
00 .00
1179.03
Other Fee Total
3012.03
.00 00
3012.03
Grand Total
6370.25
.00 .00
6370.25