04-5568 (SFD)44
!.ITYOFLgQUIR1Tf�1 I BUILDING & SAFETY DEPARTMENT
�F1�APIC� �P7
P.O. Box 15=04' (760).777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number
Property Address . . . .
APN:
Application description
Property Zoning . . . .
Application valuation . .
Owner
004 0.0.0.5-5.6.8 Date 7/20/04
51473 EL DORADO DR
772-250-996-177 -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
Qty . Unit Charge Per
Extension
WCC: LIBERTY
MUTUAL
WC: WA26DO04723013 09/01/04
CSLB: 777699
04/30/06
CCC: B
--------------------------
Structure Informa-t.ion -------------------------
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 100,001-5001000
969.50
--------------------------------------------------------------------7-------
Permit . . . . . .
MECHANICAL
Additional desc
Permit Fee . . . .
134.00 Plan Check Fee
39.13
Issue'Date . . . .
Valuation . .
. . 0.
Qty . Unit Charge Per
Extension
P.O. Box 1504�� VOICE (760) 777-7012
T"af
78.495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 55� Date: ^O
Applicant:
Applicant's Mailing Address:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under n y 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 Licens n full force and effect.
C
ense Class License No.?:7 {(/
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 1, 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.8 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 r which this permit is issued.
I have and wi maintain workers' compensation insurance, as required by Sectiofi 3700 of the Labor Code, for the performance of the work for which this permit is
issu orkers'nsation rance carrier and policy number are:
Cartier olicy Number
I certify th , i 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'
com sation 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
forth th comply with those provWQns.
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, indemnity 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 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. 1 agree to comply with all city and county ordinances and state laws relating to building
construction,, and hereby authorize representatives of this county to en r upon the above-mentioned property for inspection purposes.
ate �l V gnature (Applicant or Agent): �"'�-
Page
2
Application
Number .
. .
. . 04-00005568 Date
7/20/04
Qty
Unit Charge
Per
Extension
BASE FEE
15.00
3.00
9.0000
EA
MECH FURNACE <=100K
27.00
3.00
9.0000
EA
MECH B/C <=3HP/100K BTU
27.00
.00
16.5000
EA
MECH B/C >3-15HP/>100K-500KBTU
.00
.00
22.5000
EA
MC B/C >15 <=30HP/500K-1M BTU
.00
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
Fee summary
-----------------
Permit Fee Total
Plan Check Total
Other Fee Total
Grand Total
Charged Paid
2156.69
Page
3
Application Number . . . . .
04-00005568 Date
7/20/04
----------------------------------------------------------------------------
Special Notes and Comments
.00
SFD - LOT 177 VENTANA-A/4'/CASITA.
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
-----------------
Permit Fee Total
Plan Check Total
Other Fee Total
Grand Total
Charged Paid
2156.69
.00
1179.03
.00
3012.03
.00
6347.75
.00
Credited Due
.00
2156.69
:00
1179.03
.00
3012.03
.00
6347.75