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04-5500 (SFD)BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).•777-7012 OFAL 7 8•-49 CALLEh[AMPICO FAX (760) 777-7011 D ULNA QU.;INTA,,, C�LIFORNtA`92253 INSPECTION REQUESTS (760) 777-71.53 AU�3� 20D4 U BUILDING PERMIT C1 o I al;i r Appl IcatiarwNumb'e-r__5 04_ 0;0005500_ ` . bate .7/15/04 Property Address . . . . . 51221 _VIA-_ APN: 772-250-997-96 -31349 - Application description DWELLING - SINGLE FAMILY DETACHED Property Zoning . . . . . LOW DENSITY RESIDENTIAL Application valuation . . . 261546.., 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: LIBERTY MUTUAL WC: WA26DO0472.3013 09/01/04 CSLB: 777699 04/30/06 CCC: B ------------------------ --- Structure Information ---------- -------------- Structure Type TYPE V - NON RATED. Occupancy Type DWELLG/LODGING/LONG <=10 Flood Zone-.. NON -AO FLOOD ZONE Other struct info CODE EDITION 2001 CBC # BEDROOMS 3.00 FIRS_SPRINKLERS NO GARAGE SQ FTG 625.00 PATIO'SQ FTG 233.00 NUMBER OF UNITS 1.00 FIRST FLOOR SQ FTG 3047.00 Permit BUILDING PERMIT Additional desc Permit Fee . . .12.06.50 Plan Check Fee - 196.06 Issue Date . . Valuation .261546 Qty Unit Charge Per Extension BASE FEE 639.50 162.00. 3.5000 THOU BLDG 100,001-500,000 567.00 -------------------------------------------------------------------------- Permit . . . MECHANICAL .Additional desc Permit Fee 127.50 Plan Check Fee 7.97 Issue Date Valuation - 0 .Qty Unit Charge Per Extension P.O. BOX 1504. VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 Application Number: Applicant:. Applicant's Mailing Address: BUILDING & SAFETY DEPARTMENT or Architect Date: Engineer's Address: No. GZ 327!2 BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I he by affirm under penalty of perjury that I am licensed and visions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professiorials e, and my Licen is in full force and effect. License Class_ License No. % %% 6 92 / Date q`C/r. TD 1e2 ro �'b ev5 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. , 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 issugd. My workers' compensation inner nice carrier and golicy number are: camarl—f tIf � Nly1/0 oli.P' cy Number W ft Z(P D Ot)'472 C' _ ny person in any manner so as to become subject to the workers' I certify that, in the performance of the work for which this permit is issued, I shall not employ 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 SZ241 �%�Applicant ��ya 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 permit 1. Each person upon whose behalf this application is made, each person at whose requ st and four whose benefit work sto the andnperformed under or puset forth on thislrsuant to an 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 permit 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 re construction, and hereby authorize re esentatives of this countyr Won ve-men ' ad property for inspection purposes. lating to building ate O Signature (Applicant gent)- r-uy e Application Number 04-00005500 Date 7/15/04 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 8.00 6.5000 EA MECH VENT FAN 52.00 1.00 6.5000 EA MECH EXHAUST HOOD i 6.50 Permit ELEC-NEW RESIDENTIAL Additional desc Permit Fee 134.15 Plan Check.Fee 8.39 Issue.Date Valuation . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 .3047'.00 .0350 ELEC'NEW RES -,1 OR 2.,FAMILY 106.65 625.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 12.50 Permit . . PLUMBING Additional desc Permit Fee 207.75 Plan Check Fee'. 12.99 Issue Date . . . . Valuation 0 Qty Unit Charge Pere. Extension BASE FEE' 15.00 23..00 6.0000 EA PLB FIXTURE. 138.00 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 X7•.00 .7500 EA PLB GAS PIPE >=5 5.25 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 U Qty Unit Charge. Per Extension BASE .FEE 15.00 Special Notes and Comments SFD - LOT 96. 3047 S.F.BELIZE SB.' Page 3 _Application Number 04-00005500. Date 7/15/04' ----,-------------------------------- --------------------------- -------------- Special Notes and Comments PERMIT DOES NOT INCLUDE BLOCK WALLS, POOL/SPA,OR DRIVEWAY APPROACH:•75% PLAN' CHECK FEE REDUCTION APPLIED FOR MULTIPLE ISSUANCE OF.SAME PLAN TYPE. ----------------------------------------------------------------------------- Other Fees . . . . . . . . . ART IN PUBLIC PLACES -RES 153.86 DIF COMMUNITY CENTERS -,RES 97.00 DIF CIVIC. -CENTER - RES 366.00 ENERGY REVIEW`FEE 19.61 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 26.15 DIF STREET MAINT FAC -RES 15.00 DIF TRANSPORTATION - RES 1098.00 Fee summary Charged Paid Credited Due Permit Fee Total 1690.90 .00 x..0.0 1690.90 Plan Check Total 22'5.41 .00 .00 225:41 Other Fee Total 2604.62 .00 .00 2604.62 Grand Total 4520.93 .00 .00 4520.93