05-3879 (SFD)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 05-00003879
Property Address: 80235 AVENUE 50
APN: 772-250-999-F -30357 -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 9500
Applicant:
T414t 4 XP Q"
Architect or Engineer
N (A
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
TOLL CA V
C/O KEVIN D DUERMIT
8901 E MOUNTAIN VIEW 200
SCOTTSDALE, AZ 85258
oContractor:
OCT 1 q1 9005 TOLL BROS, INC.
L 73121 FRED WARING DRIVE, 4100
PALM DESERT, CA 92260
11 c oFLAQUINjA (760)674-9699
FIPIAN��D��T• Lic. No.: 777699
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Data: 9/02/05
-------------------------------------------------------------------------7-----------------------
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commenting with
I hereby affirm under penalty of perjury one of the following declarations!
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: B License No.: 777699
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
uate;�0'�rl 'C1i ontractor.
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 issued. My workers' compensation
OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier ZURICH INS Policy Number WC387821300
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance of the work -for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labor Code, I shall forthwith comply with those provisions. '
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).:
Gate: itant:
(_) 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
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.).
(_) 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
1 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:
LQPERNUT
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 upon the above-mentioned property for inspection purposes.
Del -:16— aturf re (Applicant or Agent):
Application Number . . . . . 05-00003879
Permit . . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . . 117.00
Plan Check
Fee
.00
Issue Date . . . .
valuation
. . .
. 9500
Expiration Date 3/01/06
Qty Unit Charge Per
Extension
BASE FEE
45.00
8.00 9.0000 THOU BLDG 2,001-25,000
72.00
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Special Notes and Comments
380 L.F. 618" BLOCK WALL (9 TRASH
ENCLOSURES)PER APPROVED PLANS
Fee summary Charged Paid
- - - - - ----- - - - - ------ - - -
Credited
- ------ - - -
- ---
Due
--- - - - - - -
-- - - - - - - - - -
Permit Fee Total 117.00
.00
.00
117.00
Plan Check Total .00
.00
.00
.00
Grand Total 117.00
.00
.00
117.00
LQPERMIT
08/31/2005 15:54
Bin #
Permit # n
3�i
Projcct Address:
A. P. Number:
ft4o-
COMP06
City of La Quinta
Building 8t SafM Division .
P.O. Box 1504, 78.495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
TrSetLQ Owners Name: X -TOLI. 5—t26T4-]
Address: -4
City. ST. Zip: K t e ,-.. .w.
FAGE 01
Contractor: KT L
T{�+ N C—.Telephone:
to
Address: _
r] eny*s
Project Description: K
City. ST, Zip: K L/a
14Z"tS 3
_
Telephone: xCie30
�IL,
I k
State Lic. # : x, G
City Lic.
C10
4
Arch., Engr." Designer:
Address:
City. ST, Zip:
Telephone:
p
U :E.fi::: ..:# g:::;.. :>s:,i,:
> `'"''; ; Consnvaion Type-. %£?sfz'::i" y
O'ccupanc,:
State Lic. #:
a ``
U." ; , : Project type (circle one): Neva
Add'n Alter Repair Demo
Name of Contact Person: "-rte SM fl Sq. Ft,: # Stories:
Telephone # of Contact Person: -175 — $ 'L.O Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
p Submittal
Req'd Reed TRACKING
PERMITTEES
Plan Sets
Plan Check submitted
Item Amount
Structural Cales.
Reviewed, readyror corrections
Plan Check Deposit
Truss Cale&
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Picehanical
Grading plan
2w' Review, ready for corrections/issue
Electrical
Subeontwor List
Called Contact Person
Plumbing
Grant Aced
Plans picked up
5.i►1.1.
II.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
"' Review, ready for corrections/issue
Dcvcioper Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Datc.of permit issue
School Fees
ITotal Permit Fees
SI
�6I
* I
451
4S'
08/31/2005 15:54 7605649510 MVCC PAGE 02
il�iot�>nl.tai>nl VicW �"v7u.�lta•y Club
Ownar Toll Brothers Inc.
8901 E, Mountain VleW Road. Ste. 200 The Village - Condos
Scottsdale, Arimis 852$8
13i.dldcr; TOII 6rothars Inc.
8901 E. Mountain Vlew RD1d, Ste. 200
Scot"dele, Arizontt 85258
CA State Ur. #777699
BIOG # 781 tt PLAN / ELEV. SQ- FT, LI11. ADgRE3S ' PARCEL tt TRACT
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