04-5492 (SFD)u�l'�,r6v
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
1 78-495.O.ALLELIT PIe�o FAX 760 777-7011
L7A-0UINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
�'� o
BUILDING PERMIT
OF
Application Nurrtber
Property Address ... . . . .
APN:
Application description . . .
Property Zoning.. . . . . . .
Application valuation . . . .
Owner
TOLL CA V
C/O KEVIN D DUERMIT
8901 E MOUNTAIN VIEW 200
SCOTTSDALE AZ 85258
"04_-0.0.0.05492_ QDate 7/15/04
51389 VIA SORRENTO
772-250-997-89 -31349
DWELLING -SINGLE FAMILY DETACHED
LOW DENSITY RESIDENTIAL
241854
Contractor
-------------------------
TOLL ` BROS , INC.
73121 FRED WARING DRIVE, #100
PALM DESERT CA 92260
Qty Unit Charge Per..Extension
. 9
WCC: LIBERTY
MUTUAL
WC: WA26DO04723013
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
# BEDROOMS
3.00
FIRE SPRINKLERS
NO
GARAGE SQ FTG.
610..00
PATIO SQ FTG
275.•00
NUMBER OF UNITS
1.00
FIRST FLOOR SQ FTG
-
2800.00
--------------------------
Permit .. . . . . .
---------------------------------
BUILDING PERMIT`
----------------
Additional desc
Permit Fee . . . .
1136.50 Plan Check Fee
184.68
Issue Date . . . .
Valuation
241854
Qty Unit Charge
Per
Extension
BASE FEE
639.50
142.00 3.5000
THOU BLDG 100,001-500,000 ;'
497..00
-----'-----------------------------------------------------------------------
Permit . . . .
MECHANICAL
Additional desc
Permit Fee . . . .
96.50 Plan Check Fee
6.03
Issue Date
Valuation
0
Qty Unit Charge Per..Extension
. 9
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:
Applicant:
Applicant's Mailing Address:
Date: �• 3'IyK
Architect or Eneer:
CT -Ci 1 g Ins m tly)
Architect or Engineer's Address:
ic. No.: C 2 3 2 7e
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I 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
Vie, and my License is in full force and effect. p G
icensa Class icense No.
..--- Date 913111D#- 'Contractor e, I,
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 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.
1 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
issu d. My y(orker� com ensation in rance carrier and policy number are:
artier t4.6Gr �-y I"��tyW �y Number W A % 2(o DC)047230lI3
I certify that, in 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'
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 4jF
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
Lenders Address A
Z
ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for
set forth on this
1. Each person upon whose behalf this application is made, each person atwhose request and for hose benefit ork srmit subject to the cotions andnperformed under or pulrsuant to an
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 Quinta, its
pernit
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 nter u entioned property for inspection purposes.
g / ignature (Applicant or Ag t
Page
2
Application Number
04-0.0005492 Date
7/15/04
Qty Unit
Charge
Per
Extension
BASE FEE
15.00
2.00
9.00,00
EA MECH FURNACE <=100K
18.00
2.00
9.0000
EA MECH B/C.,<=3HP/100K BTU
18.00
6.00
6.5:000
EA :MECH' VENT TAN
39.00
1.00
6,5000
EA MECH ' EXHAUST '.HOOD.
6.50
Permit . . .
. .
ELEC-NEW RESIDENTIAL "
Additional des.c
Permit Fee
125.-20 '''Plan Check. Fee
7.06'
Issue Date
•..Valuation
0
Qty Unit
.Charge
Per
Extension
BASE FEE
15.00
2800.00
.0350
ELEC.NEW RES - 1 OR 2 FAMILY
98.00.
61.0.00
.0200
•ELEC GARAGE.OR NON-RESIDENTIAL
12.20
Permit
PLUMBING
Additional"desc,.
Permit Fee
189.00 Phan Check. Fee
11:81
Issue Date .
. . .
Valuation . . . .
-0
Qty, Unit
Charge
Per.
Extension
BASE,'FEE
15.00
20.00
6:0000
EA PLB FIXTURE
120.00-."
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
.9.001
6,00
.7500
EA PLB GAS.PIPE >=.5
4.5Q..
1.00 .15.
0000
EA PLB GAS METER
15.00,•
----------------------=-------------------------------=-------------1--------
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 89.
2800 S.F.
SEDONA-SB.DOES
-Page 3
Application Number
04-00005492 Date 7/15/04
Special Notes'and'Comments
NOT INCLUDE BLOCK
WALLS,-POOL/SPA, OR
DRIVEWAY APPROACH.
75% PLAN CHECK FEE
DISCOUNT APPLIED FOR'MULTIPLE
ISSUANCE
OF SAME PLAN TYPE.
Other Fees .
. . . . . .
ART IN PUBLIC'PLACES-RES.
10.4.63
DIF COMMUNITY CENTERS -RES
97.00
DIF CIVIC CENTER - RES
366.00
ENERGY REVIEW FEE
18.47
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
24.18
"
DIF STREET MAINT FAC -RES
15.00
DIF TRANSPORTATION - RES
1098.00
Fee summary
Charged
Paid Credited
Due
Permit -Fee Total
1562'.20
.00 .00
1562.20 "
Plan Check. Total.
209.58
.00 .00
209.58
Other Fee Total
2552.28.00
0,0' !'
2552.28
Grand Total
4324.06
.00 .004324.06.